Does Health Insurance Cover Infertility Treatment?

• Written by Nidhi Goyal

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Today, infertility has become quite a major issue of concern in India, with 1 in 151 Indian couples experiencing infertility. In 20% of cases, the problem arises with the male reproductive system (male infertility), while 40-50% of cases are caused by abnormalities in the female reproductive system leading to female infertility. Not only do these infertility symptoms affect couples emotionally, but they also treat them with major social and financial setbacks. Late marriages, obesity, smoking, stressful lifestyles, high junk food intake, alcoholism, smoking, and drug addiction are some of the common causes of infertility.

Depending on the root cause, infertility can be treated, and pregnancy can be achieved in 85% to 90% of instances by medication, lifestyle changes, assisted reproductive technology (ART), or surgery. This article discusses the aspects of infertility, from its causes to its treatment coverage. Stay tuned!

What is Infertility?

Infertility is a medical condition where a couple is unable to conceive because their reproductive systems are malfunctioning. There are numerous causes of infertility, and it can impact anyone.

Simply put, a doctor may diagnose infertility in patients who are usually 35 or older and are trying to conceive for a long time yet failing. Contrary to popular belief, infertility isn’t just a woman’s problem; men can be infertile, too. Men and women are equally likely to have fertility problems.

Speaking of women, primary infertility is a diagnosis given to a woman when she has never been able to conceive. However, a woman is diagnosed with secondary infertility if she has had a successful pregnancy in the past and is unable to conceive the next time.

What are the Causes of Infertility?

Below is a breakdown of male and female causes of infertility. Take a look.

Male Infertility Causes

Male infertility is related to a lot of factors. Moreover, the reason why men face infertility differs from case to case. Yet, the major cases involve:

• Inefficient and effective sperm production (low sperm count signs)
• Individual sperm count
• Movement of the sperm
• Shape of the sperm

Female Infertility Causes

Female infertility occurs due to several factors. However, one thing they have in common is that each factor interferes with and affects the biological process. Any abnormalities in the following processes are the causes of infertility in females:

• Ovulation (when the egg is released from the ovary)
• Fertilisation (takes place when the sperm meets the egg in the fallopian tube)
• Implantation (takes place when a fertilised egg moves to the lining of the uterus to grow and develop into a baby).

Common Causes of Infertility

While biological processes exist, lifestyle habits contribute to the cause majorly. Some of the risk factors include:

• Excessive alcoholism
• Age (women being 35 and older, and men being 50)
• Over-exercising
• Eating disorders (bulimia, anorexia nervosa)
• Substance abuse
• Chemotherapy or any kind of radiation therapy
• Exposure to toxins like lead, pesticides, or harmful environmental toxins
• Obesity/underweight
• STI (Sexually transmitted infections)
• Smoking and consuming tobacco
• Chronic diseases
• Abnormalities in the hormone-producing centres of your brain (pituitary or hypothalamus or pituitary).

Infertility: Management and Treatment

Infertility treatment plans are mainly objective. When choosing a treatment, it's important to consider your age, the duration you've been trying to conceive, and your preferences. While treatment may be necessary for just one spouse at a time, sometimes it involves both going through the processes.

Infertility treatment involves medicine, surgery, or ART (assisted reproductive technology). Treatment works best when it involves a positive mindset, consistency and optimism.

Female Infertility Treatment

This includes:

• Make changes to your lifestyle, such as increasing or decreasing your weight, quitting smoking or drug use, and taking better care of other health issues.
• Taking fertility medicines to encourage your ovaries to release more eggs into the egg sac.
• Going for surgery can be an option. It removes scar tissue, polyps, fibroids, or obstructed fallopian tubes to restore normal uterine function.

Male Infertility Treatment

This includes:

• Improving the levels of testosterone and other hormones by medications helps with low sperm count signs. There are medications available for erectile dysfunction as well.
• To fix structural issues or open blocks in the tubes that deliver sperm, some men require surgery. To increase the likelihood of conceiving, varicocele surgery can improve the health of sperm.

Common Infertility Treatments: Assisted Conception

Alternatively, when the usual infertility treatment procedure fails, Assisted Conception enters. Some options for assisted or artificial conception methods are currently accessible. These approaches fix all types of infertility in men and women. Although these treatments are a bit expensive, they provide guaranteed results.

1. In Vitro Fertilisation (IVF): This takes place in a controlled environment after sperm and eggs have been taken from the body through different methods and placed in a lab dish. The sperm fertilises the egg. The healthcare practitioner will transfer one to three fertilised eggs into the uterus.
2. Intracytoplasmic Sperm Injection (ICSI): This procedure is performed during IVF. An embryologist injects one single sperm directly into each egg. Later, the doctor transfers one to three of these fertilised eggs into the uterus.
3. Intrauterine Insemination (IUI): Here, a medical professional places the sperm into the uterus with a long, thin tube. IUI can also be referred to as artificial insemination.
4. Assisted Hatching: This involves facilitating embryo implantation in the uterine lining by removing the outer layer of an embryo.
5. Third-Party Conception: Some couples may have to use the eggs, sperm, or embryo of a third party, i.e., a donor. This is known as a surrogate.

Are Infertility Treatments Covered Under Health Insurance?

A single cycle of infertility treatment can cost anything around ₹1,00,000 to ₹4,00,000. Most insurance providers do not usually cover the treatment. Nevertheless, some providers may offer basic or supplementary health coverage that only covers the issue partially, depending on its severity. If you already have maternity insurance coverage, IVF insurance may be added at an extra cost.

Generally, many health insurance plans pay for the IUI. IVF is a costly and time-consuming treatment that involves many procedures. Hence, not all health insurance plans will cover this treatment. However, some insurance companies provide IVF coverage as an add-on.

Similarly, gamete intrafallopian transfer (GIFT) is another technique that is very similar to IVF. However, it is slightly less technical since it does not involve implanting embryos. Hence, depending on the policy and the firm, this treatment can be covered in full or in part by your insurance provider.

Cover IVF with Care Classic Health Insurance

The average IVF treatment cost in India varies greatly from city to city. In some cities, the costs may be even more. However, At Care Health Insurance, IVF coverage is provided under its zone-based health policy termed as 'Care Classic' for a sum insured more than 5 lakh. The plan offers a reimbursement facility for assisted reproductive treatment (ART) considering the following conditions:

• 3-year waiting period
• For a sum insured over ₹5 lakh, Care Health Insurance will cover expenses up to ₹2 lakhs per policy year for IVF.
• The benefit will be made available once in a block of 3 years.

Handle Infertility with Care

Experiencing infertility can be extremely difficult and disheartening. Not only does it impact your emotional well-being, but your relationships too. Moreover, the financial burden of infertility treatments can also be hefty. Nevertheless, the joy of being a parent knows no bounds.

If you're facing infertility, connect with your healthcare provider and go over the therapy choices that best suit your case. Although most couples conceive naturally, very few might have to use assisted reproductive technology. Having a health insurance policy in place at these times not only helps you release the financial stress but saves your hard-earned money, too. Either way, it's a win-win situation!

>> Also Read: Health Insurance for IVF Treatment

Disclaimers: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.