The medical costs for a large multiple birth due to fertility treatments can top $2 million. Multiple births are more frequent because health insurers are often required to pay for infertility treatments. According to the Centers for Disease Control and Prevention:

• About 2 percent or 1.2 million women of reproductive age visited a medical professional about infertility in 1995.

• And 9.3 million women (15 percent) had used some kind of fertility service at one time in their lives, compared with 6.8 million (12 percent) who had done so in 1988.

• Most women who pursue treatment need only moderate medical intervention, which costs between $500 and $2,000.

• But in vitro fertilization can cost $10,000 to $15,000 per attempt, and it often takes several attempts.

The estimated cost per live delivery for in vitro fertilization was $66,667 to $114,286, according to a 1994 New England Journal of Medicine study.

Because infertility treatment can be expensive, advocacy groups want to require health insurers to cover it. However, the actuarial firm Milliman & Robertson found that a typical state infertility mandate would increase the cost of a health insurance policy 3 percent to 5 percent per year, or $105 to $175. Most states have adopted 30 to 40 health insurance mandates, and the their total cost can boost premiums 40 percent to 50 percent.

Fourteen states either require insurers to cover infertility treatments or offer such coverage. However, state insurance laws primarily affect only small employers and the self-employed. Most large employers self-insure under the federal Employee Retirement Income Security Act (ERISA) and avoid state mandates completely.

Thus the costs of mandates fall on a relatively small number of people who are least able to afford premium increases.

Source: Merrill Matthews Jr. (vice president of domestic policy, National Center for Policy Analysis), "Should Insurers Be Required to Pay for Infertility Treatments? No." Insight, February 8, 1999.