For the sake of consistency and fairness: why insurance companies should cover fertility preservation treatment for iatrogenic infertility.

There is much debate not only about the morality of assisted reproductive technologies (ART) but also about how they should be classified. Should ART be understood as medical treatment for a disease (infertility) or should they be relegated to boutique medicine where they are seen as elective? How we answer this question affects our thoughts about whether ART should be covered by insurance companies. Those who claim infertility is a medical disease usually advocate that ART be covered by insurance. Conversely, those who believe ART are elective procedures generally oppose insurance coverage, insisting that insurance coverage should be limited to medically necessary treatments. While the debate cannot simply be reduced to whether “real” diseases should be covered by insurance and all other conditions should not, in the minds of many, a strong connection exists between what is considered a disease and what insurance should cover. For the purposes of this chapter, therefore, the belief that medically necessary conditions should be covered by insurance whereas elective conditions should not will serve as the basis of the discussion. Most discussions of ART focus on their use in two circumstances: first, to treat people currently suffering from infertility due to disease (e.g., endometriosis) or unknown cause, and second, and more recently, to provide “insurance” against age-related infertility for women who plan to delay childbearing. Though still a contentious issue, the former – disease-induced infertility – is typically thought to be more deserving of insurance coverage than the latter – age-related infertility – because the cause of infertility is a disease, a “legitimate” medical problem rather than an individual’s action. Indeed, some have argued that insurance should cover treatment for the underlying disease that is causing infertility (e.g., open a blocked fallopian tube) even if they do not think they should cover ART (Gerrity, 2009, Executive Director of the Oncofertility Consortium, Personal conversation). The perceived cause of age-related infertility is, in contrast, not often seen as legitimate