I am looking forward to joining several other members of the RESOLVE New England (RNE) community on May 10 at the Massachusetts State House. We will be there to celebrate the 30th anniversary of the passage of the law defining infertility for the purpose of access to insurance coverage in Massachusetts. Officially identified as Chapter 175 Section 47H, I call it simply “the gift that keeps in giving.” Think of it this way: some of the earliest Assisted Reproductive Technology (ART) babies are now parents themselves. The very existence of these “ART Babies” and their ability—whether assisted or “on their own”– to usher in the next generation are cause for celebration. They surely put faces on the enduring value of this pioneering legislation.
Since most current RNE members are too young to remember a time before in-vitro fertilization (IVF) and a time before it was covered by insurance, I thought it would be helpful to take a short walk down memory lane in order to give you a better sense of why this law was transformative. To do so we need to begin with a brief history of IVF, since without it, there would have been no need for insurance coverage (and without the access to coverage in Massachusetts, the benefits of IVF would be severely limited).
The arrival of IVF in 1978 was nothing short of a game changer. IVF brought new hope and nearly boundless possibilities to all those enduring infertility. Initially heralded for bypassing tubal problems, IVF enabled women with absent or damaged fallopian tubes to become mothers. Soon it became clear that fertilization outside the body meant seismic changes in approaching male infertility as well. Men who would have been deemed “sterile” in the past were able to father children when sperm and egg were brought together. It was not long before IVF also offered what had once been unimaginable options—gestational surrogacy and egg donation. Along the way came embryo donation and before long, IVF with preimplanation genetic diagnosis (PGD) brought healthy babies to families with serious genetic conditions. Later, ART paired with oncology to offer fertility preservation to young people undergoing cancer treatments.
Try to imagine, if you will, being infertile in the early 1980’s. As I hope was evident in my mini-history, it was a time of cascading new possibilities. Gone were the days when infertility was something to be endured, with few treatment options available and those offering limited success. IVF, long imagined, was finally here, do-able and as time passed, increasingly successful. There was, however, one problem: cost. IVF, with its intense medical process and expensive medications, came with a price tag of many thousands of dollars. These were costs that hit couples at a particularly difficult time in their lives. Often newly married, many were saving for homes, re-paying college loans, completing graduate school and/or just getting a footing in their careers. Few could afford paying over $10,000 in 1980’s currency for one cycle and the maybe 40% chance that it would bring them a baby.
I think you can tell where this is leading…to the need for insurance coverage. Enter RESOLVE New England (then Resolve of the Bay State) and specifically, a small group of visionary, determined and resourceful leaders. We cannot and need not cover all the steps they took along the way to make an impossible dream become law. Suffice it to say that in 1987, Massachusetts became the first state in the US to require insurance coverage for infertility and now 30 years later, our law remains one of the most comprehensive. It will probably surprise many readers to know that even after 30 years, less than half of the states in the nation have laws relative to infertility insurance. For many years, it was not unusual for people to move to Massachusetts simply for coverage of their infertility.
Which brings me back to “the gift that keeps on giving” and why we are celebrating on May 10th. Some laws become old laws. Some laws become old and dated laws. Some laws come to matter less over time. Some laws become irrelevant. None of this pertains to Chapter 175 Section 47H. As time has passed, as new options for treating infertility have literally “come down the pike” and as new groups, including single, gay, lesbian and transgender people, have sought treatment for infertility, our law in Massachusetts has remained very much alive and increasingly relevant. And it requires both our gratitude and vigilance. Which brings me back to why I personally think of it as “a gift that keeps on giving”.
As a social worker counseling people going through infertility, the beneficiaries of this law are very much real people to me. I have had the great pleasure of knowing vast numbers of individuals and couples move from the depths of infertility to the joys and challenges of parenthood. Each year I eagerly await the arrival of their holiday cards since each one has a story behind it that I remember and a photo on it that makes me rejoice.
On a personal level, the law is very much a gift that keeps on giving. It is there for me when I play basketball with my six-year-old grandson Ryan or jump on the trampoline with his three-year-old brother Ethan. It is there also when I read to their baby brother Jake. My ART grandsons are active, high energy reminders of the vibrancy and enduring relevancy of Chapter 175, Section 47H.