{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:21:46Z","timestamp":1768569706458,"version":"3.49.0"},"posted":{"date-parts":[[2025,3,28]]},"group-title":"Sexual and Reproductive Health","reference-count":33,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>A large public university added health insurance coverage of 50% co-insurance for up to two cycles of in vitro fertilization (IVF) to eligible faculty and staff.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We describe the design and conduct of a randomized controlled trial to evaluate the effectiveness of a health insurance educational intervention on health insurance literacy and IVF benefit utilization. The intervention materials included 1) Key insurance terms; 2) Examples of premiums and deductibles across the insurance plan options; 3) Examples of how premiums and deductibles affect out-of-pocket costs; and 4) A guide to find in-network providers\/facilities. The primary outcome is health insurance literacy. Secondary outcomes are IVF services and insurance benefit utilization, out-of-pocket costs, and financial hardship related to fertility care. We collected validated patient-reported outcomes at three timepoints over 1 year. We will integrate mixed methods data to explore whether the intervention was effective, feasible, acceptable, and appropriate.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 394 faculty and staff screened, 217 (55%) reproductive-aged (18 to 50 years) employees consented, completed the baseline survey and were randomized in a 2:1 fashion. Participants were female (81%), married (63%), and worked as a staff employee (72%). Approximately 39% reported an infertility diagnosis, and 28% had undergone prior IVF treatment. Participants reported feeling slightly confident when using their health insurance plans and moderately confident being proactive when using their health insurance plans.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Our goal is to improve health insurance literacy and utilization of health insurance benefits for IVF care, thereby expanding family-building options for reproductive-aged individuals.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.03.27.25324807","type":"posted-content","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T01:22:21Z","timestamp":1743297741000},"source":"Crossref","is-referenced-by-count":0,"title":["Navigating Health Insurance Selection for in Vitro Fertilization (IVF) Benefits: A Study Protocol"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0431-0662","authenticated-orcid":false,"given":"Olumayowa","family":"Dayo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Turcotte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Breanna","family":"Reyes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo E.","family":"Flores Ortega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonnie N.","family":"Kaiser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8969-5002","authenticated-orcid":false,"given":"Gregory A.","family":"Aarons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3235-6936","authenticated-orcid":false,"given":"Sara B","family":"McMenamin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6671-5151","authenticated-orcid":false,"given":"H. Irene","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6028-4111","authenticated-orcid":false,"given":"Sally A. D.","family":"Romero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025040101400761000_2025.03.27.25324807v1.1","unstructured":"ASRM, Definition of infertility: a committee opinion (2023), https:\/\/www.asrm.org\/practice-guidance\/practice-committee-documents\/denitions-of-infertility\/, 2023. (Accessed July 15 2024)."},{"key":"2025040101400761000_2025.03.27.25324807v1.2","doi-asserted-by":"crossref","unstructured":"C.N. Nugent , A. Chandra , Infertility and impaired fecundity in women and men in the United States, 2015\u20132019, National Health Statistics Report 202 (2024).","DOI":"10.15620\/cdc\/147886"},{"key":"2025040101400761000_2025.03.27.25324807v1.3","doi-asserted-by":"crossref","unstructured":"G. Murugappan , S. Li , R.J. Alvero , B. Luke , M.L. Eisenberg , Association between infertility and all-cause mortality: analysis of US claims data, American Journal of Obstetrics and Gynecology 225(1) (2021).","DOI":"10.1016\/j.ajog.2021.02.010"},{"key":"2025040101400761000_2025.03.27.25324807v1.4","doi-asserted-by":"crossref","unstructured":"N.C. Stentz , N. Koelper , T.K. Barnhart , M.D. Sammel , S.S. Senapati , Infertility and mortality, American Journal of Obstetrics and Gynecology 222(3) (2020).","DOI":"10.1016\/j.ajog.2019.09.007"},{"key":"2025040101400761000_2025.03.27.25324807v1.5","unstructured":"ASRM, Best practices of ASRM and ESHRE: A journey through reproductive medicine (2012), https:\/\/\/practice-guidance\/practice-committee-documents\/best-practices-of-asrm-and-eshre-a-journey-through-reproductive-medicine-2012\/, 2012. 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Vassar , Inequities in medically assisted reproduction: a scoping review, Reproductive Sciences 30(8) (2023).","DOI":"10.1007\/s43032-023-01236-6"},{"key":"2025040101400761000_2025.03.27.25324807v1.9","doi-asserted-by":"crossref","unstructured":"J.C. Lee , C.E. DeSantis , A.K. Yartel , D.M. Kissin , J.F. Kawwass , Association of state insurance coverage mandates with assisted reproductive technology care discontinuation, American Journal of Obstetrics and Gynecology 228(3) (2023).","DOI":"10.1016\/j.ajog.2022.10.046"},{"key":"2025040101400761000_2025.03.27.25324807v1.10","doi-asserted-by":"crossref","unstructured":"B.J. Peipert , M.N. Montoya , B.S. Bedrick , D.B. Seifer , T. Jain , Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment, Reproductive Biology and Endocrinology 20(1) (2022).","DOI":"10.1186\/s12958-022-00984-5"},{"key":"2025040101400761000_2025.03.27.25324807v1.11","unstructured":"KFF, Coverage and Use of Fertility Services in the U.S., Kaiser Family Foundation, https:\/\/www.kff.org\/womens-health-policy\/issue-brief\/coverage-and-use-of-fertility-services-in-the-u-s\/, 2020 (Accessed October 27, 2024)."},{"key":"2025040101400761000_2025.03.27.25324807v1.12","doi-asserted-by":"crossref","unstructured":"R. Kakar , R.M. Combs , M. Hoepf Young , N. Ali , B. 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