BALTIMORE — Women with limited insurance benefits for in vitro fertilization (IVF) may be more likely to have preimplantation genetic testing for aneuploidy (PGT-A) performed on embryos to “make each cycle count,” a researcher said at the American Society For Reproductive Medicine (ASRM) 2026.

“When patients know that their covered cycles are finite, they appear twice more likely to use PGT-A, and this was independent of their age and ovarian reserve — which are the actual biological factors that should drive the decision of using PGT-A or not,” said study co-author Ecem Esencan, MD, a reproductive endocrinology and infertility fellow at Northwestern University in Chicago. The findings suggest that variation in insurance coverage may influence patient decisions, she said.

Esencan and colleagues reviewed records from 208 women participating in the PROMISE cohort study, a prospective study of people undergoing their first cycle of IVF at the Northwestern University academic center.

All patients underwent standardized review of primary insurance by financial counselors, documenting IVF coverage, plan details, and deductibles when applicable. Investigators divided the women into three groups based on insurance plan IVF access: no coverage, restricted coverage (lifetime cycle or financial limits), and comprehensive coverage (annual or unlimited cycle-based coverage).

The primary outcome was PGT-A utilization. The study authors used multivariable logistic regression to assess the association between coverage type and PGT-A utilization, adjusting for age, anti-Müllerian hormone levels (a measure related to ovarian reserve), and BMI.

Among the women, 23 (11%) had no IVF insurance coverage, 104 (50%) had restricted coverage, and 81 (39%) had comprehensive coverage. There were no differences across coverage groups in age, BMI, ovarian reserve, self-reported stress, race, or socioeconomic status.

PGT-A utilization was significantly higher in those with restricted coverage compared with comprehensive coverage (P = .039), in a subset of 168 women with data on PGT-A utilization. Of women with restricted coverage (72 of 98), 72% pursued PGT-A, compared with 57% of those with comprehensive coverage (40 of 70) and 52% of those with no coverage (11 of 21). Grouping patients with no or restricted coverage together, PGT-A utilization remained higher among patients with limited coverage than among those with comprehensive coverage but was not statistically significant (P = .09).

In multivariable analysis limited to patients with IVF coverage and adjusting for age, anti-Müllerian hormone levels, and BMI, restricted coverage remained independently associated with an increased PGT-A utilization (odds ratio, 2.10; 95% CI, 1.07-4.12; P = .030).

“The findings underscore the need for policymakers, payers, and clinicians to consider how cycle limits and financial caps influence treatment decisions,” Esencan and colleagues wrote in their abstract.

The findings are “really interesting because it poses the question of, if we are very restrictive about our insurance coverage, does that lead to increased cost to the patient in other ways, such as doing things like PGT?” commented session co-moderator Alexis Hood, MD. Hood, a reproductive endocrinology and infertility fellow at Johns Hopkins Medicine in Baltimore, told Medscape Medical News that she would be interested to learn how use of PGT-A compared to additional embryo testing such as PGT-M for monogenic conditions.

Primary care doctors most likely will come in contact with a patient with infertility challenges, she said. “It’s really important for their overall health, especially if they are struggling with infertility, to have insurance coverage.” Those with restricted coverage are incurring further costs for PGT-A, which is not usually covered, she said.

Esencan and Hood reported no relevant financial disclosures.

Karen Blum is a freelance medical and science writer in the Baltimore area.