Breaking Down Barriers for Same-Sex Female Couples Building Families: In Vitro Fertilization Utilization Following the Enactment of 2021 Legislation in New York State.

Abstract

Purpose: In 2021, New York State passed legislation that eliminated the requirement that same-sex female couples needed up to 12 months of intrauterine insemination with donor sperm to meet the medical definition of infertility and qualify for insurance coverage. This study compared the duration of time from consultation to utilization of in vitro fertilization (IVF) by same-sex female couples before and after the New York legislative change. Methods: Same-sex female couples who underwent IVF or reciprocal IVF between 2010 and 2023 in New York City were categorized into pre- and postlegislation cohorts based on when they sought initial treatment. The primary outcome was time from consultation to initiation of IVF or reciprocal IVF. Secondary outcomes included time from consultation to clinical pregnancy with discharge to obstetrical care. Results: Overall, 239 couples were included. The postlegislation cohort had a shorter median length of time from consultation to initiation of IVF (173 vs. 297 days, p < 0.001; hazard ratio 2.36, p < 0.001) and a significant increase in the proportion of couples initiating treatment less than 1 year after consultation (86% vs. 57%, p = 0.01). They also had a decreased median time to discharge with ongoing pregnancy (383 vs. 535 days, p = 0.006). Same-sex female couples had 136% increased chances of initiating IVF after consultation compared with before the legislation. Conclusion: After the expansion of fertility insurance coverage, same-sex couples at a single New York City institution initiated IVF treatment and achieved pregnancy more rapidly after consultation than prior to the expansion.