When single mother by choice, Dr. Deborah Brooks, first embarked on her family-building journey in 2018, she found it discriminatory that she did not qualify for the same access to fertility treatment benefits that married couples did. Until January 1, 2021, the Maryland Mandate infertility insurance law did not offer unwed women in vitro fertilization (IVF) coverage, a barrier that the University of Maryland School of Medicine assistant professor would soon take into her own hands.

“While I was looking through my insurance information, I thought it was strange that IVF would be covered if I was married — even if I was married to another female — but not if I’m single,” Dr. Brooks explained.

Maryland was the first state in the nation to enact infertility insurance legislation in 1985, but the previous Mandate’s criteria posed barriers for insurance holders to receive equal and timely treatment opportunities. Dr. Brooks’ attempts to find answers with the insurance companies and even the Maryland Attorney General’s office proved unsuccessful. Left without answers, Dr. Brooks’ confidence in creating change started to wane.

At the time, she was actively receiving treatment at Shady Grove Fertility’s Baltimore Harbor location with Howard McClamrock, M.D. Dr. Brooks had just completed her third intrauterine insemination (IUI), but despite best efforts, was not pregnant. The American Society for Reproductive Medicine (ASRM) recommends attempting three consecutive IUI cycles as first-line treatment before resorting to IVF due to the decline in clinical pregnancy rates.

Despite this recommendation, the Maryland Mandate required women to undergo six IUI cycles before moving on to IVF. It also stated that women must try and fail to conceive for 2 years before insurance coverage could be provided.

Nearly 9 months into her fertility journey, Dr. Brooks wasn’t prepared to pay for IVF out of pocket as her next line of treatment. Shortly after, Dr. Brooks joined UMD’s Women in Medicine and Science group where she vocalized her concerns about the Maryland Mandate. It was here that a committee member connected her with Michelle Daughtery Siri, executive director of the Women’s Law Center of Maryland.

“We started talking, and all of a sudden, it seemed like it was a true possibility that we could change the law,” Dr. Brooks shared.

Dr. Brooks and Siri soon connected with Maryland Senator Shelly Hettleman, D-Baltimore County, where their paths crossed with the advocacy efforts of SGF’s own care team.

Advocating for Infertility Coverage

SGF’s care team, including Stephanie Beall, M.D., Ph.D., and Loretta Trumble, CRNP, have called for change to the Maryland Mandate before. Due to their collective efforts, on May 15, 2018, Maryland Governor Hogan signed the bill that requires insurers to cover the expense of fertility preservation, sperm and egg freezing specifically, for patients prior to medical treatments that likely would permanently damage their reproductive ability, such as chemotherapy for cancer.
As advocacy efforts between Dr. Brooks, Siri and Hettleman took shape, Hettleman tapped Trumble once more to revise the Maryland Mandate.

“I’m so passionate about helping build families across all patient populations and this was a way to use my passion to advocate for increased coverage,” says Trumble. “Revising legislation wasn’t something I actively sought out, but change was needed and I’m so honored to be a part of it.”

While Trumble extended the advocacy opportunity to Dr. Beall, Dr. Brooks decided to try one more IUI cycle in July 2019 before pursuing more high-tech fertility treatment. Much to her surprise, her fourth IUI cycle led to a healthy pregnancy despite all odds.

“I was worried that getting pregnant with IUI would negate what I was saying about the importance of unwed women receiving IVF coverage,” Dr. Brooks recalls as she prepared to testify. “But it turns out that everyone loves a pregnant woman!”

On February 26, 2020, Dr. Beall and Trumble testified in favor of laxing limitations on infertility treatment insurance carrier require of their policyholders. Their testimonies were presented alongside RESOLVE: The National Infertility Association, Senator Hettleman, Siri, and Dr. Brooks, who was 7-months pregnant.

For SGF physicians, helping patients build their families extends beyond the exam room. During Dr. Beall’s testimony, she shared, “The diagnosis of infertility knows no boundaries. It affects individuals regardless of gender, race, sexual orientation or marital status.”

Dr. Beall’s testimony delivered statistics-driven points as to why the Maryland Mandate’s “waiting period” should be cut in half from 2 years to 1. “Given the anticipated age-related decline in fertility, and the increased incidence of pregnancy loss and having a child with a chromosomal abnormality, it is important not to delay fertility care for an individual or couple who have a clinical diagnosis of infertility.”

Dr. Beall continued, “The probability of pregnancy with fertility treatment also decreases progressively with increasing age. The percentage of IUI cycle starts that resulted in a clinical pregnancy was:

  • 11.6% for women under 35 years of age,
  • 8.84% for women 35-39,
  • 9.01% for women 40-41,
  • 6.25% for women 42-43, and
  • 3.45% for women older than 43 years of age.

“Thousands of Marylanders have difficulty becoming pregnant and deserve access to today’s modern technology that will assist them,” Shared Senator Hettleman in her testimony. “This bill brings our law up to date, reflecting modern patterns in both medicine and parenting.”

To round out the testimonies, Senator Hettleman shared, “Thousands of Marylanders have difficulty becoming pregnant and deserve access to today’s modern technology that will assist them. This bill brings our law up to date, reflecting modern patterns in both medicine and parenting.”

Maryland Mandate Expands IVF Coverage as of 2021

As of January 1, 2021, new revisions to the Maryland Mandate include:

  • the removal of a marriage requirement for patients seeking treatment,
  • reducing the 2-year “waiting” period to 1 year of unprotected sexual intercourse, and
  • reducing the attempts of intrauterine insemination from six attempts to three.

“I love my son, and I might want him to have a sibling someday,” shares Dr. Brooks. “It could be a very real possibility that I’ll be in my late 30s when that day comes and may need to try IVF. It’s comforting knowing that insurance benefits are available to me if I need them.”

To learn more about SGF’s financial programs to help make fertility treatment more affordable, review your state-issued benefits and SGF’s unique financial programs.