Missourians facing infertility say insurance is a major barrier

Springfield Angela Crawford was desperately trying to get pregnant when her niece was born.

When she held the baby in her lap for the first time, there were floods of tears. She immediately handed the baby to her mother, ran to the bathroom and became emotional. Loved ones tried to console him with kind words, but to no avail. She walked out of her brother’s door without shoes. His family found him that evening, sitting distraught in a ditch near his Springfield home.

That night so many years ago is one she still talks about often, usually to women who are just beginning their struggle with the burden of infertility that she and her husband faced.

“I was at the bottom of this deep dark well, where you are now,” Crawford says to women who reach out looking for support. And I’ll get down there with you because I know the way out.

The inability to get pregnant after trying for a year or more affects one in five married women in the U.S. between the ages of 15 and 49, according to the Centers for Disease Control and Prevention. Infertility can be caused by a myriad of conditions in both men and women and can cost thousands of dollars to treat.

Crawford, 38, was eventually diagnosed with polycystic ovary syndrome. According to the Endocrine Society, it is the most common cause of infertility in the United States. Thanks to in vitro fertilization, she and her husband were eventually able to have two children.

Infertility left her feeling isolated and suffering severe depression, suicidal thoughts and extreme loneliness.

At some point, she realized that she didn’t have to suffer alone.

So in 2018, she decided to start an infertility support group in Springfield through Resolve, a part of the National Infertility Association.

The group meets monthly, often providing others trying to complete the difficult infertility treatment process a lifeline to the countless dollars and hours spent in clinics, and, in many cases, a good insurance. To have a policy of being tied to a job they don’t like. ,

Since starting the group, Crawford has met dozens of women. Some last for a month, some for years.

Although every story is unique, its central theme is loneliness and sadness.

She gives them space to share intrusive, ugly thoughts out loud; To acknowledge that they may mourn the birth of a child or be angry when a loved one becomes pregnant.

The journey usually ends, Crawford said, either when the person has the baby, the person runs out of money or they can no longer physically or mentally tolerate the pain.

There is no off ramp. There is no maintenance phase, Crawford said. This continues until nothing is found.

A legislative solution?

Over the past decade, the number of babies born using assisted reproductive technology in the U.S. has doubled, according to the CDC. While the number of major corporations offering infertility coverage has grown, including Walmart and JPMorgan, millions of Americans still have to pay out of pocket if they can afford care.

According to the National Infertility Association, so far 21 states mandate some form of infertility coverage.

Missouri isn’t among them, but St. Louis Democrat Rep. LaDonna Appelbaum hopes to change that.

Appelbaum has proposed legislation for the second year in a row


It would mandate insurance coverage for the diagnosis and treatment of infertility, including in vitro fertilization, uterine embryo wash, embryo transfer, artificial insemination, gamete intrafallopian tube transfer or zygote intrafallopian tube transfer and short tubal ovum transfer. Not limited to these.

He said he filed the bill for a few reasons: A constituent struggling with infertility reached out asking for support for services; And her dear friend and former state legislator, the late Cora Faith Walker, had proposed similar legislation a few years earlier, but it never received a legislative hearing.

Appelbaum herself experienced infertility, and she and her husband were never able to have a child.

“I will do everything I can to make sure women can have children if they want to,” Appelbaum said, though she acknowledged it would be difficult without a Republican co-sponsor on her bill. .

When a similar bill was heard in California, insurers opposed it, arguing it could raise premiums statewide, the Associated Press reports. Appelbaum said no one has directly opposed his legislation.

The Missouri Insurance Coalition declined to comment on Appelbaum’s bill.

Appelbaum doesn’t think it should be controversial.

“It just wants to bring life, love and hope into the world,” he said.

Crawford said Appelbaum’s bill would be a big step forward, but other barriers still remain, especially for women in rural areas far from medical specialists.

A support group in Springfield

When Crawford began in vitro fertilization treatments in 2016, she had to take unpaid leaves of absence from work to drive 7 hours round-trip to St. Louis for procedures as simple as blood draws and as complex as egg retrieval. That care was not covered in Springfield, despite being the third-largest metro in the state.

She was not enjoying her job at the time, or not feeling challenged or paid enough. But it offered her the best insurance coverage, so she stayed there until she got pregnant.

“I had to run around for years to play catch-up, while (my husband) had the ability to go ahead and pursue in his spare time,” Crawford said. But what if I didn’t have the same limitations and restrictions that handcuff me? Did he bother me?

Now she said she is in a better job with two healthy children and a happy marriage. But the pain is still fresh, and she uses that memory to help others.

In a quiet meeting room at the Springfield Library branch in early December, Crawford distributed homemade macaroons for the celebration and group member Jessica Cody, 32, handed out hand-sewn bookmarks.

As the women settled into their chairs, Cody joked, “I can make all kinds of things, but not humans right now.”

This fall, Cody suffered her first miscarriage.

This is the most painful, frustrating experience I’ve ever had, she told other women.

While not announcing the onset of pregnancy, she expressed her grief in a quiet manner.

She painted forget-me-nots for the child who might have been, whom she and her husband named Embryo #6. She avoided her pregnancy cravings for chicken tenders and macaroni and cheese; They make him sad now. And she posted on Instagram a photo of a woman with a black heart above her uterus, a cryptic message of grief.

But in Resolve, Cody opened up.

“Until I actually have a baby in my hands, there will always be a shadow of sadness over everything I do,” Cody said. I feel like that innocence of being excited about being pregnant has been taken away from me.

She recounted learning on Google that postpartum depression is possible after a miscarriage, but bereavement leave does not cover her loss. She remembered crying over an energy drink at a gas station on the way home from her last ultrasound appointment. She worried that her husband, who had been her rock, needed his own community to grieve.

She described how difficult it was to juggle IVF and her career, and lamented having to show up for work hours after an ultrasound, where she learned her fetus had no heartbeat, only to be met by a colleague who was carrying a newborn. Was showing the baby.

She was worried about scheduling her next embryo transfer with work projects and potentially self-administering the shots on work trips. The other two women offered to get on FaceTime to help talk to him.

Cody said that going through the spasms, contractions and crushing pain of abortion, helped by prescribed medication, grew her empathy for women who have abortions.

That said, I have to have another person present to make sure I don’t bleed to death. No one wants this to ever become their form of birth control.

another embryo transfer

Ashley Cossins has always had painful and heavy periods. In 2014, after trying to get pregnant with her husband for more than a year, they learned it was due to endometriosis, which, according to the World Health Organization, kills 15 percent of all girls and women of childbearing age worldwide. Affects about 10%.

Almost a decade later, and now 34, she has gone through multiple surgeries, five rounds of IVF and an abortion. She found a job that covered most of her treatment.

The nearest specialist covered by her insurance is at Barnes-Jewish Hospital in St. Louis, more than 200 miles from her home in Greene County.

While searching for a therapist, Cossins found an email for her local RESOLVE support group. Crawford replied almost immediately: You’re not alone. You have reached the right people. I’m sorry this is happening to you.

By that time, Cossins had exhausted the lifetime fertility insurance benefits available through her previous workplace, so Crawford helped her get a job with a new employer so she could get benefits again.

There’s no room for us, Cossins said. There is no grace. Nothing is to be given unless we ask for it.

Kosins learned again in early 2022 that she had a non-viable pregnancy, after a draft of the U.S. Supreme Court decision striking down the constitutional right to abortion was leaked. Her doctor recommended a medical abortion that would soon be illegal in Missouri so they could collect and analyze tissue in hopes of learning more about the cause of her infertility.

Since then, Cossins has decided to run for state legislature, inspired by the stigma and red tape she experienced during her infertility journey.

It’s more like gambling than health care because you’re putting a huge amount of money at stake, Cossins said. And you may not have anything.

She focuses on hope. It’s what draws him to the quiet aisles of Target, and what sends him home to cry over a glass of wine and a puzzle after seeing an adorable baby.

Just before the group meeting in early December, Kossins gave herself her first progesterone shot. A few days later she had her fifth and final embryo transfer.

They named the final two embryos Spirit and Opportunity after Mars exploration rovers.

They are his world in a future that is impossible to plan.

That said, everything else falls far short.

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