Association of Fertility Preservation Benefit Mandates With Sperm Bank Network Adequacy: A Mixed-Methods Study
5 affiliations
- 1Department of Urology, Naval Medical Center San Diego, San Diego, California
- 2Herbert Wertheim School of Public Health, UC San Diego, La Jolla, California
- 3Department of Obstetrics, Gynecology, and Reproductive Services, UC San Diego, La Jolla, California
- 4Department of Anthropology and Global Health Program, UC San Diego, La Jolla, California
- 5Rosalind Franklin University of Medicine & Science, North Chicago, Illinois
Abstract
Introduction:: The effect of states mandating insurance coverage of fertility preservation for those facing iatrogenic infertility is unclear. We sought to qualitatively understand barriers to clinic acceptance of insurance coverage for sperm banking fertility preservation services and quantitatively estimate the association between mandated fertility benefits and clinics accepting insurance.
Methods:: Staff at sperm banks in 3 mandate states completed in-depth interviews regarding patients accessing fertility preservation benefits through their insurance. Recruitment stopped at information saturation. Subsequently, a United States–wide secret shopper study was completed of andrology/fertility clinics evaluating acceptance of insurance for sperm freezing services and cash costs of services for a fictitious male patient with cancer.
Results:: Seven interviews provided 4 dominant themes to describe clinic experience in mandated states: (1) coverage gaps/low reimbursement for sperm banking services, (2) clinic resources needed to navigate insurance, (3) prior authorization care delays, and (4) need for sperm banks to educate patients and insurers on mandates. In total, 200 of 418 clinics (56%) answered the secret shopper survey, with a majority (69.5%, n = 153) offering sperm banking services. Only 36.9% of these accepted insurance, with clinics in mandate states being more likely to accept insurance than in nonmandate states (61.0% vs 27.8%, P value = .0002). Only 37 (24.5%) of the clinics provided cash cost of sperm banking (ranging from $50 to $2000).
Conclusions:: The intent of fertility preservation mandates may be limited by barriers at insurer and clinic levels. Strategies to overcome barriers are needed to improve access to the full scope of fertility preservation benefits for male patients with cancer.
Related
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- Precision Oncofertility: Integrating Genomics, Reproductive Biomarkers, Treatment Toxicity Profiles, and Foundation Models for Fertility Preservation in Men and Women with Cancer
- Fertility preservation in girls and adolescents with Turner syndrome: lessons for reproductive care in differences of sex development - a mini-review
BibTeX
@article{berger2026association,
title = {{Association of Fertility Preservation Benefit Mandates With Sperm Bank Network Adequacy: A Mixed-Methods Study}},
author = {Jonathan H. Berger and Sara W. Yoeun and Ricardo E. Flores Ortega and Bonnie N. Kaiser and Kristina Nguyen and Victoria Turcotte and Natasha Bisarya and H. Irene Su and Sara B. McMenamin},
journal = {Urology Practice},
year = {2026},
month = jun,
doi = {10.1097/upj.0000000000001039},
url = {https://doi.org/10.1097/upj.0000000000001039},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Association of Fertility Preservation Benefit Mandates With Sperm Bank Network Adequacy: A Mixed-Methods Study
AU - Jonathan H. Berger
AU - Sara W. Yoeun
AU - Ricardo E. Flores Ortega
AU - Bonnie N. Kaiser
AU - Kristina Nguyen
AU - Victoria Turcotte
AU - Natasha Bisarya
AU - H. Irene Su
AU - Sara B. McMenamin
PY - 2026
DA - 2026/06/25
JO - Urology Practice
DO - 10.1097/upj.0000000000001039
UR - https://doi.org/10.1097/upj.0000000000001039
AB - Introduction:: The effect of states mandating insurance coverage of fertility preservation for those facing iatrogenic infertility is unclear. We sought to qualitatively understand barriers to clinic acceptance of insurance coverage for sperm banking fertility preservation services and quantitatively estimate the association between mandated fertility benefits and clinics accepting insurance. Methods:: Staff at sperm banks in 3 mandate states completed in-depth interviews regarding patients accessing fertility preservation benefits through their insurance. Recruitment stopped at information saturation. Subsequently, a United States–wide secret shopper study was completed of andrology/fertility clinics evaluating acceptance of insurance for sperm freezing services and cash costs of services for a fictitious male patient with cancer. Results:: Seven interviews provided 4 dominant themes to describe clinic experience in mandated states: (1) coverage gaps/low reimbursement for sperm banking services, (2) clinic resources needed to navigate insurance, (3) prior authorization care delays, and (4) need for sperm banks to educate patients and insurers on mandates. In total, 200 of 418 clinics (56%) answered the secret shopper survey, with a majority (69.5%, n = 153) offering sperm banking services. Only 36.9% of these accepted insurance, with clinics in mandate states being more likely to accept insurance than in nonmandate states (61.0% vs 27.8%, P value = .0002). Only 37 (24.5%) of the clinics provided cash cost of sperm banking (ranging from $50 to $2000). Conclusions:: The intent of fertility preservation mandates may be limited by barriers at insurer and clinic levels. Strategies to overcome barriers are needed to improve access to the full scope of fertility preservation benefits for male patients with cancer.
SN - 2352-0779
SN - 2352-0787
ER -