William & Mary Journal of Race, Gender, and Social Justice
Abstract
This article examines the public health, legal, and policy implications of multi-fetal pregnancies resulting from in vitro fertilization (IVF), using the 2009 “Octomom” case as a catalyst for discussion. Camille M. Davidson argues that the high rate of multi-fetal pregnancies in the United States is a direct consequence of the unregulated fertility industry, the financial burden of IVF on patients, and the incentive structures created by the Fertility Clinic Success Rate and Certification Act. She contends that lack of mandated insurance coverage compels patients and physicians to transfer multiple embryos per cycle to maximize pregnancy chances, increasing the risks of preterm birth, long-term disabilities, and societal healthcare costs. The article reviews the limitations of current federal law, the permissive nature of American Society for Reproductive Medicine (ASRM) guidelines, inconsistent and incomplete state mandates, and relevant Supreme Court decisions. It proposes that Congress revise and pass the Family Building Act to federally mandate insurance coverage for IVF, tying reimbursement to adherence to professional embryo transfer guidelines. Davidson outlines policy considerations—such as cycle limits, age restrictions, definitions of infertility, and coverage for donors and surrogacy—that could strengthen legislation. The paper concludes that a federal insurance mandate is the most effective means to reduce multi-fetal pregnancies, improve maternal-infant health outcomes, and control long-term healthcare costs.