Infertility Treatment, ART and IUI Procedures and Delivery Part 3

Table and Figures Table 1 Mandate Variations by State State Year Massachusetts Rhode Island New Jersey New York Illinois Maryland Texas California 1987 1989, 2006 2001 1990, 2002 1991, 1997 2000 1987 1989 Connecticut Hawaii Arkansas Louisiana Ohio Montana West Virginia 2005 1989, 2003 1987, 1991 2001 1991 1987 1995 Cover/ Includes Max Offer IVF IVF? Small Age Employees Cap? Exempt? Dollar Cap Male Marriage Facility Cyropreservation Infertility HMOs Required Restriction allowed? Covered? Exempt Cover Cover Cover Cover Cover Cover Offer Yes No No Yes No 25‐40 Yes No 46 No 0 21‐44 Yes 6 No Yes min 3 No only IVF No No No No <50 No <25 <50 No No 100000 No No No 100000 No No Yes No No No Yes Yes No No Yes No Yes Yes Yes Yes DK No DK Dk DK DK Yes DK Yes DK Yes Yes Yes No No No No No No No Offer Cover Cover Cover Cover Cover Cover Cover No Yes Yes Yes No not req DK DK No No No No DK No DK DK No No No 15000 DK No DK DK No No Yes Yes DK No DK DK No Yes Yes Yes DK No DK DK DK DK DK Yes DK DK DK DK DK DK Yes Yes DK Yes DK DK No No No Yes DK No No No No 2 1 No DK No DK DK No 40 No No DK No DK DK Table 2: Descriptive Statistics, All Women in Two-Year Sample All Women: Means Average Age Average Risk Score 41.47 1.296 N Percent Patients Pregnancies Delivery Failure Major Complications Multiple Birth No ART/FERT Women FERT Women ART Women 3617579 207326 122509 28915 16805 1046 3462418 150306 4855 100.00% 5.73% 3.39% 0.80% 0.46% 0.03% 95.71% 4.15% 0.13% Table 3: Descriptive Statistics, All Completed Pregnancies, Two-Year Sample Infertility Claims ART FERT No ART/FERT Women 2004 CDC Results Means Means Means N=Non-donor Cycles & not patients 35.66 42.12 41.46 36 Average Risk Score 2.498 1.910 1.227 Average Age N Percent N Patients 4855 100% 150306 NA Percent N Percent Percent 100% 3462418 100% 94,242=100% Clinical Pregnancy 2746 56.56% 18660 12.41% 185919 5.37% 1906 1481 528 39.26% 30.50% 10.88% 12815 9491 3934 8.53% 6.31% 2.62% 132553 111537 145767 3.83% 31,758=33.70% 3.22% 26,059=27.65% 4.21% 5699=6.05% 406 62 8.36% 1.28% 1821 299 1.21% 0.20% 24453 6845 0.71% 0.20% Completed Pregnancy Delivery Failure Major Complications Multiple Birth NA 3589=3.81% Table 4: Descriptive Statistics, All Women in Two-Year Sample, By Fertility Status Completed Pregnancy Sample Average Age Average Risk Score Completed Pregnancies Delivery Failure Major Complications Multiple Birth All women in Completed Pregnancy sample 31.744 2.987 N Percent 147274 100.00% 122509 83.18% 28915 19.63% 16805 11.41% 1046 0.71% All ART women in All FERT women in 2004 CDC Completed Completed Results Pregnancy sample Pregnancy sample 35.268 33.168 36 3.145 2.684 N Percent N Percent 1906 100.00% 12815 100.00% 100.00% 1481 77.70% 9491 74.06% 82.10% 528 27.70% 3934 30.70% 17.00% 406 21.30% 1821 14.21% 62 3.25% 299 2.33% 26.70% Table 5: OLS regression of ART on selected instruments in different datasets * All Women Aged 21‐54 All Completed Pregnancies All Mothers with Babies Coefficients T Ratio Coefficients T Ratio Coefficients T Ratio mandate 0.00093 23.42 0.0052 8.61 0.0014 1.86 Massachusettes Rhode Island New Jersey New York Illinois Ohio Maryland West Virginia Arkansas Texas California Hawaii Louisiana Montana Observations Dep Var Mean 0.00224 ‐0.00020 0.00503 0.00166 0.00016 ‐0.00007 0.00152 0.00011 0.00036 0.00103 ‐0.00010 ‐0.00030 ‐0.00009 0.00015 3617579 0.13 24.25 ‐0.32 41.59 12.37 1.56 ‐0.62 7.76 0.36 1.41 11.26 ‐1.72 ‐0.13 ‐0.40 0.24 0.0148 ‐0.0043 0.0301 0.0073 ‐0.0031 ‐0.0009 0.0105 ‐0.0010 0.0022 0.0103 ‐0.0039 ‐0.0058 ‐0.0044 ‐0.0025 147274 1.29 10.66 ‐0.47 19.18 3.88 ‐2.18 ‐0.48 3.46 ‐0.18 0.53 7.68 ‐4.19 ‐0.12 ‐1.14 ‐0.26 0.0063 0.0015 0.0165 0.0054 ‐0.0038 ‐0.0014 ‐0.0007 ‐0.0020 ‐0.0017 0.0082 ‐0.0047 ‐0.0046 ‐0.0031 0.0067 75263 1.11 3.38 0.13 7.83 2.26 ‐2.12 ‐0.61 ‐0.18 ‐0.28 ‐0.34 4.92 ‐4.01 ‐0.10 ‐0.63 0.54 *(Included but not shown are Age, Year dummies and risk score--separate regressions with mandate and state dummies) Table 6: OLS regression of FERT on selected instruments in different datasets * All Women Aged 21‐54 Coefficients T Ratio All Completed Pregnancies Coefficients T Ratio All Mothers with Babies Coefficients T Ratio mandate 0.00839 39.02 0.01373 9.13 0.00873 4.50 Massachusettes Rhode Island New Jersey New York Illinois Ohio Maryland West Virginia Arkansas Texas California Hawaii Louisiana Montana Observations Dep Var Mean 0.02839 0.01184 0.00376 0.00461 ‐0.00309 ‐0.00525 0.00966 ‐0.00950 ‐0.00382 0.01234 0.00929 0.02013 0.00074 ‐0.01009 3617579 4.15 56.96 3.59 5.76 6.36 ‐5.60 ‐9.18 9.14 ‐5.56 ‐2.80 24.90 28.48 1.61 0.61 ‐2.93 0.04795 0.05360 0.02704 0.01525 0.01598 0.00168 0.01575 ‐0.00224 ‐0.02469 0.00786 0.00172 ‐0.07009 ‐0.00104 0.02316 147274 8.7 13.91 2.36 6.93 3.27 4.59 0.37 2.08 ‐0.16 ‐2.45 2.35 0.74 ‐0.56 ‐0.11 0.98 0.04134 0.03368 0.02617 0.01659 0.00747 ‐0.00454 0.03039 0.00162 ‐0.02093 0.00446 ‐0.00391 ‐0.05170 0.01199 ‐0.00272 75263 7.45 8.94 1.18 4.97 2.77 1.69 ‐0.79 3.11 0.09 ‐1.69 1.07 ‐1.35 ‐0.45 0.97 ‐0.09 *(Included but not shown are Age, Year dummies and risk score--separate regressions with mandate and state dummies) Table 7: OLS and TSLS results ART/FERT Association with Various Dependent Variables, 14 State Dummies as Instruments, 2 year sample, state cluster Major Complications OLS Failure in Pregnancy TSLS OLS Babies' Risk Score TSLS OLS TSLS Variable Coeff Z Coeff Z Coeff Z Coeff Z Coeff Z Coeff Z ART 0.061 4.97 0.076 0.25 0.097 10.26 0.652 1.73 3.324 5.47 -15.220 -0.47 FERT 0.009 2.02 0.018 0.13 0.131 22.39 0.939 3.60 0.940 5.42 4.548 0.67 Risk Score 0.042 17.11 0.041 12.42 -0.040 -12.98 -0.058 -8.70 0.972 16.12 1.004 4.87 2002 0.010 2.59 0.010 2.47 -0.001 -0.11 -0.008 -1.17 0.422 3.06 0.481 2.78 2003 0.014 5.41 0.014 4.92 -0.006 -0.98 -0.013 -1.53 0.211 1.36 0.193 0.90 2004 0.017 5.67 0.017 3.72 -0.008 -1.13 -0.006 -0.87 0.168 1.57 0.267 1.07 age22 0.033 1.92 0.032 1.92 -0.082 -2.59 -0.102 -2.55 -0.383 -0.18 -0.523 -0.24 age23 0.042 2.66 0.042 2.58 -0.097 -2.87 -0.118 -2.82 -0.682 -0.33 -0.768 -0.37 age24 0.036 1.96 0.035 1.92 -0.111 -3.36 -0.139 -3.21 -1.087 -0.53 -1.183 -0.57 age25 0.037 2.09 0.037 1.98 -0.116 -3.16 -0.150 -3.00 -0.917 -0.45 -1.055 -0.51 age26 0.033 1.84 0.033 1.75 -0.125 -3.48 -0.168 -3.31 -0.915 -0.45 -1.050 -0.51 age27 0.041 2.29 0.041 2.14 -0.129 -3.34 -0.175 -3.22 -1.013 -0.50 -1.181 -0.57 age28 0.042 2.26 0.042 2.12 -0.129 -3.41 -0.179 -3.36 -1.088 -0.54 -1.274 -0.61 age29 0.045 2.64 0.044 2.33 -0.125 -3.31 -0.184 -3.33 -0.765 -0.37 -0.905 -0.44 age30 0.044 2.35 0.043 2.23 -0.130 -3.47 -0.185 -3.54 -0.779 -0.38 -0.839 -0.41 age31 0.044 2.23 0.043 2.17 -0.116 -2.90 -0.175 -3.12 -1.108 -0.54 -1.179 -0.57 age32 0.044 2.37 0.043 2.19 -0.124 -3.34 -0.188 -3.44 -1.217 -0.60 -1.266 -0.62 age33 0.046 2.48 0.046 2.27 -0.107 -2.81 -0.179 -3.15 -1.057 -0.52 -1.103 -0.54 age34 0.043 2.28 0.042 2.12 -0.097 -2.50 -0.171 -3.06 -1.058 -0.52 -1.068 -0.51 age35 0.037 1.73 0.036 1.62 -0.085 -2.14 -0.168 -2.80 -1.274 -0.62 -1.277 -0.62 age36 0.041 2.17 0.040 1.96 -0.067 -1.80 -0.151 -2.65 -0.921 -0.45 -0.941 -0.45 age37 0.038 1.92 0.036 1.71 -0.041 -1.08 -0.142 -2.40 -0.762 -0.37 -0.641 -0.31 age38 0.032 1.51 0.031 1.42 -0.023 -0.58 -0.126 -1.95 -1.033 -0.51 -0.950 -0.45 age39 0.031 1.42 0.029 1.27 0.020 0.56 -0.094 -1.61 -0.759 -0.38 -0.522 -0.25 age40 0.020 0.98 0.018 0.79 0.052 1.33 -0.071 -1.02 -1.593 -0.78 -1.417 -0.67 age41 0.003 0.17 0.001 0.06 0.079 2.00 -0.068 -0.96 -0.108 -0.05 -0.079 -0.03 age42 0.006 0.32 0.004 0.20 0.099 2.63 -0.032 -0.48 -1.207 -0.58 -0.788 -0.33 age43 -0.010 -0.40 -0.012 -0.45 0.120 3.03 0.002 0.04 -0.756 -0.35 0.377 0.12 age44 -0.027 -1.35 -0.029 -1.19 0.067 2.17 -0.035 -0.58 -0.590 -0.28 -0.086 -0.03 age45 -0.048 -1.86 -0.050 -1.66 0.065 1.55 -0.043 -0.77 -0.215 -0.08 2.220 0.38 age46 -0.081 -3.70 -0.082 -3.47 -0.004 -0.11 -0.082 -1.73 6.046 1.53 6.310 1.61 age47 -0.087 -4.30 -0.088 -4.16 -0.031 -0.88 -0.086 -1.69 -1.794 -0.74 -0.867 -0.25 age48 -0.137 -5.66 -0.138 -5.70 -0.090 -2.22 -0.127 -2.32 2.443 0.53 4.595 0.60 age49 -0.112 -5.81 -0.112 -5.41 -0.101 -2.61 -0.154 -2.76 -4.841 -1.60 -1.462 -0.21 age50+ -0.155 -8.14 -0.154 -7.71 -0.070 -1.99 -0.073 -1.83 5.940 0.88 7.384 1.39 Constant -0.025 -1.32 -0.024 -1.30 0.366 8.68 0.395 7.88 1.898 0.92 1.769 0.85 OBS RMSE R Square Dep. Var. 147274 0.3107 0.0455 147274 0.3107 147274 0.3875 0.0484 147274 0.451 75263 8.961 0.023 75263 9.223 0.114 0.114 0.196 0.196 3.323 3.323 Mean Table 8: OLS and TSLS results ART/FERT Association with Various Dependent Variables, 8 State Dummies as Instruments for Mandates, 2 year sample, state cluster Variable Major Complications Failure in Pregnancy OLS OLS Coeff TSLS Babies' Risk Score TSLS OLS TSLS Z Coeff Z Coeff Z Coeff Z Coeff Z Coeff Z -0.41 ART 0.061 4.97 0.080 0.26 0.097 10.26 0.661 1.69 3.324 5.47 -13.554 FERT 0.009 2.02 0.028 0.18 0.131 22.39 0.930 3.36 0.940 5.42 3.298 0.44 Risk Score 0.042 17.11 0.041 12.11 -0.040 -12.98 -0.057 -8.47 0.972 16.12 1.028 4.84 2002 0.010 2.59 0.010 2.43 -0.001 -0.11 -0.008 -1.17 0.422 3.06 0.483 2.75 2003 0.014 5.41 0.014 4.76 -0.006 -0.98 -0.013 -1.52 0.211 1.36 0.211 0.95 2004 0.017 5.67 0.017 3.65 -0.008 -1.13 -0.006 -0.89 0.168 1.57 0.267 1.07 age22 0.033 1.92 0.032 1.92 -0.082 -2.59 -0.102 -2.53 -0.383 -0.18 -0.486 -0.23 age23 0.042 2.66 0.042 2.56 -0.097 -2.87 -0.118 -2.81 -0.682 -0.33 -0.747 -0.36 age24 0.036 1.96 0.035 1.89 -0.111 -3.36 -0.139 -3.18 -1.087 -0.53 -1.153 -0.56 age25 0.037 2.09 0.036 1.95 -0.116 -3.16 -0.150 -2.96 -0.917 -0.45 -1.012 -0.49 age26 0.033 1.84 0.032 1.72 -0.125 -3.48 -0.167 -3.27 -0.915 -0.45 -0.999 -0.48 age27 0.041 2.29 0.040 2.09 -0.129 -3.34 -0.174 -3.19 -1.013 -0.5 -1.125 -0.54 age28 0.042 2.26 0.041 2.06 -0.129 -3.41 -0.178 -3.31 -1.088 -0.54 -1.213 -0.58 age29 0.045 2.64 0.044 2.25 -0.125 -3.31 -0.184 -3.27 -0.765 -0.37 -0.842 -0.41 age30 0.044 2.35 0.043 2.17 -0.130 -3.47 -0.185 -3.50 -0.779 -0.38 -0.793 -0.39 age31 0.044 2.23 0.043 2.12 -0.116 -2.9 -0.174 -3.08 -1.108 -0.54 -1.125 -0.54 age32 0.044 2.37 0.043 2.10 -0.124 -3.34 -0.188 -3.39 -1.217 -0.6 -1.213 -0.59 age33 0.046 2.48 0.045 2.19 -0.107 -2.81 -0.178 -3.10 -1.057 -0.52 -1.043 -0.51 age34 0.043 2.28 0.041 2.04 -0.097 -2.5 -0.171 -3.02 -1.058 -0.52 -1.012 -0.49 age35 0.037 1.73 0.035 1.56 -0.085 -2.14 -0.167 -2.76 -1.274 -0.62 -1.214 -0.59 age36 0.041 2.17 0.039 1.87 -0.067 -1.8 -0.150 -2.60 -0.921 -0.45 -0.873 -0.42 age37 0.038 1.92 0.035 1.61 -0.041 -1.08 -0.142 -2.35 -0.762 -0.37 -0.577 -0.28 age38 0.032 1.51 0.030 1.35 -0.023 -0.58 -0.125 -1.91 -1.033 -0.51 -0.873 -0.42 age39 0.031 1.42 0.028 1.20 0.020 0.56 -0.093 -1.56 -0.759 -0.38 -0.462 -0.22 age40 0.020 0.98 0.016 0.71 0.052 1.33 -0.071 -0.99 -1.593 -0.78 -1.328 -0.62 age41 0.003 0.17 0.000 -0.01 0.079 2 -0.067 -0.93 -0.108 -0.05 0.044 0.02 age42 0.006 0.32 0.003 0.13 0.099 2.63 -0.031 -0.46 -1.207 -0.58 -0.739 -0.31 age43 -0.010 -0.4 -0.013 -0.50 0.120 3.03 0.003 0.05 -0.756 -0.35 0.359 0.11 age44 -0.027 -1.35 -0.030 -1.20 0.067 2.17 -0.034 -0.56 -0.590 -0.28 0.004 0.00 age45 -0.048 -1.86 -0.051 -1.68 0.065 1.55 -0.042 -0.75 -0.215 -0.08 2.037 0.35 age46 -0.081 -3.7 -0.083 -3.42 -0.004 -0.11 -0.081 -1.69 6.046 1.53 6.402 1.65 age47 -0.087 -4.3 -0.088 -4.16 -0.031 -0.88 -0.085 -1.67 -1.794 -0.74 -0.924 -0.28 age48 -0.137 -5.66 -0.138 -5.75 -0.090 -2.22 -0.127 -2.32 2.443 0.53 4.506 0.60 age49 -0.112 -5.81 -0.113 -5.33 -0.101 -2.61 -0.154 -2.71 -4.841 -1.6 -1.635 -0.23 age50+ -0.155 -8.14 -0.155 -7.74 -0.070 -1.99 -0.073 -1.82 5.940 0.88 7.300 1.38 Constant -0.025 -1.32 -0.024 -1.28 0.366 8.68 0.395 7.86 1.898 0.92 1.730 0.83 OBS 147274 147274 147274 147274 75263 75263 RMSE 0.3107 0.3107 0.3875 0.4499 8.9610 9.1575 R Square Dep. Var. 0.0455 Mean 0.114 0.0484 0.114 0.196 0.0228 0.196 Note: Mandate States Include MA, RI, NJ, NY, MD, IL, TX and CA 3.323 3.323 Figures Figure 1: Among All Women in Two-Year Sample, Age Distribution of Completed Pregnancies by Fertility Status 7.00% 6.00% Percent of all No ART/FERT Wom en Percent of all FERT Wom en 5.00% Percent of pregnancies in cohort Percent of all ART Wom en N=147274 4.00% 3.00% 2.00% 1.00% 0.00% 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of Mother Figure 2: Among All Women in Two-Year Sample, Average Health Risk Score, by Fertility Status 5.00 Avg Risk Score Not Including Pregnancy Related Diagnoses 4.50 4.00 No ART/FERT Women FERT Wom en ART Wom en 3.50 N=3617579 3.00 2.50 2.00 1.50 1.00 0.50 0.00 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of Woman Figure 3: Among All Women in Two Year Sample, Success Rate By Fertility Status and Age of Mother Percentage Pregnancies Within Age Category 120.0% 100.0% No ART/FERT Wom en FERT Wom en ART Wom en 80.0% N=3617579 60.0% 40.0% 20.0% 0.0% 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of Mother Figure 4: Among Women in Two-Year Sample, With Completed Pregnancy, Complication Rate By Age and Fertility Status 100.0% 90.0% No ART/FERT Women 80.0% FERT Women ART Women 70.0% N=147274 Mean Rate 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of the Woman Figure 5: Among Women in Two-Year Sample, With Completed Pregnancy, Failure Rate By Age and Fertility Status 60.0% No ART/FERT Women 50.0% FERT Women ART Women N=147274 Mean Rate 40.0% 30.0% 20.0% 10.0% 0.0% 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of Woman Figure 6: Among All Women in Two Year Sample, With Completed Pregnancies and Baby Information, Mean Risk Score of the Baby By Age of Mother and Fertility Status 35.00 30.00 No ART/FERT Wom en FERT Wom en 25.00 Mean Risk Score ART Women N=75263 20.00 15.00 10.00 5.00 0.00 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of Mother Figure 7: Among All Women in Two Year Sample, With Completed Pregnancy, Mean Complications Rate by Mother's Risk Score Category 0.8 0.7 No ART/FERT Wom en 0.6 FERT Wom en Mean Complications Rate ART Women N=147274 0.5 0.4 0.3 0.2 0.1 0 0-1 1-2 2-3 3-4 4-5 5-6 6-8 8-10 10-12 12-15 >15 Mother's Risk Score Category Figure 8: Among All Women in Two-Year Samples, With Completed Pregnancy, Mean Failure Rate by Mother's Risk Score Category 1 0.9 0.8 No ART/FERT Women FERT Women 0.7 ART Women Mean Failure Rate N=147274 0.6 0.5 0.4 0.3 0.2 0.1 0 0-1 1-2 2-3 3-4 4-5 5-6 6-8 Mother's Risk Score Category 8-10 10-12 12-15 >15 Figure 9: Among All Women in Two-Year Samples, With Completed Pregnancy and Baby Information, Mean Baby's Risk Score For Each of Mother's Risk Category, By Mother's Fertility Status 40.0 35.0 No ART/FERT Wom en FERT Wom en 30.0 Baby's Mean Risk Score ART Wom en N=75263 25.0 20.0 15.0 10.0 5.0 0.0 0-1 1-2 2-3 3-4 4-5 5-6 6-8 8-10 10-12 12-15 >15 Mother's Risk Score Category Figure 10: Among All Women in Two-Year Sample, Proportion of All Pregnancies by Age and fertility category 100% 90% Proportion of completed pregnancies 80% 70% 60% 50% No ART/FERT Wom en FERT Wom en ART Wom en 40% N=3617579 30% 20% 10% 0% 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of mother Figure 11: Among All Women in Two-Year Sample, Age distribution of ART women in mandate and no mandate states 250 Mandate States 200 No mandate states Number of women N=3617579 150 100 50 0 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Age of mother Figure 12: Among All Women in Two-Year Sample, ART Success rate by age of mother, mandate versus non-mandate states 100.0% 90.0% 80.0% Mandate states Percentage success rate No m andate states 70.0% N=3617579 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 25 26 27 28 29 30 31 32 33 34 35 36 Age of mother 37 38 39 40 41 42 43 44 45 Figure 13: Raw Means, Mean FERT Rate vs. Mean ART Rate, By State 0.16 MA RI 0.14 DC R2= 0.213 0.12 SD CT MI NY MD MT Mean FERT Rate CO MN AL CAOH ME NH 0.08 TN UT 0.06 KY LA ND IN DE WV NC TX NV FL VT WI GA OR WA KS PA NE IL 0.1 R2=0.142 NJ AZ MO VA IA NM OK SC 0.04 With DC & HI AR AK Without DC & HI ID MS 0.02 HI 0 WY 0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 Mean ART Rate Figure 14: Mean Residual FERT Rate vs. Mean Residual ART Rate, By State 0.06 RI MA SD 0.04 AZ MI MT IL ME Mean Residual FERT Rate ‐0.02 DC NE 0.02 NY AL MN CO NV CA ND OH 0 LA TN KY NH ‐0.01 WV DE 0 VT IN IA NM WI UT OR ‐0.02 GA AR KS WA R2= 0.116 PA MD NC R2=0.072 FL TX 0.01 MO VA 0.02 0.03 OK ID AK MS NJ CT ‐0.04 SC With DC & HI Without DC & HI ‐0.06 WY HI ‐0.08 ‐0.1 Mean Residual ART Rate 0.04 0.05 Figure 15: Raw Means, Mean Rate of Major Complications vs. Mean ART Rate, By State 0.25 DC Mean Major Complications 0.2 SD RI LA UT IN TNMIGA WY MS 0.1 NH R2=0.122 OK AZ OH 0.15 CA CO AR NC MD WV IL MN IASC KY AK ND AL WI OR MT DE VT ME VAMO NY NV TX WANJ MA FL PA NE CT R2=1E‐05 KS NM ID 0.05 With DC & HI Without DC & HI HI 0 0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 Mean ART Rate Figure 16: Mean Residual Complications vs. Mean Residual ART Rate, By State 0.15 Residuals were calculated by regressing complications on age, year and risk score. ART residuals were calculated similarly Mean Residual Complications 0.1 ‐0.02 DC SD 0.05 OK RI AZ UT OH LA NY CO AR NV WY IN MS CA TN GA MD MA IA AK NC FL 0 IL WV MN SC MI WI TX AL0 KY ‐0.01 0.01 CT NH ND DE OR MT NM VT ME ID R2=0.076 VA MO NJ R2=0.002 WA PA 0.02 NE KS 0.03 ‐0.05 With DC & HI Without DC & HI HI ‐0.1 Mean Residual ART Rate 0.04 0.05 Figure 17: Raw Means, Mean Rate of Major Complications vs. Mean FERT Rate, By State 0.25 DC SD Mean Complication Rate 0.2 RI OK VA MO LA 0.15 UT AR WY GA IA SC AK 0.1 OH CO IN MS AZ R2=0.200 NY NVCA NC WA IL MD FL MN PA AL KS NH NE MT ME TN WV WI ND KY OR NM DE TX VT NJ MA R2=0.056 MI CT ID 0.05 With DC & HI Without DC & HI HI 0 0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16 Mean FERT Rate Figure 18: Mean Residual Complications Rate vs. Mean Residual FERT Rate, By State 0.15 DC 0.1 Mean Residual Complications Rate SD ‐0.1 0.05 OK VA UT AR WY MS GA AK SC ‐0.08 ‐0.06 ‐0.04 IA WI ‐0.02 OR NM RI AZ LAOH MO IN CA TN WV 0 CO NV R2=0.128 NY NJ MDIL NC WA TXMN PA FL AL 0 0.02 KY ND CT NH NE DE KS MT VT ME ID ‐0.05 With DC & HI HI Without DC & HI ‐0.1 Mean Residual FERT Rate MA R2=0.026 MI 0.04 0.06 Figure 19: Raw Means, Mean Failure Rate vs. Mean ART Rate, By State 0.3 DC 0.25 RI R2=0.139 VT AK MD WA WV CA MN NV ALIA IL OH SC NH LA NM AZ TN OR CO MS KY MT ME UT ND AR IN WI MIGA Mean Failure Rate 0.2 0.15 R2=0.230 NJ MA NY DE FL VA CT PA TX NC KS OK MO NE ID SD 0.1 With DC & HI WY Without DC & HI 0.05 HI 0 0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 Mean ART Rate Figure 20: Mean Residual failure Rate vs. Mean Residual ART Rate, By State 0.1 DC RI 0.05 DE MA NY AK WVVT IA NV MN AL CA OH IL 0 SC NM LA CT TN OR NH ‐0.01 KY 0 ND CO MS ME IN AR WI MT UT ‐0.05 SD WA MI MD R2=0.069 GA Mean Residual Failure Rate ‐0.02 FL NC TX OK AZ 0.01 VA PA MO KS 0.02 NE ID ‐0.1 WY ‐0.15 With DC & HI Without DC & HI HI ‐0.2 ‐0.25 R2=0.130 NJ Mean Residual ART Rate 0.03 0.04 0.05 Figure 21: Raw Means, Mean Failure Rate vs. Mean FERT Rate, By State 0.3 DC AK Mean Failure Rate 0.2 IA GA NM OR OK MS UT AR MA RI VT SC NJ NY DE 0.25 MD WV VA CA MN PA NV AL FL IL OH TX NH NC TNLA KS MO CO IN KY MT WI ND ME NE R2=0.426 R2=0.285 WA MICT AZ 0.15 ID SD 0.1 WY 0.05 With DC & HI Without DC & HI HI 0 0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16 Mean FERT Rate Figure 22: Mean Residual failure Rate vs. Mean Residual FERT Rate, By State 0.1 DC MD MNAL NV PA OH VA FL0 TX NC IL NM OR TN CA KS CT ‐0.02OK INNH 0 0.02 KY LA CO ME NE UT AR MO WI MT GA SC Mean Residual Failure Rate ‐0.1 ‐0.08 ‐0.06 WA VTWV AK ‐0.04 MS MA NJ NY 0.05 DE R2=0.381 MI IA ‐0.05 R2=0.228 AZ ND ‐0.1 WY ‐0.15 With DC & HI Without DC & HI HI ‐0.25 Mean Residual FERT Rate 0.04 SD ID ‐0.2 RI 0.06 Figure 23: Raw Means Mean Baby Risk Score vs. Mean ART Rate, By State 6 SD Mean Baby Risk Score 4 MA GA MS TN ME WY 3 DC CO 5 NV MD IN WV IL LA MI KY AZ IA IDMN OH ARCA ND OR NH WI HI TX OK SC AL FL NC NE NY AK CT UT WA VA 2 KS VT NJ PA DE NM RI R2= 0.005 MO R2=0.058 MT 1 With DC & HI Without DC & HI 0 0 0.01 0.02 0.03 0.04 0.05 0.06 0.07 Mean ART Rate Figure 24: Mean Residual Baby Score vs. Mean Residual ART, By State 0.05 DC 0.04 Mean Residual Baby Score 0.03 VT KS PA MO VA NC 0.01 DE MT NY NM RI ‐2 0.02 WA NJ CT ‐1.5 ‐1 ‐0.5 WI NH AK OH FL NE TX OK SC AL ID MN AR 0 AZ 0 UT CA MI OR ND KY CO MA NV IA IN IL WY R2=0.001 MD WV LA HI 0.5 GA ME MS 1 TN ‐0.01 With DC & HI Without DC & HI ‐0.02 Mean Residual ART 1.5 2 SD R2=0.095 Figure 25: Raw Means Mean Baby Risk Score vs. Mean FERT Rate, By State 6 Mean Baby Risk Score 4 MA GA MS WV IN OK KY IA NV MO OH TN ND VA WI SC ID WY AK 3 SD DC CO 5 VT AR DE UT OR MD ME TX IL FLLA MN NE NC AZ KS CA R2=0.026 CT NJ PA HI R2=0.048 MI AL WA NY NH NM 2 RI MT 1 With DC & HI Without DC & HI 0 0 0.02 0.04 0.06 0.08 0.1 0.12 0.14 Mean FERT Rate Figure 26: Mean Residual Baby Risk Score vs. Mean Residual FERT Rate, By State 0.06 SD MA 0.04 RI MD Mean Residual Baby Risk Score NJ ‐2 CT KS PA NH MT ‐1.5 ‐1 NM AL MI 0.02 AZ NY WA MN LA NE NC ME IL FL TX WV NV MO 0 IA ND CA IN OH ‐0.5 0 0.5 WI TN OK ID VA UT KY AR ‐0.02 OR 1 GA SC MS DE VT CO DC AK ‐0.04 HI WY ‐0.06 With DC & HI Without DC & HI ‐0.08 Mean Residual FERT Rate 1.5 R2=0.006 R2=0.013 2