Currently 15 US states have laws that regulate insurance coverage for fertility treatments.  Differences between states with a comprehensive mandate (>2 in vitro fertilization (IVF) cycles) and non-comprehensive mandate (≤2 cycles) has been studied using CDC Assisted Reproductive Technology data, but less is known about the managed care perspective.  OBJECTIVES: To study the impact of state mandate on in vitro fertilization (IVF) outcomes using a claims database. METHODS: PharMetrics® data for patients with continuous eligibility for 12 months before and after first gonadotropin-releasing hormone agonist or antagonist prescription (index date) between January 1, 1999 and May 31, 2009.  Patients without a prescription for follicle stimulating hormone, human chorionic gonadatropin, or evidence of an embryo transfer within 60 days of index were excluded.  Patient descriptors were: state mandate type (comprehensive versus non-comprehensive), age (<38y, >38y) and year of IVF procedure (≤2005, >2005).  ICD-9-CM code for live birth (V27.0, V27.2, V27.3, V27.5, or V27.6) was evaluated through 42 weeks post embryo transfer.  Logistic regression evaluated effects across variables.   RESULTS: A total of 880 patients met study criteria.  49.4% resided in a comprehensive mandate state.  Fewer patients in comprehensive mandate states were identified prior to 2006 (52.0%) versus non-comprehensive mandate states (58.9%) (P=0.0389).  The percentage of patients aged ≥38y was 23.0% in comprehensive versus 17.1% for non-comprehensive mandate states (P=0.0284).  There was no difference in live births between comprehensive and non-comprehensive mandate patients (49.2 and 51.5% respectively; P=0.5016).  Logistic regression results showed that patients ≤38y were more likely to have a live birth (OR 2.70; 95%CI=1.90-3.86); state mandate and year range showed no association. There were no significant interactions.  CONCLUSIONS: The live birth rate from one IVF cycle in a managed care population was ~50% and was not affected by state mandate.  Patients with completed IVF before age 38 experienced almost 3 times greater odds of live birth.