Background
Assisted reproductive technologies (ARTs) provide effective treatment for infertility but are underutilized due to high costs. In November 2023, Guangxi province of China incorporated a range of ART procedures into social health insurance (SHI) coverage. This study aimed to evaluate the short-term impacts of the policy.

Methods
We used aggregated claims data from the Guangxi Healthcare Security Administration between January 2022 and July 2024, including 22 months before and 9 months after policy implementation. The primary study population comprised women with newly recorded pregnancies achieved through ARTs, identified through ICD-10 (International Classification of Diseases, 10th Revision) codes. We employed an interrupted time series (ITS) design to estimate the policy impact on monthly number of ART pregnancies and multiple pregnancy proportion among ART pregnancies. Non-ART pregnancies were additionally examined as a comparison series in a robustness analysis.

Results
After policy implementation, monthly ART pregnancies increased significantly, with an immediate level increase of 0.693 (P < .001) and a trend increase of 0.050 per month (P = .001) for the nine post-policy months. Multiple pregnancy proportion among ART pregnancies showed no significant level or trend change. Subgroup analyses indicated stronger and more sustained increases among women <40 years and enrollees in the Urban and Rural Resident Basic Medical Insurance (URRBMI). Geographically, areas with no or only one ART facility had larger immediate increases, while regions with two or more facilities showed a significant sustained upward trend.

Conclusion
In the first nine months after implementation, the inclusion of ART in Guangxi’s SHI program effectively increased pregnancies achieved through ARTs without raising multiple pregnancy proportion among ART pregnancies. These findings indicate that, in the short term, the policy improved access to ARTs and equity in access to reproductive healthcare among different population groups in a resource-constrained province in China.