Disparities in accessing infertility care in the United States: results from the National Health and Nutrition Examination Survey, 2013–16

Although infertility equally affects women of all sociodemographic backgrounds, there are disparities in accessing infertility care based on income, education, insurance, U.S. citizenship, and access to medical services.

Volume 112, Issue 3, Pages 562–568


Angela S. Kelley, M.D., Yongmei Qin, M.D., M.S., Erica E. Marsh, M.D., M.S.C.I., James M. Dupree, M.D., M.P.H.



To investigate infertility rates and access to infertility care among women in the United States.


Retrospective cross-sectional.


Not applicable.


Women between 20 and 44 years-old who participated in the National Health and Nutrition Examination Survey between 2013 and 2016 and answered questions RHQ074 (“have you ever attempted to become pregnant over a period of at least a year without becoming pregnant?”) and RHQ076 (“have you ever been to a doctor or other medical provider because you were unable to become pregnant?”).



Main Outcome Measure(s)

Rates of infertility and accessing infertility care.


Women reported infertility at a rate of 12.5% (95% confidence interval, 10.8–14.4). Higher infertility rates were noted with increasing age and body mass index. There were no differences in infertility rates by race/ethnicity, education, income, U.S. citizenship, insurance, or primary location of health care. However, women with less than a high school diploma accessed infertility care less than women with a college degree (5.0% vs. 11.6%). Women with incomes less than $25,000 sought infertility care less than those with incomes above $100,000 (5.4% vs. 11.6%). Non-U.S. citizens accessed infertility care less than U.S. citizens (6.9% vs. 9.4%), and uninsured women reported fewer visits for infertility than insured women (5.9% vs. 9.9%). Women who used the emergency department as their primary medical location reported accessing infertility care less than those who relied on a hospital outpatient unit (1.4% vs. 14.9%).


These nationally representative findings highlight the need to address disparities in access to infertility care.

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