Use of fertility treatment modalities in a large United States cohort of professional women

Approximately 94% of women using fertility treatment used clomiphene, with smaller proportions using gonadotropin alone, intrauterine insemination, and in vitro fertilization. These patterns varied by financial, biologic, and temporal factors.

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Leslie V. Farland, S.M., Stacey A. Missmer, Sc.D., Janet Rich-Edwards, Sc.D., Jorge E. Chavarro, M.D., Sc.D., Robert L. Barbieri, M.D., Francine Grodstein, Sc.D.

Volume 101, Issue 6, Pages 1705–1710



To evaluate the use of fertility treatments among a large cohort of women in the United States.


Cohort study.


Nurses’ Health Study II.


Ten thousand thirty-six women who reported having used fertility treatment on biennial questionnaires from 1993–2009.



Main Outcome Measure(s):

Data on patterns of treatment modality were collected via self-report from validated mailed questionnaires. Information on clomiphene, gonadotropin injections alone, and gonadotropin injections as part of intrauterine insemination (IUI) and in vitro fertilization (IVF) was queried.


Most women who reported fertility treatment used clomiphene (94%), with a large majority reporting clomiphene as their only form of treatment (73%). Of women who reported treatment more advanced than clomiphene, 13% had used gonadotropin injections alone, 11% IUI treatment, and 11% IVF. Several subgroups were more likely to use multiple treatment modalities and to initiate treatment with gonadotropins rather than clomiphene, including women living in states with insurance coverage of fertility procedures, with higher household income, younger in age, who remained nulliparous at the study close, and treated after 2000.


Results should be interpreted cautiously, but to our knowledge, this represents the first study of fertility treatment patterns in the United States and could inform public health planning.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.