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

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Authors:

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.

Abstract:

Objective

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

Design

Retrospective cross-sectional.

Setting

Not applicable.

Patient(s)

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?”).

Intervention(s)

None.

Main Outcome Measure(s)

Rates of infertility and accessing infertility care.

Result(s)

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%).

Conclusion(s)

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


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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. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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