ArticleFertility and sterility2025
Determinants of utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate.
Article in Fertility and sterility, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Cumulative adverse social determinants of health, prolonged unsuccessful conception, and infertility-related healthcare contact among U.S. women: NHANES 2013-2016.Journal of assisted reproduction and genetics · 2026Article
- In Vitro Fertilization is Essential Healthcare for Patients With Rheumatic Disease.ACR open rheumatology · 2026Review
- From Genes to Lives: Integrating the Complexities of Primary Ovarian Insufficiency.International journal of molecular sciences · 2026Review
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Authors and funding
7 authors.
Funding
Abstract
objectiveTo examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate.
designRetrospective cohort. EXPOSURE: Initial infertility evaluation and treatment utilization.
main outcome measuresThe prevalence of reproductive-aged women who reside in Massachusetts presenting for initial consult vs. census-based estimates was calculated for each racial and ethnic group. Age at initial consult, insurance coverage, drive time to nearest affiliated center, and neighborhood deprivation as measured by Area Deprivation Index (ADI) were considered determinants of treatment utilization in regression analysis.
resultsA total of 16,160 women presenting for an infertility consult from 2010-2021 met inclusion criteria. Compared with census estimates, Non-Hispanic (NH) Asian and NH White individuals were overrepresented in initial consults, whereas the NH Black and Hispanic populations were underrepresented throughout the study period. Mean age at presentation was higher in NH Black women compared with the NH Asian reference group (35.7 ± 5.1 vs. 34.6 ± 4.4 years old). A lower proportion of Hispanic and NH Black women had private insurance (78% and 79%, respectively) compared with 86% of NH Asian women. Over a fifth of Hispanic and NH Black women lived in the most disadvantaged ADI quintile (23% and 21%, respectively) compared with 6% of the reference population. Overall, the absence of private insurance, greater neighborhood disadvantage, and increased driving distance were associated with lower treatment utilization (odds ratio [OR]: 0.79 [95% confidence interval 0.71-0.87], for other vs. private insurance; OR: 0.62 [0.53-0.72], for ADI quintile 5 vs. 1, OR: 0.84 [0.72-0.97] for drive time 15-30 vs. <15 minutes), whereas age was not (OR: 0.96 [0.93-1.00] for each 5-year increase).
conclusionsRelative to their numbers in the broader population of reproductive-aged women in Massachusetts, the NH Black and Hispanic populations were the most underrepresented racial and ethnic groups seen for infertility evaluation at our center. These individuals were less likely to have private insurance coverage and more likely to live in disadvantaged neighborhoods, which are variables that negatively impact infertility treatment utilization.
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