Providers Need to Be Aware of Disparities in Reproductive, Infertility Care

Those who provide reproductive and infertility care are responsible for being mindful of economic, racial, and ethnic disparities that are barriers to care, and to reduce the impact of these barriers, according to a recent study in Fertility and Sterility.

This study was conducted to further examine the disparities present in the United States regarding assisted reproductive technology (ART) and fertility care service access, while also investigating the underlying causes of the disparities. “Reproduction is a basic human right and there are unique challenges that racial and ethnic minorities face is accessing fertility care and assisted reproductive technology. Identification of these disparities can aid in identifying areas for interventions to improve, and resolve, the inequities that exist in providing care for minority populations.”

A comprehensive literature search was conducted in PubMed to find articles with specific data related to racial and ethnic differences in study populations as they related to infertility, care access, and treatment outcomes. After the search, 30 manuscripts were in the final review.

Past literature on these subjects have revealed racial inequities that influence fertility care access, such as a report conducted from 1982-2010 that showed that fertility services were most used among non-Hispanic White women, women with current fertility problems, and women with higher education and household income levels.

Upon review, one study’s findings showed that Black women were seen to have longer periods of infertility, higher tubal disease incidence, higher body mass index, and needed more aggressive ovarian stimulation compared with White women. They also had a significantly lower implantation and pregnancy rate compared with White women.

Even though infertility coverage appeared to increase utilization rates of infertility care among Black women, it did not seem to improve disparate treatment outcomes, found another study. ART utilization rates by Black women increased 4-fold in an equal access fertility clinic setting, compared to the private setting in another study. Black women also experienced an increased miscarriage rate, lower live birth rates, and higher spontaneous abortion rates.

The factor of Black race continued to be an independent predictor of reduced live birth rate in frozen embryo transfer cycles, ascribed to the higher clinical loss rate. In another study, Black women were significantly less likely to reach a positive human chorionic gonadotoptin level, clinical pregnancy, or live birth.

Black women were found to experience a longer period of infertility before their case is presented to a fertility specialist and are less likely to be referred. After care starts, they are more likely to get care at clinics with smaller IVF volumes and/or lower success rates.

Additionally, it was also seen that being Black and living a far distance from care were independent risk factors that increased the likelihood that treatment would be stopped after an unsuccessful IVF cycle.

Regarding the study objective of access to care, researchers saw that there was great variation in fertility coverage given to patients based on state mandates and private insurance providers.

On the evaluation of studies about patient perceptions that influence access to care, it was seen that there are specific cultural and ethnical perceptions that might impact patients’ decisions about fertility care.

The authors concluded that increasing provider diversity and cultural competency training will help strengthen the patient-provider relationship and allow patients to choose a provider they feel comfortable with. They also highlight that regardless of the way fertility services are provided, it’s vital to know the underlying factors that lead to disparities so that these areas can be addressed to improve patient care and outcomes.

A limitation of this review is that not all groups are accounted for, and bias may be present in collection and reporting of data. Some studies had small patient numbers for certain racial categories and ART utilization rates couldn’t be studied for some groups.

“Further research is needed to better understand the causative factors to racial and ethnic disparities in access to care and treatment success in order to establish interventions that will improve the outcomes for all patients,” the authors said.

Reference

Merkison J, Chada AR, Marsidi AM, Spencer JB. Racial and ethnic disparities in assisted reproductive technology, a systematic review. Fertil Steril. Published online January 20, 2023. doi:10.1016/j.fertnstert.2023.01.023