July 17, 2019 / 7:17 PM / a month ago

U.S. women with less income, education often lack access to infertility care

(Reuters Health) - Although women from all walks of life tend to experience infertility at similar rates, a new U.S. study suggests there are wide disparities in access to treatment.

FILE PHOTO: An employee demonstrates the process to extract eggs in a lab at the e-Stork Reproductive Center in Hsinchu, northern Taiwan, August 8, 2013. REUTERS/Pichi Chuang

Researchers examined survey data collected between 2013 and 2016 from 2,052 women, ages 20 to 44, who were representative of more than 45 million women nationwide.

Overall, 12.5% of the women reported trying to conceive for one year without becoming pregnant, the timeline doctors typically use to define infertility. Just a third of those making less than $25,000 a year sought treatment for infertility, compared with two thirds of those making $100,000 or more, researchers report in Fertility and Sterility.

“People of all races, education levels, incomes, citizenship statuses, health insurances and sites of health care use report similar rates of having infertility,” said Dr. James Dupree, an assistant professor of urology and obstetrics and gynecology at the University of Michigan in Ann Arbor.

“Women with less education, lower incomes, non-citizens and women without health insurance and without access to physician offices did not see their doctors as often for help with infertility,” Dupree said by email. “So, patients and families should know that if they have infertility, they’re not alone, and they should go to see their doctor for help.”

Most healthy couples can conceive within three to six months, although the process can take longer for people who are older or who have fertility compromised by certain medical conditions or lifestyle habits.

Infertility rates in the study ranged from 5.8% among women 20 to 24 years old up to 20.5% among women 40 to 44 years old.

Older women were also more likely to seek help: 67.3% of women 35 to 39 years old with infertility saw a medical provider, as did 61.7% of infertile women 40 to 44 years old. Only 11.7% of women 20 to 24 years old sought treatment for infertility.

Among women earning under $25,000 a year, 33.1% of women with infertility sought treatment, compared with 66.8% of infertile women earning at least $100,000 annually.

Only 33.1% of women without education beyond high school saw a medical provider for infertility, compared with 80.8% of women with college degrees.

And 65.3% of white women and 79.8% of Asian women with infertility sought treatment, compared with 40.6% of black women, 44% of Mexican American women and 54.9% of women of other Hispanic backgrounds.

While 65% of women with insurance saw medical providers for infertility treatment, only 39.7% of women without health insurance did.

The study doesn’t prove whether or how specific patient characteristics influence a woman’s choice to seek help for infertility.

Even so, the results offer fresh evidence of disparities in access to care, said Dr. Kevin Doody, director of CARE Fertility in Fort Worth, Texas, and past president of the Society for Assisted Reproductive Technology.

“Access to infertility care has several barriers including patient lack of awareness, geographic access to specialists, financial burdens and time burdens,” Doody, who wasn’t involved in the study, said by email.

Even with insurance, many women may lack benefits for infertility care or face other obstacles to treatment, said Dr. Emily Jungheim, chief of reproductive endocrinology and infertility at Washington University in St. Louis.

“Perhaps women with more education and more income are in positions where they can take the time off for treatment,” Jungheim, who wasn’t involved in the study, said by email.

“Maybe they have better benefits overall and can take medical leave,” Jungheim added. “Or they have a boss who is flexible with their plans – or they are the boss and can make their own schedule.”

SOURCE: bit.ly/2Y2Y5Rq Fertility and Sterility, online June 28, 2019.

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