Infertility evaluation and treatment among women in the United States

Capsule:
In a population of U.S. women, only half of those seeking a preliminary infertility evaluation sought eventual treatment, and the likelihood of treatment was associated with income, employment, and ethnicity.

Authors:
Lawrence M. Kessler, Ph.D., Benjamin M. Craig, Ph.D., Shayne M. Plosker, M.D., Damon R. Reed, M.D., Gwendolyn P. Quinn, Ph.D.

Volume 100, Issue 4, Pages 1025-1032.e2, October 2013

Abstract:

Objective:
To examine the characteristics of women seeking infertility evaluation and treatment.

Design:
Cross-sectional survey based on in-person interviews, followed by two-step hurdle analysis.

Setting:
Not applicable.

Patient(s):
4,558 married or cohabitating women ages 25 to 44 years.

Intervention(s):
None.

Main Outcome Measure(s):
Likelihood of seeking a preliminary infertility evaluation and of seeking infertility treatment once evaluated, and the treatment type provided.

Result(s):
Of 623 women (13.7%) who reported seeking an infertility evaluation, 328 reported undergoing subsequent infertility treatment. Age at marriage, marital status, education, health insurance status, race/ethnicity, and religion were associated with the likelihood of seeking infertility evaluation. For example, the predicted probability that a non-white woman who married at age 25 will seek evaluation was 12%. This probability increased to 34% for white women with a graduate degree who had married at age 30. Among women who were evaluated, income, employment status, and ethnicity correlated strongly with the likelihood of seeking infertility treatment. Infertility drug therapy was the most frequent treatment used, and reproductive surgery and in vitro fertilization (IVF) were used the least often.

Conclusion(s):
The use of infertility services is not random. Understanding the sociodemographic factors correlated with use may assist new couples with family planning. Roughly 50% of the women evaluated for infertility progressed to treatment, and only a small proportion were treated with more advanced assisted reproductive technologies such as in vitro fertilization. Future research aimed at improving access to effective health-care treatments within the boundaries of affordability is warranted.

  • Jason Kovac

    This study would have been enhanced if the authors tracked the male partner in these couples. The fact that the male partner is typically ignored is well known but examining how socio-economic factors, ethnicity, employment status, etc.. are affected, in conjunction with the woman, would add a certain depth of understanding that is currently not available.

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