TOPLINE

Infertility treatment use among US birthing individuals with live births increased from 1.55% in 2011 to 2.18% in 2022, driven by a near doubling of assisted reproductive technology (ART) utilization. Despite these gains, American Indian/Alaska Native, Black, and Hispanic individuals had notably lower odds of receiving infertility treatment compared with White counterparts, and those with Medicaid insurance or residing in the South also faced substantially lower utilization rates.

METHODOLOGY

• A serial cross-sectional analysis examined birth certificate data on 40,053,571 live births in the United States from 2011 to 2022, using the National Center for Health Statistics database.
• Researchers calculated age-standardized rates of infertility treatment utilization among live births — overall and by race/ethnicity, socioeconomic status, and geographic region.
• They also analyzed the utilization of specific treatment modalities — ART (eg, in vitro fertilization, gamete or zygote intrafallopian transfer) and fertility-enhancing drugs (pharmacologic agents for ovarian stimulation and ovulation induction) or intrauterine insemination.
• Analysis included average annual percent change (APC) to assess trends and adjusted odds ratios (aOR) to evaluate associations with maternal characteristics, including age, race/ethnicity, education, insurance type, geographic region, nativity, parity, pre-pregnancy BMI, pre-existing hypertension, pre-pregnancy diabetes, and delivery year.

TAKEAWAY

• Age-standardized rates of overall infertility treatment utilization increased significantly from 1.55% (95% CI, 1.54%-1.57%) in 2011 to 2.18% (95% CI, 2.16%-2.19%) in 2022 (APC, 2.81%), with the largest increase among Hispanic individuals (APC, 6.19%).
• ART utilization nearly doubled from 0.78% (95% CI, 0.77%-0.79%) in 2011 to 1.54% (95% CI, 1.52%-1.55%) in 2022 (APC, 6.01%), while fertility-enhancing drugs and insemination decreased from 0.83% (95% CI, 0.82%-0.84%) to 0.78% (95% CI, 0.77%-0.79%; APC, -1.05%).
• After adjusting for covariates, American Indian/Alaska Native individuals had the lowest odds of infertility treatment utilization (aOR, 0.46; 95% CI, 0.44-0.48), followed by Black individuals (0.50; 95% CI, 0.49-0.50) and Hispanic individuals (0.53; 95% CI, 0.52-0.53), compared with White individuals.
• Individuals with Medicaid insurance had substantially lower odds of infertility treatment utilization (aOR, 0.21; 95% CI, 0.20-0.21) compared with those with private insurance, and those in the South had the lowest odds by region (0.54; 95% CI, 0.53-0.54) compared with the Northeast.

IN PRACTICE

"Addressing these disparities is crucial to promoting accessible and affordable fertility care as a core component of reproductive health," wrote the authors of the study.

SOURCE

The study was led by Mariana C. Cabatu, BA, Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California. It was published online on July 3 in American Journal of Obstetrics and Gynecology.

LIMITATIONS

Birth certificate data captured only infertility treatments resulting in live births, excluding treatments that did not result in live birth. Misclassification or underreporting of infertility treatment may have occurred. The 2003 revised birth certificate did not distinguish between fertility-enhancing drugs and insemination.

DISCLOSURES

The study was supported by grants from the US National Heart, Lung, and Blood Institute and the Kaiser Permanente Center for Upstream Prevention of Adiposity and Diabetes Mellitus. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.