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. 2025 Apr;123(4):709-717.
doi: 10.1016/j.fertnstert.2024.10.036. Epub 2024 Oct 31.

Determinants of utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate

Ann Korkidakis  1 , Veronica Wang  2 , Riwa Sabbagh  3 , Quetrell Heyward  3 , Michele R Hacker  4 , Kim L Thornton  3 , Alan S Penzias  3
Affiliations

Determinants of utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate

Ann Korkidakis et al. Fertil Steril. 2025 Apr.

Abstract

Objective: To examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate.

Design: Retrospective cohort.

Exposure: Initial infertility evaluation and treatment utilization.

Main outcome measures: The 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.

Results: A 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).

Conclusions: Relative 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.

Keywords: Health disparities; access to care; assisted reproductive technology; state mandates.

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Conflict of interest statement

Declaration of Interests A.K. reports that this project is supported by the Ferring Innovation Grant for Racial Equity in Reproductive Medicine and Maternal Health. This work was also conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. V.W. reports funding from Ferring Innovation Grants for Racial Equality in Reproductive Medicine and Maternal Health and Harvard TH Chan School of Public Health for the submitted work; consulting fees from Ferring Innovation Grants for Racial Equality in Reproductive Medicine and Maternal Health outside the submitted work. R.S. has nothing to disclose. Q.H. has nothing to disclose. M.R.H. reports that this work was conducted with support from UM1TR004408 award through Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health; funding from NIH, Breast Cancer Research Foundation, US Department of Health and Human Services; honoraria from Harvard University outside the submitted work. K.L.T. reports consulting fees from Ferring and Labcorp; honorarium from Midwest Reproductive Symposium International and Medstar Grand rounds; DSMB with Yale University: Prefriend and Pregnant Trials; ASRM Board of Directors; ALIFE—stock, no value currently; Boston IVF PCA investors group Dividends received outside the submitted work. A.S.P. has nothing to disclose.

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