Inequities in Medically Assisted Reproduction: a Scoping Review

Abstract

Infertility has a high prevalence in the USA and health inequities play a large role in access to medically assisted reproduction (MAR). The aim of this study was to identify gaps in research pertaining to inequities in MAR and propose suggestions for future research directions. Searches were performed using MEDLINE and Ovid Embase. Articles that reported on MAR inequities, published between 2016 and 2021 in the USA, and written in English were included. The inequities investigated were adapted from the NIH-designated health disparities populations. Each article’s inequity findings were extracted and reported, along with frequencies of inequities. Our sample included 66 studies. The majority of the studies investigated MAR outcomes by race/ethnicity and found that historically marginalized populations had poorer outcomes. LGBTQ + populations were less likely to use MAR or seek infertility care. Most studies found positive correlations with MAR use with income and education. The least commonly studied inequities in our sample were sex and/or gender and rural/under-resourced populations; findings showed that men and people from rural/under-resourced populations were less likely to access MAR. Studies that examined occupational status had varying findings. We suggest that future research be targeted toward: (1) standardizing and diversifying race/ethnicity reporting regarding MAR, (2) the use of community-based participatory research to increase data for LGBTQ + patients, and (3) increasing access to infertility care for men. Supplementary Information The online version contains supplementary material available at 10.1007/s43032-023-01236-6.

Racial Disparities in Fertility Care: A Narrative Review of Challenges in the Utilization of Fertility Preservation and ART in Minority Populations

“…The etiology of the disparities in the uptake of planned oocyte or embryo cryopreservation is unclear. However these disparities can be reasonably attributed to barriers that prevent the pursuit of any fertility treatment, including perceived racism, lack of insurance coverage for these procedures, and ease of access to an IVF clinic [3,19,20]. Minority patients have been shown to be less likely to seek infertility treatment and be more likely to discontinue treatment [19].…”

“…However these disparities can be reasonably attributed to barriers that prevent the pursuit of any fertility treatment, including perceived racism, lack of insurance coverage for these procedures, and ease of access to an IVF clinic [3,19,20]. Minority patients have been shown to be less likely to seek infertility treatment and be more likely to discontinue treatment [19]. In a study querying barriers to access to care for minority patients at an academic center in Illinois, Black and Hispanic women were more likely to perceive race, weight, and income as direct barriers to accessing fertility care in comparison to White and Asian participants in the study.…”

“…A review by Huddleston et al further examined inequities in medically assisted reproduction and found lower live birth rates among multiple minority groups (Black, Asian, Middle Eastern/North African). These groups were additionally challenged by high miscarriage rates, low implantation rates, lower fertilization rates, and higher likelihoods of preterm or early preterm delivery [19].…”