Infertility status and infertility treatment: Racial and ethnic disparities

Difficulties in conceiving or carrying a child to term affect 12% of American women between ages 15-44. Evidence suggests important racial/ethnic disparities in the diagnosis and prevalence of infertility. Furthermore, the privatization of infertility clinical services and the high costs of these services have contributed to wide racial and socioeconomic inequalities in utilization of treatment.

Some couples require assisted reproductive technology (ART) to achieve a pregnancy. In vitro fertilization (IVF) accounts for 99% of ART. Unlike other reproductive interventions which are directed at reducing high risk births, IVF may actually increase the rate of preterm deliveries and multiple births. White, affluent, well-educated women are more likely to utilize IVF, and thereby incur higher risks of preterm delivery, multiple births and adverse maternal outcomes. Ironically, the racial/ethnic differentials in IVF use may contribute to narrowing the racial gap in preterm and low birth weight.

In our presentation, we first cover the prevalence of infertility, impaired fecundity, and utilization of infertility services among racial/ethnic populations in the U.S. Next, we review the effectiveness of IVF in producing live births and provide an evidence-based summary of reproductive responses to IVF by race/ethnicity. Finally, we discuss the public health implications of our societal approach to infertility treatment. Our session can be incorporated into the broader discussion of Evidence for Population-Based Interventions in Reducing Racial/ethnic Disparities in Reproductive and Perinatal Outcomes, an upcoming book edited by A. Handler, J. Kennelly and N Peacock.