While there is nothing in this report that is surprising, the health disparities pointed out are an important piece of information. The fact that Hispanic and non-Hispanic black women used infertility services at a lower rate than non-Hispanic white women is a potential concern. This holds true for women with less than a bachelor’s degree or those living below the poverty level as well. Infertility services are health care services, and these data are similar to what we see in other population-based studies; people of color, and those who are less well educated or less well off, have a more difficult time accessing health care.
Meanwhile, infertility services tend to be more acceptable among white women, with financial means and higher education, than among women and men in other demographic groups. Couples in this group often delay childbearing until education is complete and careers are started, leaving them older and with increased age-related needs for infertility services, as well as the means to afford that care.
I believe the 3% decline in the use of fertility services relates mainly to finances. After the recession of 2008, many infertility physicians saw a decrease in activity as patients were concerned about their families’ finances. Yet, in states where insurance mandates have required infertility services, the costs of care are not very high. In an older study, the cost of infertility coverage per contract-month was only $1.71 after the IVF mandate was added in Massachusetts (Fertil. Steril. 1998;70:22-9). Unfortunately, infertility services were not included in the Patient Protection and Affordable Care Act (Obamacare). Awareness campaigns to both patients and providers, along with lobbying efforts at the state and federal level, could be helpful in expanding knowledge of and access to fertility services in a wider range of demographics.
Dr. David A. Forstein is with the department of obstetrics and gynecology at the University of South Carolina, Columbia. He reported having no relevant financial disclosures. He made these comments in an interview.
