Socioeconomic disparities in the use and success of fertility treatments: analysis of data from a prospective cohort in the United States.

OBJECTIVE: To determine the effect of income, education, and race on the use and outcomes of infertility care.
DESIGN: Prospective cohort.
SETTING: Eight community and academic infertility practices. PATIENT(S): Three hundred ninety-one women presenting for an infertility evaluation. INTERVENTION(S): Face-to-face and telephone interviews and questionnaires. MAIN OUTCOME MEASURE(S): Use of infertility services and odds of pregnancy. Linear and logistic regression used to assess relationship between racial and socioeconomic characteristics, use of infertility services, and infertility outcomes. RESULT(S): After adjustment for age and demographic and fertility characteristics, college-educated couples (β = $5,786) and households earning $100,000-$150,000 (β = $6,465) and ≥$150,000 (β = $8,602) spent significantly more on infertility care than their non-college-educated, lower-income counterparts. Higher income and college-educated couples were much more likely to use more cycles of higher-intensity fertility treatment. The increased cost of infertility care was primarily explained by these differences in number and type of infertility treatment. Even after adjustment for these factors and total amount spent on fertility care, having a college degree was associated with persistently higher odds of achieving a pregnancy (OR = 1.9). CONCLUSION(S): Education and household income were independently associated with the amount of money spent on fertility care. This relationship was primarily explained by types and intensity of infertility treatments used. Having at least a college degree was independently associated with improved odds of pregnancy.