Disparities in accessing infertility care in the United States: results from the National Health and Nutrition Examination Survey, 2013-16.

OBJECTIVE: To investigate infertility rates and access to infertility care among women in the United States.
DESIGN: Retrospective cross-sectional.
SETTING: Not applicable. PATIENT(S): Women between 20 and 44 years-old who participated in the National Health and Nutrition Examination Survey between 2013 and 2016 and answered questions RHQ074 ("have you ever attempted to become pregnant over a period of at least a year without becoming pregnant?") and RHQ076 ("have you ever been to a doctor or other medical provider because you were unable to become pregnant?"). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of infertility and accessing infertility care. RESULT(S): Women reported infertility at a rate of 12.5% (95% confidence interval, 10.8-14.4). Higher infertility rates were noted with increasing age and body mass index. There were no differences in infertility rates by race/ethnicity, education, income, U.S. citizenship, insurance, or primary location of health care. However, women with less than a high school diploma accessed infertility care less than women with a college degree (5.0% vs. 11.6%). Women with incomes less than $25,000 sought infertility care less than those with incomes above $100,000 (5.4% vs. 11.6%). Non-U.S. citizens accessed infertility care less than U.S. citizens (6.9% vs. 9.4%), and uninsured women reported fewer visits for infertility than insured women (5.9% vs. 9.9%). Women who used the emergency department as their primary medical location reported accessing infertility care less than those who relied on a hospital outpatient unit (1.4% vs. 14.9%). CONCLUSION(S): These nationally representative findings highlight the need to address disparities in access to infertility care.