As infertility rates around the globe rise at alarming rates, more and more couples or individuals are seeking medical help to start families of their own. However, great discrepancies among who can receive such treatment exist. With around 17.5% of the global adult population being infertile, it is of extreme importance to expand the range of people able to find medical aid for these issues.
Currently, the World Health Organization lists infertility as fifth on its international list of most serious diseases associated with women’s health, however, treatment paths for this type of care are not mandated to be covered by insurance. Not only does this leave couples to struggle with high expenses to pay for undergoing this type of care, but it also creates the sense that the challenge to conceive is not a medical problem deserving of financial aid or attention. Moreover, of the mere fourteen states that cover private insurance plans for fertility medicine, only three include LGBTQ+ members in such benefits because many of these individuals do not have a diagnosis of infertility, revealing the inequities that persist even in places more open to such treatments.
On top of the general financial burden that patients must endure to follow through with their care plans, the largest number of medical centers for In vitro fertilization treatment as well as male reproductive specialists are found in states with high median incomes and mandated insurance coverage of infertility treatment. This inconsistency in the geographical location of specialists often leaves certain communities without access to credible physicians and creates a patient population of mainly highly educated, white individuals. Furthermore, researchers have found that certain minorities such as Hispanics, Muslims, Asians, and African Americans are more likely to be discouraged from seeking medical attention for infertility due to cultural barriers or stigmas, communication challenges, or prior negative experiences with the United States healthcare system. For example, it takes an African American woman on average 4.3 years to seek medical help after being unable to conceive naturally versus 3.3 years for a white woman to do the same. Plus, black women are more than half as likely to be evaluated for infertility than their white counterparts.
In some cases, women encounter both economic and racial barriers when hoping to raise their fertility rates. One type of infertility is a tubal factor, which roughly 25% to 35% of In Vitro fertilization patients are affected by. This problem is signified by tubal damage or dilation, which can reduce the effectiveness of fertility treatments. Due to this, The American Society for Reproductive Medicine recommends that such tubal damage be treated before the start of assisted reproductive technology. However, a study including more than 400 infertility physicians found that in states without mandated insurance for infertility care, doctors were more likely not to execute necessary tubal factor treatment before starting AST because of this lack of financial coverage. Thus, a patient suffering from tubal factor infertility will likely have less success from In vitro fertilization on top of the fact that they will be paying high expenses for such care. On top of this, a common disease contributing to tubal factor infertility is chlamydia, an infection that is 6 times more likely to affect a black woman and 2 times more likely to affect a Hispanic female than a white one. Thus, this type of infertility is just one branch of the fertility crisis within the nation, yet it illustrates how both racial and economic disparities are occurring within infertility treatment.
Smaller-scale and larger approaches can be taken to mitigate some of these challenges. Hospitals themselves should make sure to hire multicultural physicians and have translators on staff as well as provide mandatory cultural competency training to avoid looking at others with unconscious biases when thinking of a care plan. Additionally, one suggestion is to require a certain geographical distance between reproductive care providers or mandate that the location of such clinics has citizens of great racial and cultural diversity to ensure that certain communities are isolated from treatment options.
Especially with the alarmingly increasing rates of global infertility, it is of urgent importance to seek ways for a variety of populations to find help for their struggles surrounding conception. Patients of all identities should not feel afraid or unable to find a reliable doctor and affordable treatment plan.
Citations
“1 in 6 People Globally Affected by Infertility: Who.” World Health Organization, World Health Organization, http://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility. Accessed 2 Feb. 2025.
“Assisted Human Reproduction and Ontario Fertility Clinic Regulations.” Gluckstein LLP, Gluckstein LLP, 16 Oct. 2024, http://www.gluckstein.com/news-item/embryos-eggs-errors-examining-fertility-clinic-negligence-part-1.
“Disparities in Access to Effective Treatment for Infertility in the United States: An Ethics Committee Opinion (2021).” ASRM, http://www.asrm.org/practice-guidance/ethics-opinions/disparities-in-access-to-effective-treatment-for-infertility-in-the-united-states-an-ethics-committee-opinion-2021/. Accessed 2 Feb. 2025.
Dwyer, Devin, and Patty See. “ LGBTQ Couples Push for ‘fertility Equality’ in Family-Building Benefits.” ABC News, ABC News Network, 27 June 2023, abcnews.go.com/US/lgbtq-couples-push-fertility-equality-family-building-benefits/story?id=100243800.
Insogna, Iris G., and Elizabeth S. Ginsburg. “Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy.” Journal of Ethics | American Medical Association, American Medical Association, 1 Dec. 2018, journalofethics.ama-assn.org/article/infertility-inequality-and-how-lack-insurance-coverage-compromises-reproductive-autonomy/2018-12.
Weiss, Marissa Steinberg, and Erica E Marsh. “Navigating Unequal Paths: Racial Disparities in the Infertility Journey.” Obstetrics and Gynecology, U.S. National Library of Medicine, 1 Oct. 2023, pmc.ncbi.nlm.nih.gov/articles/PMC10510808/.
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