Provision of Infertility Care for the Underserved in Reproductive Endocrinology and Infertility Practices Associated with Obstetrics and Gynecology Residency Training Programs in the United States

Overview

Journal F S Rep

Specialty Reproductive Medicine

Date 2022 Aug 8

PMID 35937453

Authors

Tia Jackson-Bey

Holly Mehr

Jacqueline R Ho

Molly M Quinn

Lusine Aghajanova

Michelle Vu

Christopher N Herndon

Affiliations

Soon will be listed here.

Abstract

Objective: To survey practice patterns designed to increase access to infertility care and evaluate the exposure of obstetrics and gynecology residents to infertility care for the underserved.

Design: Cross-sectional.

Setting: Reproductive endocrinology and infertility (REI) practices associated with Accreditation Council for Graduate Medical Education-accredited obstetrics and gynecology residency training programs.

Patients: None.

Interventions: Questionnaire survey.

Main Outcome Measures: Presence of clinical programs designed to improve access to REI care, resident involvement in such programs, and perceived barriers to expanding access to care.

Results: Clinical initiatives to expand access included discounted infertility services (38%, n = 30), utilization of a low-cost in vitro fertilization (IVF) program (28%, n = 22), and utilization of a resident- and/or fellow-staffed clinic to provide infertility care (39%, n = 31). The most commonly discounted infertility services were IVF (73%, n = 22), clinical consultation (70%, n = 21), and intrauterine insemination (53%, n = 16). The provision of discounted prices was correlated with the increasing practice size (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.23-4.24) and number of assisted reproductive technology cycles performed annually (OR, 3.65; 95% CI, 1.48-9.02). Academic REI practices (OR, 3.6; 95% CI, 0.98-13.25) were more likely to have a low-cost IVF program. Less than half of obstetrics and gynecology residency programs (39%, n = 31) had an associated REI clinic in which obstetrics and gynecology residents provide direct infertility care to the medically underserved. Frequency and services offered in trainee clinics varied. Multiple barriers to expanding access to care were reported.

Conclusions: Reproductive endocrinology and infertility practices associated with obstetrics and gynecology residency programs utilize a diverse range of approaches to provide infertility care to the underserved in the backdrop of considerable challenges and barriers, but significant gaps persist.

Citing Articles

Strengthening the Reproductive Endocrinology and Infertility Curriculum Through Three Interactive Cases.

Kornfield M, Rubin E, Parker P, Garg B, Stenson A, Amato P MedEdPORTAL. 2023; 19:11375.

PMID: 38131037 PMC: 10733559. DOI: 10.15766/mep_2374-8265.11375.

References

Feinberg E, Larsen F, Catherino W, Zhang J, Armstrong A . Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting. Fertil Steril. 2006; 85(4):888-94. DOI: 10.1016/j.fertnstert.2005.10.028. View

. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertil Steril. 2015; 104(5):1104-10. DOI: 10.1016/j.fertnstert.2015.07.1139. View

Yu L, Peterson B, Inhorn M, Boehm J, Patrizio P . Knowledge, attitudes, and intentions toward fertility awareness and oocyte cryopreservation among obstetrics and gynecology resident physicians. Hum Reprod. 2015; 31(2):403-11. DOI: 10.1093/humrep/dev308. View

Jain T, D Hornstein M . Disparities in access to infertility services in a state with mandated insurance coverage. Fertil Steril. 2005; 84(1):221-3. DOI: 10.1016/j.fertnstert.2005.01.118. View

Steiner A, Fritz M, Sites C, Coutifaris C, Carr B, Barnhart K . Resident experience on reproductive endocrinology and infertility rotations and perceived knowledge. Obstet Gynecol. 2011; 117(2 Pt 1):324-330. DOI: 10.1097/AOG.0b013e3182056457. View

Insogna I, Lanes A, Hariton E, Blake-Lamb T, Schilling S, D Hornstein M . Self-reported barriers to accessing infertility care: patient perspectives from urban gynecology clinics. J Assist Reprod Genet. 2020; 37(12):3007-3014. PMC: 7714827. DOI: 10.1007/s10815-020-01997-y. View

Feinberg E, Larsen F, Wah R, Alvero R, Armstrong A . Economics may not explain Hispanic underutilization of assisted reproductive technology services. Fertil Steril. 2007; 88(5):1439-41. DOI: 10.1016/j.fertnstert.2007.01.031. View

Nachtigall R, Castrillo M, Shah N, Turner D, Harrington J, Jackson R . The challenge of providing infertility services to a low-income immigrant Latino population. Fertil Steril. 2008; 92(1):116-23. PMC: 2722953. DOI: 10.1016/j.fertnstert.2008.05.037. View

Blakemore J, Maxwell S, Hodes-Wertz B, Goldman K . Access to infertility care in a low-resource setting: bridging the gap through resident and fellow education in a New York City public hospital. J Assist Reprod Genet. 2020; 37(7):1545-1552. PMC: 7376609. DOI: 10.1007/s10815-020-01781-y. View

10.

Katz P, Showstack J, Smith J, Nachtigall R, Millstein S, Wing H . Costs of infertility treatment: results from an 18-month prospective cohort study. Fertil Steril. 2010; 95(3):915-21. PMC: 3043157. DOI: 10.1016/j.fertnstert.2010.11.026. View

11.

Roberts L, Kudesia R, Zhao H, Dolan S, Rose M . A cross-sectional survey of fertility knowledge in obstetrics and gynecology residents. Fertil Res Pract. 2020; 6(1):22. PMC: 7724860. DOI: 10.1186/s40738-020-00091-2. View

12.

Kelley K, Clark B, Brown V, Sitzia J . Good practice in the conduct and reporting of survey research. Int J Qual Health Care. 2003; 15(3):261-6. DOI: 10.1093/intqhc/mzg031. View

13.

Wu A, Odisho A, Washington 3rd S, Katz P, Smith J . Out-of-pocket fertility patient expense: data from a multicenter prospective infertility cohort. J Urol. 2013; 191(2):427-32. DOI: 10.1016/j.juro.2013.08.083. View

14.

Herndon C, Anaya Y, Noel M, Cakmak H, Cedars M . Outcomes from a university-based low-cost in vitro fertilization program providing access to care for a low-resource socioculturally diverse urban community. Fertil Steril. 2017; 108(4):642-649.e4. DOI: 10.1016/j.fertnstert.2017.06.035. View

15.

Harris J, Menke M, Haefner J, Moniz M, Perumalswami C . Geographic access to assisted reproductive technology health care in the United States: a population-based cross-sectional study. Fertil Steril. 2017; 107(4):1023-1027. DOI: 10.1016/j.fertnstert.2017.02.101. View

16.

Chambers G, Sullivan E, Ishihara O, Chapman M, Adamson G . The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril. 2009; 91(6):2281-94. DOI: 10.1016/j.fertnstert.2009.04.029. View

17.

Becker G, Castrillo M, Jackson R, Nachtigall R . Infertility among low-income Latinos. Fertil Steril. 2006; 85(4):882-7. DOI: 10.1016/j.fertnstert.2005.09.052. View

18.

Chandra A, Copen C, Stephen E . Infertility service use in the United States: data from the National Survey of Family Growth, 1982-2010. Natl Health Stat Report. 2014; (73):1-21. View

19.

Peipert B, Hairston J, McQueen D, Hammond C, Feinberg E . Increasing access to fertility care through private foundations. Fertil Steril. 2019; 111(6):1211-1216. DOI: 10.1016/j.fertnstert.2019.02.025. View

20.

Missmer S, Seifer D, Jain T . Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States. Fertil Steril. 2011; 95(6):1943-9. DOI: 10.1016/j.fertnstert.2011.02.039. View