This serial cross-sectional study examined age-standardized rates and trends in infertility treatment use (ART and non-ART) among 40,053,571 U.S. birthing individuals with live births from 2011–2022, stratified by race/ethnicity, socioeconomic status (insurance type, education), and geographic region.
Overall infertility treatment rates rose from 1.55% to 2.18% (APC +2.81%); ART use grew sharply (APC +6.01%) while non-ART declined (APC −1.05%). In 2022, utilization was lowest for American Indian/Alaska Native (0.76%), Black (0.93%), and Hispanic (0.98%) individuals vs. Asian/Pacific Islander (3.01%) and White (2.89%). Medicaid users had strikingly lower rates than non-Medicaid users (0.34% vs. 2.55%), and the South lagged the Northeast (1.49% vs. 3.23%).
- Data are limited to live births recorded on birth certificates, excluding those who used infertility treatment but did not achieve a live birth, likely underestimating true disparities. - Birth certificate self-report may misclassify treatment type or underreport use. - Socioeconomic proxies (insurance, education) are coarse and may not capture full economic barriers.
Clinicians and health systems should recognize that non-White patients and those on Medicaid access infertility care at dramatically lower rates — screening for financial and structural barriers and advocating for insurance parity policies can help close these gaps.
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