Background
Although infertility affects an estimated 6.1 million individuals in the United States,
only half of those individuals seek fertility treatment and the majority of those
patients are White and of high socioeconomic status. Research has shown that insurance
mandates are not enough to ensure equal access. Many workplaces, schools, and medical
education programs have made efforts in recent years to improve the cultural humility
of providers in efforts to engage more racially and economically underrepresented
groups in medical care. However, these efforts have not been assessed on a population
of patients receiving fertility care, an experience that is uniquely shaped by individual
social, cultural, and economic factors.
Objective
This study aimed to better understand the racial, cultural, economic, and religious
factors that impact patient experiences obtaining fertility care.
Study Design
A cross-sectional self-administered survey was administered at an academic fertility
center in Chicago, Illinois. Of 5000 consecutive fertility care patients, 1460 completed
the survey and were included in the study sample. No interventions were used. Descriptive
univariate frequencies and percentages were calculated to summarize sociodemographic
and other relevant patient characteristics (eg, race or ethnicity, age, household
income, religious affiliation, insurance coverage). Rates of endorsing perceived physician
cultural competency were compared among demographic subgroups using Pearson chi-squared
tests with 2-sided P<.05 indicative of statistical significance. To identify the key determinants of patient-reported
worry regarding 9 different fertility treatment outcomes and related concerns, a series
of multiple logistic regression models were fit to examine factors associated with
patient report of being “very worried” or “extremely worried.”
Results
Members of our sample (N=1460) were between 20 and 58 years of age (meanadjusted, 36.2; standard deviation, 4.4). Among Black participants, 42.3% reported that their
physician does not understand their cultural background compared with 16.5% of White
participants (P<.0001). Participants who identified as Latinx were significantly more likely than
White participants to report being very/extremely worried about side effects of treatment,
a miscarriage, ectopic pregnancies, and birth defects (P<.05, P=.02, P=.002, P=.001, respectively). Individuals who identify as Hindu were nearly 4 times more likely
to report being very/extremely worried about experiencing an ectopic pregnancy than
nonreligious participants (P<.0002). Respondents most strongly identified the biology or physiology of the couple
(meanadjusted, 21.6; confidence interval, 20.4–22.7) and timing or age (meanadjusted, 27.8; confidence interval, 26.5–29.1) as being associated with fertility. Overall,
respondents most strongly disagreed that the ability to bear children rests upon God’s
will (meanadjusted, 65.4; confidence interval, 63.7–67.1), which differed most significantly by race
(P<.0001) and religion (P<.0001).
Conclusion
Of the patient characteristics investigated, racial and ethnic subgroups showed the
greatest degree of variation in regard to worries and concerns surrounding the experience
of fertility treatment. Our findings emphasize a need for improved cultural humility
on behalf of physicians, in addition to affordable psychological support for all patients
seeking fertility care.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth.Vital Health Stat. 2005; 23: 1-160
- Understanding the perceptions of and emotional barriers to infertility treatment: a survey in four European countries.Hum Reprod. 2012; 27: 1073-1079
- Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment.Hum Reprod. 2008; 23: 2056-2063
- Key substance use and mental health indicators in the United States: results from the 2016 National Survey on Drug Use and Health.(Available at:) (Accessed September 1, 2020)
- Religion, infertility and assisted reproductive technology.Best Pract Res Clin Obstet Gynaecol. 2007; 21: 169-180
- Motherhood and infertility: viewing motherhood through the lens of infertility.Feminism Psychol. 2000; 10: 323-336
- Missing motherhood: infertility, technology, and poverty in Egyptian women’s lives.2000
- Perceptions of informal sanctioning and the stigma of involuntary childlessness.Deviant Behav. 1985; 6: 383-403
- The current status of sperm donation in assisted reproduction technology: ethical and legal considerations.J Assist Reprod Genet. 1997; 14: 133-138
- Decision-making about seeking medical advice in an internet sample of women trying to get pregnant.Hum Reprod. 2007; 22: 1662-1668
- Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States.Fertil Steril. 2011; 95: 1943-1949
- Racial and ethnic disparities in assisted reproductive technology access and outcomes.Fertil Steril. 2016; 105: 1119-1123
- Ethnicity and assisted reproductive technologies.Clin Pract (Lond). 2012; 9: 651-658
- Culturally competent healthcare systems. A systematic review.Am J Prev Med. 2003; 24: 68-79
- Cultural competence and medical education: many names, many perspectives, one goal.Acad Med. 2006; 81: 499-501
- Cultural competence in health care: emerging frameworks and practical approaches. Vol 576. The Commonwealth Fund, New York, NY2002
- The experience of infertility: a review of recent literature.Sociol Health Illn. 2010; 32: 140-162
- The challenge of providing infertility services to a low-income immigrant Latino population.Fertil Steril. 2009; 92: 116-123
- Race and trust in the health care system.Public Health Rep. 2003; 118: 358-365
- Attitudes and beliefs of African Americans toward participation in medical research.J Gen Intern Med. 1999; 14: 537-546
- Infertility service use among U.S. women: 1995 and 2002.Fertil Steril. 2010; 93: 725-736
- Disparities in access to infertility services in a state with mandated insurance coverage.Fertil Steril. 2005; 84: 221-223
- Socioeconomic and racial disparities among infertility patients seeking care.Fertil Steril. 2006; 85: 876-881
- Insurance coverage and outcomes of in vitro fertilization.N Engl J Med. 2002; 347: 661-666
- Infertility among low-income Latinos.Fertil Steril. 2006; 85: 882-887
- Delayed referral of black, Hispanic, and older patients with chronic renal failure.Am J Kidney Dis. 1999; 33: 728-733
- Trends of socioeconomic disparities in referral patterns for fertility preservation consultation.Hum Reprod. 2012; 27: 2076-2081
- The effects of race and racial concordance on patient-physician communication: a systematic review of the literature.J Racial Ethn Health Disparities. 2018; 5: 117-140
- Limited evidence of non-response bias despite modest response rate in a nationwide survey of long-term cancer survivors-results from the NOR-CAYACS study.J Cancer Surviv. 2019; 13: 353-363
Article info
Publication history
Published online: February 19, 2021
Accepted:
February 10,
2021
Received in revised form:
February 9,
2021
Received:
September 28,
2020
Footnotes
The authors report no conflict of interest.
The authors report no funding sources.
Cite this article as: Galic I, Swanson A, Warren C, et al. Infertility in the Midwest: perceptions and attitudes of current treatment. Am J Obstet Gynecol 2021;225:61.e1-11.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
