Trends in infertility treatments by race, ethnicity, socioeconomic status, and region in US birth certificates from live births: 2011 to 2022.

Abstract

Understanding national trends and disparities in infertility treatment utilization and modalities is crucial for equitable reproductive care. We examined age-standardized rates of infertility treatment utilization and specific treatment modalities among birthing individuals in the United States from 2011 to 2022 and assessed differences by race/ethnicity, socioeconomic status, and geographic region. To identify how trends in infertility treatment utilization among birthing individuals have changed in the United States from 2011 to 2022, and how utilization differs by treatment modalities, race, ethnicity, socioeconomic status, and geographic region. We performed a serial cross-sectional analysis using birth certificate data on live births (2011-2022) from the National Center for Health Statistics. Outcomes included infertility treatment utilization and modalities, including assisted reproductive technology and fertility-enhancing drugs and insemination (nonassisted reproductive technology). We estimated age-standardized rates, average annual percent change, and adjusted odds ratios by race, ethnicity, socioeconomic status, and geographic region. From 2011 to 2022, age-standardized rates of infertility treatment utilization among 40,053,571 birthing individuals with live births increased from 1.55% to 2.18% (average annual percent change: 2.81% [95% confidence interval, 2.15% to 3.56%]), with nonassisted reproductive technology decreasing (average annual percent change: -1.05% [-1.99% to -0.04%]) and assisted reproductive technology increasing (average annual percent change: 6.01% [5.22% to 6.94%]). In 2022, rates of infertility treatment utilization were the lowest among American Indian/Alaska Natives (0.76%), followed by Black (0.93%), Hispanic (0.98%), Multiracial (1.91%), White (2.89%), and Asian/Pacific Islander individuals (3.01%). After adjusting for covariates, non-White birthing individuals had lower odds of infertility treatment (adjusted odds ratio, 0.46-0.84) than White counterparts. Disparities were marked by socioeconomic status: infertility treatment utilization was lowest among those with Medicaid insurance (0.34% vs 2.55% non-Medicaid) and those with a high school education or less (0.52% vs 2.37% college-educated). Compared with the Northeast (3.23%), the South (1.49%), West (2.25%), and Midwest (2.39%) had consistently lower rates of infertility treatment in 2011 to 2022. Similar patterns were observed by treatment modality. Among US birthing individuals with live births (2011-2022), birth certificate-recorded infertility treatment usage increased, with opposing trends in nonassisted reproductive technology versus assisted reproductive technology. Substantial racial, ethnic, socioeconomic, and geographic disparities highlight opportunities to improve infertility care accessibility and equity.