Racial Disparities, Neighborhood Disadvantages Present Challenges for Patients Seeking Fertility Care

Researchers have identified key factors when it comes to racial and socioeconomic disadvantages that may have a negatively impact on reproductive health outcomes. Two posters presented at the American Society for Reproductive Medicine (ASRM) 2023 Scientific Congress & Expo address these issues.

IVF, In vitro fertilization. Fertilized egg cell and needle realistic illustration | Image Credit: grethental - stock.adobe.com

The first poster aimed to understand the relationship between time to conception and living in disadvantaged areas in the United States.¹ Using an academic-based database of over 50,000 unique deliveries with conception, pregnancy, and delivery data from August 2011 to July 2022, the researchers obtained records of all singleton deliveries of nulliparous gravidae patients who were actively trying to conceive.

For each delivery, the researchers assigned a Social Deprivation Index (SDI) score based on the preconception ZIP code of residence. SDI is a composite measure from 1 to 100 that includes 7 demographic characteristics collected by the American Community Survey based on percentages of the following:

• People living in poverty
• People with less than 12 years of education
• Single-parent households
• Living in rented housing units
• Living in overcrowded housing
• Households without a car
• Unemployed adults

In total, there were 4788 deliveries recorded, in which a significant association was found between SDI and time to conception (odds ratio [OR], 1.05; 95% CI, 1.01-1.10) and in models adjusted for age (adjusted OR [aOR], 1.09; 95% CI, 1.04-1.14). This association was also observed in those younger than 35 years at the time of delivery (n = 4234) on unadjusted models (OR, 1.06; 95% CI, 1.01-1.11) and adjusted for age (aOR, 1.09; 95% CI, 1.04-1.14)

Therefore, the study found that preconception while living in a socially disadvantaged neighborhood was associated with increased time to conception in nulliparous gravidae individuals who go on to successfully deliver a baby.

A second poster aimed to investigate the impact of racial disparities on health insurance coverage for those who initiate oocyte preservation due to newly diagnosed cancer.²

The researchers performed a retrospective cohort analysis in a state with mandated insurance coverage for medically necessary fertility preservation, which includes patients with cancer. Sixty-eight patients who completed 72 oocyte preservations due to planned gonadotoxic treatment were included in the study from October 2010 to March 2023. Forty-one (60.3%) of the patients were White; 2 (2.9%), Asian; 5 (7.35%), Black; 5 (7.35%), Hispanic; 1 (1.5), mixed race; and 14 (20.6%), omitted.

Electronic medical records of these patients were obtained, in which the researchers extracted data pertaining to patient-identified race/ethnicity and insurance coverage status or self-pay.

The analysis showed the proportion of individuals with insurance coverage for fertility preservation did not differ significantly by race or ethnicity (P = .702), and insurance coverage was not significantly different between White patients and those who identified as a minority (63.4% vs 53.8%; P = .5373).

These findings suggest that minority individuals seeking fertility preservation with a recent cancer diagnosis and planned gonadotoxic treatment may benefit from living in a state with mandatory insurance coverage for medically necessary fertility preservation and may face fewer disparities because of this.

References

1. Sassin A, Goulding A, Aagaard K. Association between time to conception and neighborhood disadvantage as measured by social deprivation index (SDI) score in nulliparous gravidae. Poster presented at: ASRM 2023 Scientific Congress & Expo; October 14-18, 2023; New Orleans, LA.

2. So M, Koniares K, Godiwala P. Racial disparities in access to fertility preservation for oncofertility patients are alleviated in the setting of a comprehensive fertility mandate. Poster presented at: ASRM 2023 Scientific Congress & Expo; October 14-18, 2023; New Orleans, LA.