Access to Care

Infertility affects approximately 10–15% of the US patient population, yet only a fraction of patients receive adequate and appropriate fertility services largely due to inequities in access to care. Through a comprehensive review of the existing literature, this chapter aims to delineate the barriers to access to fertility care into three main categories: the limitations to the definition of infertility, the role of insurance mandates in reducing costs, and the impact of geographical factors. The cost of in vitro fertilization (IVF) is one of the most limiting factors in access to fertility care for patients and insurance coverage can significantly reduce out-of-pocket expenditures. A growing number of states have passed mandates that require insurers to cover fertility services. However, the restrictions and variability among state mandates do not fully address the demand and can further exacerbate existing disparities in access experienced by marginalized patient populations such as racial minorities and LGBTQIA+ patients. Finally, geographic availability of IVF centers is a major barrier as these centers tend to concentrate in metropolitan/urban regions with denser patient populations, higher median levels of income, and states with IVF insurance mandates. In addition to promoting advocacy work to mitigate disparities in access to fertility care, further solutions include increasing the number of Reproductive Endocrinology and Infertility (REI) training programs to amplify the workforce and developing novel technology aimed toward a lower cost IVF. As the demand for fertility services continues to rise, it becomes more important than ever to consider an individual’s access to care.