Provision of infertility care for the underserved in reproductive endocrinology and infertility practices associated with obstetrics and gynecology residency training programs in the United States

Tia Jackson-Bey; Holly Mehr; Jacqueline R Ho; Molly M Quinn; Lusine Aghajanova; Michelle Vu; Christopher N Herndon

doi:10.1016/j.xfre.2021.11.002

Provision of infertility care for the underserved in reproductive endocrinology and infertility practices associated with obstetrics and gynecology residency training programs in the United States

F S Rep. 2021 Nov 5;3(2 Suppl):106-113. doi: 10.1016/j.xfre.2021.11.002. eCollection 2022 May.

Authors

Tia Jackson-Bey^{1

2}, Holly Mehr³, Jacqueline R Ho⁴, Molly M Quinn³, Lusine Aghajanova⁵, Michelle Vu⁶, Christopher N Herndon⁷

Affiliations

¹ Reproductive Medicine Associates of New York, New York, New York.
² Department of Obstetrics and Gynecology and Reproductive Science, Division of Reproductive Endocrinology and Infertility, Mount Sinai School of Medicine, New York, New York.
³ University of California, Los Angeles, Los Angeles, California.
⁴ University of Southern California, Los Angeles, California.
⁵ Stanford University School of Medicine, Stanford, California.
⁶ University of Rochester Medical Center, Rochester, New York.
⁷ University of Washington, Seattle, Washington.

Abstract

Objective: To survey practice patterns designed to increase access to infertility care and evaluate the exposure of obstetrics and gynecology residents to infertility care for the underserved.

Design: Cross-sectional.

Setting: Reproductive endocrinology and infertility (REI) practices associated with Accreditation Council for Graduate Medical Education-accredited obstetrics and gynecology residency training programs.

Patients: None.

Interventions: Questionnaire survey.

Main outcome measures: Presence of clinical programs designed to improve access to REI care, resident involvement in such programs, and perceived barriers to expanding access to care.

Results: Clinical initiatives to expand access included discounted infertility services (38%, n = 30), utilization of a low-cost in vitro fertilization (IVF) program (28%, n = 22), and utilization of a resident- and/or fellow-staffed clinic to provide infertility care (39%, n = 31). The most commonly discounted infertility services were IVF (73%, n = 22), clinical consultation (70%, n = 21), and intrauterine insemination (53%, n = 16). The provision of discounted prices was correlated with the increasing practice size (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.23-4.24) and number of assisted reproductive technology cycles performed annually (OR, 3.65; 95% CI, 1.48-9.02). Academic REI practices (OR, 3.6; 95% CI, 0.98-13.25) were more likely to have a low-cost IVF program. Less than half of obstetrics and gynecology residency programs (39%, n = 31) had an associated REI clinic in which obstetrics and gynecology residents provide direct infertility care to the medically underserved. Frequency and services offered in trainee clinics varied. Multiple barriers to expanding access to care were reported.

Conclusions: Reproductive endocrinology and infertility practices associated with obstetrics and gynecology residency programs utilize a diverse range of approaches to provide infertility care to the underserved in the backdrop of considerable challenges and barriers, but significant gaps persist.

Keywords: Infertility; access to care; barriers to care; disparities; obstetrics and gynecology residency.