Racial disparities and neighborhood disadvantage present challenges for patients seeking fertility care

Researchers have identified key factors in racial and socioeconomic disadvantage that can negatively impact reproductive health outcomes. Two posters presented at the 2023 American Society for Reproductive Medicine (ASRM) Meeting and Scientific Exhibition address these questions.

The first poster aimed to understand the relationship between time to conception and living in disadvantaged areas in the United States.¹ Using a university database of more than 50,000 singleton births with conception, pregnancy and delivery data from August 2011 to July 2022, researchers obtained records of all singleton births nulliparous gravid patients who were actively trying to conceive.

For each delivery, researchers assigned a Social Deprivation Index (SDI) score based on the postcode of residence before conception. The 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 accommodation
• Living in overcrowded housing
• Households without a car
• Unemployed adults

A total of 4,788 deliveries were recorded, in which a significant association was found between IDS and time to conception (odds ratio [OR], 1.05; 95% CI, 1.01-1.10) and in age-adjusted models (adjusted OR [aOR], 1.09; 95% CI, 1.04-1.14). This association was also observed in women younger than 35 years at the time of delivery (n = 4234) in 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 deprived neighborhood was associated with a longer time to conception in nulliparous gravid individuals who successfully delivered their babies.

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

Researchers performed a retrospective cohort analysis in a state with mandatory insurance coverage for medically necessary fertility preservation, which includes cancer patients. 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.

These patients’ electronic medical records were obtained, from which researchers extracted data related to patient-identified race/ethnicity and insurance coverage or self-payment status.

The analysis showed that the proportion of people with fertility preservation insurance coverage did not differ significantly by race or ethnicity (P. = 0.702), and insurance coverage was not significantly different between white and minority-identified patients (63.4% versus 53.8%; P. = 0.5373).

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

The 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 gravids. Poster presented at: ASRM 2023 Congress and Scientific Exhibition; October 14-18, 2023; New Orleans, LA.

2. So M, Koniares K, Godiwala P. Racial disparities in access to fertility preservation for patients with oncofertility are mitigated under a comprehensive fertility mandate. Poster presented at: ASRM 2023 Congress and Scientific Exhibition; October 14-18, 2023; New Orleans, LA.