Impact of access to care and race/ethnicity on in vitro fertilization care discontinuation

Published:November 29, 2021DOI:


      Research Question

      Is race/ethnicity or access to care, as defined by insurance coverage, distance to clinic, and zip code, associated with care discontinuation following in vitro fertilization (IVF)?


      A retrospective cohort study of 878 diverse women who underwent 1,689 IVF cycles from 2014-2018 at a Southeastern academic medical center was performed. Women were divided into low (LAC) and high (HAC) access to care groups. HAC was defined as possessing IVF insurance coverage, living ≤25 miles from the clinic, and living in a zip code with a median income ≥$75,000. Access groups and racial/ethnic groups were compared for differences in relative risk of care discontinuation following an unsuccessful IVF cycle.


      Women with HAC had a poorer IVF prognosis than the LAC group, which possibly impacted the association with care discontinuation. Distance to clinic, but not insurance coverage or zip code, was associated with increased risk of care discontinuation. Variation in insurance coverage existed among patients, possibly impacting its association with discontinuation. Among women ≤34 years, HAC was associated with an increased risk of care discontinuation (aRR 2.5, 95% CI: 0.8-8.1). Despite having higher rates of insurance coverage (51.2% vs. 36.5%), non-Hispanic Black women were more likely to discontinue care (58.3% vs. 40.2%) and less likely to achieve a live birth (53% vs. 68%) than non-Hispanic White women.


      HAC women ≤34 years old, identification as non-Hispanic Black, and distance to clinic, but not insurance coverage or zip code, were associated with an increased risk of care discontinuation following an unsuccessful IVF cycle.


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      Dr. Heather Hipp is an Assistant Professor at the Emory Reproductive Center and Assistant Program Director for Emory's Reproductive Endocrinology and Infertility fellowship. Her research focuses on national trends and outcomes of in-vitro fertilization, and she has a particular interest in oocyte donation and primary ovarian insufficiency.
      Key Message
      There was an increased risk of IVF care discontinuation for patients who were ≤34 years old with high access to care, who identified as non-Hispanic Black, and who lived further from the clinic. Insurance coverage and zip code were not associated with an increased risk. To provide equitable care to all patients, future work must investigate ways to mitigate the systemic impact of race/ethnicity on fertility treatment outcomes.