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
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.