Subject characteristics are shown in . In bivariate analyses, college education, white race, and higher income were associated with higher fertility treatment expenditures. The likelihood of achieving a pregnancy was significantly higher for higher income and college educated couples. Fertility treatment intensity and number of treatments were associated with higher fertility treatment costs and improved pregnancy rates. Higher fertility expenditures were associated with improved pregnancy rates; however, a threshold was observed at $2,500 at which point pregnancy rates remained relatively constant until $45,000 at which point they began to decline.
Demographic, Socioeconomic, and Fertility Characteristics of Cohort and the Cost and Outcome of Fertility Care (n=391)
After multivariable adjustment for female age, marital status, previous children, insurance coverage for fertility care, duration of infertility, and couple infertility diagnosis, compared to women not using fertility treatment, women with household incomes of more than $150,000 per year were more likely to use IUI (RR 2.4, 95% CI[1.0–5.9], ), and IVF (RR 5.2, 95% CI [2.4–11.3], ) relative to household incomes <$100,000 (A→B). Couples earning $100,000–149,999 were more likely to use IVF (RR 2.5, 95% CI[1.2–5.1]). The highest income households were also more likely to use 1–2 cycles (RR 3.4, 95% CI [1.5–7.6], ), 3–4 cycles (RR 4.3, 95% CI [1.7–10.7], ), and 5 or more cycles (RR 3.5, 95% CI [1.4–8.5], ) compared to 0 cycles. Household incomes $100-000–$149,000 were more likely to use 3–4 cycles and 5+ cycles compared to lower income couples.
Multinomial Logistic Regression Characterizing Relationship between Socioeconomic and Racial Characteristics, Intensity of Fertility Treatment, and Number of Treatment Cycles
Furthermore, in these same models (A→B), compared to choosing no treatment, women with a college degree were more likely to use IUI (RR 2.0, 95% CI [1.0–4.2], ) and IVF (RR 2.3, 95% CI [1.3–4.3], ). College educated women were also more likely to use 3–4 cycles (RR 3.0, 95% CI [1.4–6.5], ), and five or more cycles (RR 2.6, 95% CI [1.2–5.3], ) compared to 0 cycles. There were no statistically significant differences in the use of medications only as a treatment choice between women with and without a college degree. A college degree did not increase the probability of using 1–2 cycles compared to no treatment.
Multivariable Relationship between Socioeconomic and Racial Characteristics, Infertility Utilization, and Fertility Outcomes
Although white women were slightly more likely to choose higher levels of reproductive care and more treatment cycles, these differences did not achieve statistical significance after multivariable adjustment ().
After adjustment for female age, marital status, prior parity, duration of infertility, insurance coverage for fertility services, and infertility diagnosis; several significant income and education differences in infertility expenditure were found (A→C, ). Although white women relative to non-white women (β: $3,172, 95% CI [$-876– $7,220) spent slightly more, this difference was not statistically significant. Those women with a college degree (β: $5,786, 95% CI [$1,658–$9,914) and households earning $100,000–$149,999 per year (β: $6,465, 95% CI [$1,697–$11,232) and more than $150,000 per year (β: $8,602, 95% CI [$3,805–$13,399) incurred higher infertility costs than households earning less than $100,000 annually. The addition of treatment pathway (i.e. no treatment, ovulation induction medications only, IUI only, or IVF) and number of treatment cycles to the models resulted in loss of significant differences in fertility costs ().
Although odds ratios for pregnancy were somewhat improved among white women and higher household income groups in bivariate analyses, multivariable logistic regression revealed statistically significant differences in the odds of achieving a pregnancy only among women with a college degree (OR 2.1, 95% CI [1.2 – 3.5]). This relationship persisted after adjustment for treatments used and number of cycles (OR 2.0, 95% CI[1.1–3.4], ) and total fertility cost (OR 1.9, 95% CI[1.1–3.3]), ; A→D).