To determine the effect of income, education, and race on the utilization and outcomes of infertility care.
8 community and academic infertility practices
391 women presenting for an infertility evaluation
Face-to-face and telephone interviews and questionnaires
Main Outcome Measures
Utilization of infertility services and odds of pregnancy. Linear and logistic regression used to assess relationship between racial and socioeconomic (SES) characteristics, utilization of fertility services, and fertility outcomes.
After adjustment for age, demographic and fertility characteristics, college-educated couples (β $5,786, p=0.006) and households earning $100,000–$150,000 (β $6,465, p=0.01) and ≥$150,000 (β $8,602, p < 0.001) spent significantly more on fertility care than their non-college-educated, lower income couples. Higher income and college-educated couples were much more likely to utilize more cycles of higher intensity fertility treatment. The increased cost of fertility care was primarily explained by these differences in number and type of fertility treatment. Even after adjustment for these factors and total amount spent on fertility care, having a college degree was associated with persistently higher odds of achieving a pregnancy (OR 1.9, p=0.02).
Education and household income were independently associated with the amount of money spent on fertility care. This relationship was primarily explained by types and intensity of fertility treatments used. Having at least a college degree was independently associated with improved odds of pregnancy.