Abstract

In the United States, unmet needs for infertility treatment are high, and the proportion of patients that are “underserved” exceeds that in most other fields (ASRM Ethics Committee, https://www.asrm.org/about-us/initiatives/diversity-task-force/dei/asrm-task-force-on-diversity-equity-and-inclusion-issues-statement-recommendations/, 2021). Infertility may be detrimental to an individual or family’s health, social status, family stability and psychological wellness (ASRM Ethics Committee, https://www.asrm.org/about-us/initiatives/diversity-task-force/dei/asrm-task-force-on-diversity-equity-and-inclusion-issues-statement-recommendations/, 2021). This chapter explores the disparities that prevent equitable access to treatment and impact treatment outcomes in the U.S. The most salient barrier to treatment access is financial; many patients lack access due to its high cost and limited coverage by insurance. Only a portion of U.S. states mandate coverage of infertility testing and treatment, and several state mandates carry significant restrictions (RESOLVE, https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/insurance-coverage-by-state/, 2021). In addition to financial barriers, this chapter explores ethnic, racial, and geographic barriers to care. Reproductive justice demands that persons have equitable opportunities to have children when they wish to and are free from serious medical contraindications (SisterSong, https://www.sistersong.net/reproductive-justice, 2022). Physicians have an ethical obligation to engage with payors, employers, and policymakers to advocate for equitable and affordable care. In addition, REI clinics should recruit a diverse and informed workforce, require cultural competence trainings, identify cost-effective infertility treatments and research how to improve treatment outcomes across diverse populations (ASRM Ethics Committee, https://www.asrm.org/about-us/initiatives/diversity-task-force/dei/asrm-task-force-on-diversity-equity-and-inclusion-issues-statement-recommendations/, 2021).