Infertility Does Not See Race, Unfortunately Society Does

According to data from the 2006 – 2010 National Survey of Family Growth, infertility or impaired fecundity affects between 6 – 12% of the U.S. population aged 15 to 44, depending on the definition used when assessing prevalence of this reproductive health condition (NSFG, 2015; Chandra et al. 2013). For nulliparous (no prior conception) females, who have had unprotected intercourse in the past 12 months and intended to conceive, infertility rates were as high as 46% between 2006 - 2010 (see Figure 1).

Figure 1 - Percentage of married females reporting primary infertility: infertility among females who have not previously conceived

In addition, clinical and population-based comparisons of the racial/ ethnic burden of infertility have identified disparities in infertility prevalence and infertility care. These disparities are predominantly focused on rates of infertility among African American and Hispanic females.

Given that infertility is a public health issue with considerable social, economic, and health consequences that extend beyond quality-of-life issues, it is important to understand why disparities in infertility rates exist across race & ethnicity.

1. Access to Care and Infertility Support

Women who have used fertility services are likely to be higher income, white, married and older. In 2016, 15% of white women aged 25 to 44 in the United States have sought medical help to get pregnant, compared with 7.6% of Hispanic women and 8% of black women, according to the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control (CDC) and Prevention.

Access to care is a strong predictor of infertility diagnosis and ultimately access to treatment. At the same time, access to care is strongly correlated with race and socioeconomic status (Dieke et al. 2012; CDC 2013). For example, a 2012 National Healthcare Disparities Report concluded that ethnic minorities had poorer quality of and access to care than whites across a broad range of healthcare indices. Additionally, delays in accessing infertility care have been described for some racial/ ethnic groups. For example, Asian/ Pacific Islander (A/PI) and black non-Hispanic women reported longer durations of infertility (National Health Interview Survey (NHIS), 2012) and accessed Assisted Reproductive Technologies (ART) at a later age compared with white non-Hispanic women. 

The main driving factor behind racial disparities in accessing ART is usually access to insurance that covers ART therapies (e.g.: infertility lab work and In Vitro Fertilization). An interesting study on military females found no disparities in rates of infertility by race among military females. This was because there was no  difference in the proportion of women using infertility treatments in the military between black non-Hispanic women and their white non-Hispanic counterparts, suggesting that insurance coverage from the military may reduce disparities in access to treatment and ultimately disparities in infertility (Feinberg et al. 2006) 

2. Access to Education and Income

Figure 2, which is also from the National Survey of Family Growth (2006 - 2010), illustrates that a pattern of primary impaired fecundity may exist by educational attainment, race, and origin (except for Hispanic females). The link between education and infertility is likely due to income and again, access to treatment and quicker diagnosis.

Figure 2 - Rates of Fecundity (difficulty conceiving) by Race and Education

Holding age fixed, non-Hispanic white females with less than a bachelor degree were 53% (20% vs 13%) more likely to report difficulty conceiving (fecundity) than non-Hispanic white females with a bachelor degree or more.

The point of this discussion is that there is strong evidence suggesting that racial disparities in infertility rates are due to mechanisms correlated with access to treatment, income and education and not biology. Understanding these factors should give females in communities with high infertility rates hope and reassurance. Infertility does not see race, but unfortunately, society does. These racial misconceptions unfortunately have also been harmful.

Relevancy to Supplemena

With an infertility blood test costing being between $200 and $400, often requiring a referral after a physician visit, we at Supplemena want to help reduce these costs. Our pregnancy bundle boxes come with male infertility testing kits and female hormone testing kits, and provide clinical-grade results (unlike other home tests) and do not require physician referrals. These testing kits help identify actual sperm count, motility counts & characteristics, and morphology characteristics (not simply providing an indicator of whether you're above or below a threshold of motile sperm), identifying quickly if any of the indications associated with male infertility: Asthenospermia (suboptimal motility), Oligospermia (reduced count) and Teratospermia (abnormal morphology) are present. In cases of Azoospermia, where a zero sperm count is recorded, our products are not the answer and other useful medical care would be more productive. Similarly for females, the ovulation tests in our bundles can help you gather data on your own cycle and quickly identify your most fertile 72-hour window, eventually also reducing costs. If you already have access to your own pregnancy & ovulation tests, our fertility supplements may offer a relatively low cost solution for providing the nutritional nudge that might support your efforts towards successful conception.

References

Dieke, Ada C., et al. "Disparities in assisted reproductive technology utilization by race and ethnicity, United States, 2014: a commentary." Journal of Women's Health 26.6 (2017): 605-608.

Frieden, Thomas R. "CDC health disparities and inequalities report-United States, 2013. Foreword." MMWR supplements 62.3 (2013): 1-2.

Feinberg EC, Larsen FW, Catherino WH, Zhang J, Armstrong AY. Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting. Fertil Steril. 2006;85:888–894. [PubMed] [Google Scholar]

Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth. Chandra A, Copen CE, Stephen EH Natl Health Stat Report. 2013 Aug 14; (67):1-18, 1 p following 19

Summary Health Statistics: National Health Interview Survey, 2014. Table A-15 Body mass index among adults aged 18 and over, by selected characteristics: United States, 2014. National Center for Health Statistics 2016. http://www.cdc.gov/nchs/nhis/shs/tables.htm. Accessed August 10, 2017.

Warner, Lee, Denise J. Jamieson, and Wanda D. Barfield. "CDC releases a national public health action plan for the detection, prevention, and management of infertility." Journal Of Women's Health 24.7 (2015): 548-549.