Inequities in medically assisted reproduction: A scoping review

Abstract

Introduction: Infertility affects one in five women in the United States and may do so regardless of race/ethnicity, socioeconomic status, geographic location, income, or educational status. These factors, however, may play a large role in access to infertility treatments, or medically assisted reproduction (MAR). This scoping review aimed to identify gaps in research pertaining to inequities in MAR, and propose suggestions for future research directions.

Methods: This review was conducted following the guidance of the Joanna Briggs Institute methodology for scoping reviews. Searches were performed in July 2022 using MEDLINE (via PubMed) and Ovid Embase, identifying articles for screening. Articles that reported on MAR inequities, published between 2016–2021 in the United States, and written in English were included. Each article’s inequity findings were analyzed, extracted, and reported. The frequencies of the inequities investigated were recorded.

Results: Ninety-six articles underwent full-text screening and 66 were included in our sample. Race/ethnicity was the most commonly reported inequity. The majority of the studies focused on MAR outcomes by race/ethnicity, and many found that historically marginalized populations had worse outcomes. Since the NIH’s classification of Sexual and Gender Minorities as a health disparity population in 2016, 15 articles within our sample investigated LGBTQ+ inequities in MAR. Historically marginalized populations were less likely to use MAR or seek infertility care and findings were similar among LGBTQ+ populations. The majority of studies found positive correlations with MAR use with income and education. The least commonly studied inequities in our sample were sex or gender and rural/under-resourced populations; findings showed that men and people from rural/under-resourced populations were less likely to access MAR. Studies that examined occupational status had varying findings.

Conclusion: Our study identified research gaps regarding MAR within each of the inequities examined, though some gaps were more prominent than others. We suggest that future research be targeted toward: (1) standardizing and diversifying race/ethnicity reporting regarding MAR, (2) increasing access to infertility care for LGBTQ+ populations by providing more inclusive care, (3) increasing access to infertility care for men, and (4) increasing access to MAR for rural/under-represented populations by identifying logistic challenges.