GEOGRAPHIC DISPARITIES IN ACCESS TO FERTILITY SERVICES IN THE UNITED STATES

Availability of fertility services is fundamental for individuals requiring assistance to conceive. However, hidden barriers such as the need to travel long distances to obtain treatment can lead to foregone care.1 Repeated visits to distant centers increase financial strains associated with treatments and can adversely affect employment and personal life.2 To describe geographic disparities in access to assisted reproduction (AR) treatments, this study quantifies distance to fertility centers (FC) in the continental US. In this retrospective study, we used the Society for Assisted Reproductive Technology (SART) dataset from 2018 to measure utilization of AR services (as defined by SART). Number of cycles per thousand (Cycles/1k) and fertility centers per million (FC/M) were based on the US Census number of women of reproductive age (20-44 years). Distances between county centroids and FCs were calculated using the Haversine formula. Comparisons were assessed with Mann-Whitney U test and statistical significance set at p<0.05. There were 304,085 cycles (5.68/1k women) performed in the US in 2018. While the number of clinics/million women is similar in the US regions, median distance to FC vary from 33 miles in the Northeast to 95 miles in the West (Table). Among states, the median distance to fertility centers is negatively associated with the number of Cycles/1k. On average, a distance increase of 10 miles is associated with 370 fewer cycles/million women. In the US, 7.4 million (13.9%) women live farther than 60 miles from a fertility center. A considerable number of women have to travel long distances to undergo fertility services, with significant regional variation and potential impact in access to care.