Racial and Ethnic Differences in Infertility Care Utilization Among Women with Infertility in the United States: A Nationally Representative Analysis of the 2022-2023 National Survey of Family Growth

Background

Racial and ethnic minority populations remain underrepresented in obstetric and gynecologic clinical research, particularly in reproductive endocrinology and infertility studies. This limits the ability to characterize potential disparities in access to infertility care. Nationally representative survey data provide an opportunity to compare infertility-care utilization across racial and ethnic groups. Prior studies have documented suboptimal racial and ethnic representation in OB-GYN research, with reproductive endocrinology and infertility studies demonstrating especially low Hispanic representation. This study aimed to compare infertility- care utilization among Hispanic, non- Hispanic White and non- Hispanic Black women classified as infertile in the 2022-2023 National Survey of Family Growth (NSFG).

Methods

We performed a secondary cross- sectional analysis of the 2022-2023 NSFG, Female Respondent File. Women classified as infertile by the NSFG were included, and analyses were restricted to Hispanic, non-Hispanic White, and non-Hispanic Black respondents. Infertility-care utilization was defined as ever receiving medical help to become pregnant. Given the complex survey design, weights, strata, and clusters were incorporated to calculate weighted proportions and 95% confidence intervals using Taylor series linearization. Overall differences were assessed by a survey- adjusted Wald F test, with a secondary pairwise Wald contrast comparing Hispanic and non-Hispanic White women.

Results

The analytic sample included 181 women: 65 Hispanic, 98 non-Hispanic White, and 18 non-Hispanic Black. Weighted infertility-care utilization was 26.4% (95% CI, 14.1%–38.7%) among Hispanic women, 39.3% (95% CI, 26.8%–51.7%) among non-Hispanic White women, and 25.4% (95% CI, 2.2%–48.6%) among non-Hispanic Black women. Overall differences were not statistically significant (F=1.17; p=0.317). Non-Hispanic White women had an estimated 12.9-percentage-point higher utilization than Hispanic women (95% CI, −4.9 to 30.6; p=0.152).

Discussion & Conclusion

Infertility-care utilization was descriptively lower among Hispanic and non-Hispanic Black women than among non-Hispanic White women, although differences were not statistically significant. Wide confidence intervals, particularly among non-Hispanic Black women, reflect limited precision due to small subgroup sample sizes in reproductive health. These findings underscore the importance of adequately powered racial and ethnic subgroup analyses when evaluating access and utilization of reproductive health services. Without sufficient representation and subgroup- specific data, clinically meaningful disparities in infertility care may remain undetected, limiting efforts to identify and address barriers to equitable reproductive care.