Disparities in Infertility Drug and ART Use among Primiparous Mothers in 28 States in 2011

Introduction:
As of 2011, 28 states representing 67% of all US births had adopted the revised 2003 U.S. Standard Certificate of a Live Birth including items on the use Assisted Reproductive Technology (ART) and infertility drug use. This provides an opportunity to examine the use of infertility assistance by demographic and health measures at national and state levels.

Methods:
Bivariate and multivariate analyses were performed on the 28 states that reported ART using 2011 birth certificate from the public use datafile from the National Vital Statistics System.

Results:
Preliminary analysis of births to first time mothers found 0.89% reported ART and 2.0% fertility drug use, with wide variation across states, from Maryland at 2.8% ART use to Indiana at 0.2%.  ART use was also strongly associated with delivery payer source with those reporting private insurance coverage (1.7%) almost 25 times more likely to report ART use than those on Medicaid (0.07%). Non-Hispanic white primiparous mothers reported higher rates of ART(1.2%) and fertility drug (4.0%) use compared to non-Hispanic black (0.3% ART; 0.6% fertility drug) or Hispanic (0.3% and 0.4%) mothers. Among primiparous mothers, non-Hispanic white mothers were at least twice as likely as non-Hispanic black mothers to use either ART or fertility drugs even after controlling for payer source and age. The use of ART was positively associated with prepregnancy BMI for non-Hispanic black mothers but not for non-Hispanic whites.

 

Discussion/Conclusion:
Analysis of infertility assistance using the revised birth certificate data identifies wide disparities by race/ethnicity, payer source and age.