Role of complementary and alternative medicine to achieve fertility in uninsured patients.
Among those facing infertility in the United States, underinsured and uninsured women are at the greatest disadvantage. Women who receive medical care under Medicaid are rarely covered for infertility testing; only 4 states will cover infertility treatment as an element of family planning and preconception care. Studies exploring the use of complementary and alternative medicine (CAM) in infertility patients have focused on patients who have insurance. We conducted a review of the literature via MEDLINE. Articles were limited to English-language, human studies published between 1990 and 2011. Significant disparities exist in access to infertility treatment based on race and ethnicity, household income, and level of education, even in states with mandated insurance coverage. Given the steep costs of assisted reproductive technologies, many infertility patients augment traditional medical treatment with CAM. Acupuncture and herbal supplements are the most studied therapies. Although dietary supplementsmay enhance fertility, the use of othermore expensive forms of CAM such as acupuncture has had mixed results. Complementary and alternative medicine may be a viable option for infertility care for uninsured patients who cannot otherwise afford treatment.


BACKGROUND
Obstetricians and gynecologists, family physicians


OBJECTIVE
After completing this CME activity, physicians should be better able to analyze the effects that health care disparities have on fertility treatments for uninsured and underinsured women and evaluate the literature to determine which complementary and alternative treatments for infertility can improve fertility.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA. teperry@uic.edu
Tashera E
TE
Perry
Jennifer
J
Hirshfeld-Cytron
D000529:Complementary Therapies / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007247:Infertility, Female / Q000191:economics* / Q000628:therapy*; D017057:Medically Uninsured; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States