title: Who receives a medical evaluation for infertility in the United States?
abstract: To investigate characteristics of receiving a medical evaluation for infertility among infertile women.
  
  
  
  Prospective cohort.
  
  
  
  Academic institution.
  
  
  
  A total of 7,422 women who reported incident infertility between 1989 and 2009 in the Nurses' Health Study II.
  
  
  
  None.
  
  
  
  Report of receiving a medical evaluation for infertility.
  
  
  
  Approximately 65% of women who reported infertility had a medical evaluation for infertility. Infertile women who were parous (relative risk [RR] = 0.81, 95% confidence interval [CI] 0.78-0.84), older, current smokers (RR = 0.89, 95% CI 0.83-0.96), or who had a higher body mass index (BMI) were less likely to report receiving a medical infertility evaluation. Infertile women who exercised frequently, took multivitamins (RR = 1.03, 95% CI 1.00-1.07), lived in states with comprehensive insurance coverage (RR = 1.09, 95% CI 1.00-1.19), had a high household income, or who had a recent physical examination (RR = 1.15, 95% CI 1.06-1.24) were more likely to report receiving a medical infertility evaluation.
  
  
  
  These findings highlight demographic, lifestyle, and access barriers to receiving medical infertility care. Historically, the discussion of barriers to infertility care has centered on financial access, geographic access, and socioeconomic status. Our findings build off literature by supporting previously reported associations and showcasing the importance of demographic and lifestyle factors in accessing care.
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Electronic address: lfarland@hsph.harvard.edu.
authors.forename: Leslie V
authors.initials: LV
authors.lastname: Farland
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Ai-Ris Y
authors.initials: AY
authors.lastname: Collier
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Katharine F
authors.initials: KF
authors.lastname: Correia
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Francine
authors.initials: F
authors.lastname: Grodstein
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Chavarro
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Janet
authors.initials: J
authors.lastname: Rich-Edwards
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D000070536:Independent Medical Evaluation; D007247:Infertility, Female / Q000175:diagnosis* / Q000453:epidemiology*; D008019:Life Style; D010808:Physical Examination / Q000639:trends; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted / Q000639:trends; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Infertility; barriers to access; barriers to care; fertility evaluation; fertility treatment