Trends in Infertility Care Among Commercially Insured US Women During the COVID-19 Pandemic

Abstract

Author Contributions: Drs Zhou and Su had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Zhou and Joudeh contributed equally to the work.

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth

“…9 , 10 , 11 , 12 A prior study of over 8 million commercially insured women in the United States (US) showed a dramatic decline in ART procedures between February and April 2020 and a subsequent increase, which surpassed the pre‐pandemic. 13 This study further showed that changes occurred in all age groups, although lower utilisation rates and slower recovery rates of infertility care were observed among women aged 40 years and older. A survey of US women who were planning or undergoing fertility treatment during the beginning of the pandemic showed a large negative emotional impact of the interruption of the reproductive services, predominantly among women of advanced age and those with diminished ovarian reserve.…”

“…Third, data on live births in the US in 2021 were not available (when the study was finalised); limiting the time frame of our study to changes during the initial weeks of the pandemic. Zhou et al 13 showed that the recovery in the use of fertility services was quite rapid in a large sample of commercially insured women in the US, suggesting that the decline in the rate of live births following ART was limited to 2–3 months. Fourth, we lacked data on miscarriage which precluded an assessment of changes in the rate of fetal loss before 20 weeks' gestation (the conception cohorts in our study were reconstructed from birth cohorts and are therefore incomplete and left‐truncated).…”

“…Some of the most impactful measures during the early period of the pandemic included the American Society of Reproductive Medicine ([ASMR] and other scientific and professional fertility societies) guidelines recommending suspension of new fertility treatments 9–12 . A prior study of over 8 million commercially insured women in the United States (US) showed a dramatic decline in ART procedures between February and April 2020 and a subsequent increase, which surpassed the pre‐pandemic 13 . This study further showed that changes occurred in all age groups, although lower utilisation rates and slower recovery rates of infertility care were observed among women aged 40 years and older.…”

Inequities in Medically Assisted Reproduction: a Scoping Review

“…Asian recipients had significantly more fertilized oocytes, but similar pregnancy, live birth, and spontaneous abortion rates. Zhou et al, 2021 [ 89 ] Cross-sectional analysis National database n = 8,755,271 2018–2020 Infertility treatment Race/ethnicity, income Before the COVID-19 pandemic, ART usage was highest among Asian women and those with higher incomes. The recovery of ART usage after the pandemic was faster among Asian women, while overall usage rates were similar among other racial groups and incomes.…”

“…In addition to investigating outcomes following MAR, the included studies evaluated the likelihood of seeking infertility treatment. Four studies found that ART use was highest in white women [ 27 , 28 , 43 , 73 ], while three studies found that Asian women had the highest rate of use [ 38 , 84 , 89 ]. Seven studies found that Hispanic women were less likely to seek out infertility treatments or use ART [ 6 , 35 , 38 , 45 , 54 , 83 , 84 ].…”