Utilization of infertility services: how much does money matter?

OBJECTIVE: To estimate the effects of financial access and other individual characteristics on the likelihood that a woman pursues infertility treatment and the choice of treatment type. DATA SOURCE/STUDY SETTING: The 1995 National Survey of Family Growth. STUDY DESIGN: We use a binomial logit model to estimate the effects of financial access and individual characteristics on the likelihood that a woman pursues infertility treatment. We then use a multinomial logit model to estimate the differential effects of these variables across treatment types. DATA COLLECTION/EXTRACTION METHOD: This study analyzes the subset of 1,210 women who meet the definition of infertile or subfecund from the 1995 National Survey of Family Growth. PRINCIPAL FINDINGS: We find that income, insurance coverage, age, and parity (number of previous births) all significantly affect the probability of seeking infertility treatment; however, the effect of these variables on choice of treatment type varies significantly. Neither income nor insurance influences the probability of seeking advice, a relatively low cost, low yield treatment. At the other end of the spectrum, the choice to pursue assisted reproductive technologies (ARTs)-a much more expensive but potentially more productive option-is highly influenced by income, but merely having private insurance has no significant effect. In the middle of the spectrum are treatment options such as testing, surgery, and medications, for which "financial access" increases their probability of selection. CONCLUSIONS: Our results illustrate that for the sample of infertile of subfecund women of childbearing age studied, and considering their options, financial access to infertility treatment does matter.