Provision of Infertility Care for the Underserved in REI Practices Associated with OB/GYN Residency Training Programs in the United States

Abstract Objective To survey practice patterns designed to increase access to infertility care and assess exposure of OB/GYN residents to infertility care for the underserved. Design Cross-sectional Setting REI practices associated with ACGME-accredited OB/GYN residency training programs Patients None Intervention Questionnaire survey Main Outcome Measures Presence of clinical programs designed to improve access to care, resident involvement in such programs, and perceived barriers to expanding access to care. Results Clinical initiatives to expand access included discounted infertility services (38%, n=30), utilization of a low-cost IVF program (28%, n=22), and utilization of a resident and/or fellow staffed clinic to provide infertility care (39%, n=31). The most commonly discounted infertility services were IVF (73%, n=22), clinical consultation (70%, n=21), and IUI (53%, n=16). The provision of discounted prices was correlated with increasing practice size (OR 2.29, 95% CI 1.23, 4.24, p=0.01) and number of ART cycles performed annually (OR 3.65, 95% CI 1.48, 9.02, p=0.005). Academic REI practices (OR 3.6, 95% CI 0.98, 13.25, p=0.05) trended to be more likely to have a low-cost IVF program. Less than half of OB/GYN residency programs (39%, n=31) have an associated REI clinic in which OB/GYN residents provide direct infertility care to the medically underserved. Frequency and services offered in trainee clinics varied. Multiple barriers to expanding access to care were reported. Conclusion REI practices associated with OB/GYN residency programs utilize a diverse range of approaches to provide infertility care to the undeserved in the backdrop of considerable challenges and barriers, but significant gaps exist.