Management of encounters related to subfertility and infertility among Aboriginal and Torres Strait Islander females in Australian general practice

Abstract Objective: To investigate the management of subfertility and infertility among Aboriginal and Torres Strait Islander females attending Australian general practice. Methods: Cross-sectional study of 1,258,581 women (18-49 years) attending general practice between January 2011 and June 2019, utilising data from NPS MedicineWise MedicineInsight, a national general practice database in Australia. Results: The prevalence of subfertility/infertility encounters was lower for Aboriginal and Torres Strait Islander females (12.4 per 1000) than for non-Indigenous females (16.6 per 1000). Aboriginal and Torres Strait Islander females with a subfertility/infertility encounter were younger and more likely to live outside Major cities and in areas of socioeconomic disadvantage than non-Indigenous females. Rates of prescribed infertility medications were not different between groups, however Aboriginal and Torres Strait Islander females were more likely to receive a pelvic ultrasound (24.3% vs. 19.9%); tests for LH (31.9% vs. 25.7%), testosterone (14.9% vs. 10.0%) and HbA1c (6.3% vs. 3.4%); but less likely to receive an AMH test (2.8% vs. 7.0%). Conclusions: Lower encounter rates for infertility/subfertility among Aboriginal and Torres Strait Islander people may indicate access issues, preferred use of Aboriginal community-controlled health centres or younger average age at first birth and thus less age-related infertility. Implications for public health : Future efforts should focus on maximising the inclusiveness of infertility surveillance. There is also a needfor further research into the experiences of and preferences for infertility care and associated barriers among Aboriginal and Torres Strait Islander people.