Fertility benefits do not eliminate racial gaps in treatment uptake, study finds

Racial and ethnic disparities in fertility treatment uptake persist even among patients with access to fertility benefits, a study of 12,516 patients has found.

The research identified differences in treatment initiation, waiting times and treatment selection, despite patients having access to fertility coverage.

However, the time from initial consultation to the start of a treatment cycle resulting in pregnancy was largely similar across racial and ethnic groups.

Dr Janet Choi, chief medical officer at Progyny, said: “Expanding access to fertility benefits is an important step toward making care more equitable, but this research reminds us that coverage alone does not eliminate every barrier patients may face.

“What stands out is that once patients engage in treatment, time to pregnancy is largely similar across groups.”

The study examined patients who accessed fertility benefits between 2024 and 2025, assessing differences in treatment initiation, time to care, treatment selection and time to pregnancy.

Researchers were affiliated with Progyny, Shady Grove Fertility – Jones Institute at EVMS/ODU, the Icahn School of Medicine at Mount Sinai and Reproductive Medicine Associates of New York.

Compared with White patients, treatment initiation rates were approximately:

• 10 per cent lower among African American/Black patients.
• 19 per cent lower among Asian/Pacific Islander patients.
• 11 per cent lower among patients identifying as Other/Mixed race and ethnicity.

Waiting times between the initial fertility consultation and the start of treatment also varied.

White patients waited an average of 127 days, compared with 136 days for African American/Black patients and 144 days for those identifying as Other/Mixed race and ethnicity.

This represented additional waits of nine and 17 days, respectively.

Despite these differences, the time from initial consultation to the start of a treatment cycle resulting in pregnancy ranged from 180 to 190 days across racial and ethnic groups.

The researchers also found differences in treatment selection.

Compared with White patients, Asian/Pacific Islander patients had 23 per cent higher adjusted odds of starting intrauterine insemination (IUI), a procedure that places sperm directly into the uterus.

They also had 15 per cent lower adjusted odds of starting in vitro fertilisation (IVF), which involves fertilising eggs outside the body.

Although IVF generally has higher success rates per treatment cycle than IUI, researchers noted that treatment decisions depend on individual clinical circumstances.

The study did not investigate why treatment initiation rates differed between groups.

Researchers suggested that clinical needs, patient preferences, decisions to delay treatment and potential barriers to care could all play a role.

Choi said further investigation was needed into barriers that may prevent some patients from seeking appropriate clinical evaluations or delay their access to timely, indicated treatment, even when comprehensive fertility benefits are available.

The findings were presented at the American Society for Reproductive Medicine 2026 Scientific Congress & Expo.

Dr Kyle Le, a reproductive endocrinology and infertility fellow at Shady Grove Fertility who presented the research, said: “Improving fertility care requires us to understand not only what happens during treatment, but also who is getting to treatment in the first place.”

“These findings highlight the importance of looking more closely at differences in treatment decisions across patient populations and identifying opportunities to ensure every individual receives appropriate, personalised care.”

Further research is needed to understand why disparities in treatment initiation persist among patients with fertility benefits.

Examining the factors behind treatment decisions could help identify ways to support informed, individualised fertility care.