Abstract
Purpose
To analyze the geographic distribution of REI fellowships and clinics across the USA and to strategize ways to improve patient access to care.
Methods
Cross-sectional study using population data obtained from publicly available United States Census Bureau, Society for Assisted Reproductive Technology (SART), and National Resident Matching Program websites. Outcomes include the number of REI clinics, REI fellowship-trained physicians, and REI fellowship programs.
Results
In 2020, there were 643 assisted reproductive technology (ART) clinics reporting to SART and 1351 fellowship-trained REI physicians. Most clinics are located in the south (n = 209); however, the northeast has the highest density of REI clinics. Out of 301,316 in vitro fertilization (IVF) cycles in the USA in 2020, northeastern states initiated the most cycles (n = 93,565), and Midwestern states initiated the fewest cycles (n = 50,000). The northeast has the most REI physicians per million women aged 20–44 years (42.4) while the Midwest has the lowest ratio (19.5). There are fewer REI physicians per million women aged 20–44 years in states with a lower proportion of patients with health insurance (r = 0.56, 95% confidence interval ([CI] 0.34–0.73) and in states with a lower average income per resident (r = 0.65, 95% CI 0.46–0.79). Most of the 49 accredited REI fellowship programs in the USA are in the northeast (n = 18), and there are fewest in the south (n = 10) and west (n = 10).
Conclusion
Access to REI care has large geographic disparities from a clinic, physician, and training program perspective. Creative solutions are needed to remedy this problem.
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Data availability
Data can be made available upon request.
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The authors did not receive support from any organization for the submitted work, and they have no relevant financial or non-financial interests to disclose. This is an observational study. The Human Investigation Committee (IRB) of Emory University has confirmed that no ethical approval is required. Daniela Diego, Heather Hipp, and Jennifer Kawwass contributed to the study conception and design. Material preparation and data collection were performed by Daniela Diego. Data analysis was performed by Lisa Shandley. The first draft of the manuscript was written by Daniela Diego, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.
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Diego, D., Shandley, L.M., Feinberg, E.C. et al. REI clinics and fellowship training—a national snapshot to improve access to reproductive care. J Assist Reprod Genet 40, 2101–2108 (2023). https://doi.org/10.1007/s10815-023-02868-y
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DOI: https://doi.org/10.1007/s10815-023-02868-y