Systematic review of racial and ethnic disparities in reproductive endocrinology and infertility: where do we stand today?

Abstract Objective To conduct a comprehensive review of racial and ethnic health disparities in infertility care and treatment. Evidence Review Systematic literature searches were performed in PubMed and Embase from inception to April 2021. Studies were eligible for inclusion if they were original research performed in humans, observational study design, focused on circumstances contributing to infertility, access to infertility care, or outcomes of infertility treatment, and provided relevant information on racial or ethnic groups. Titles and abstracts were reviewed independently by two reviewers to identify pertinent articles. References of included articles were also screened. Results The PubMed search yielded 2,113 articles. An additional 2,301 articles were found in the Embase search. In total, 4,414 articles were screened based on title and, where necessary, abstract. Thirty-four were found to meet inclusion criteria and included in this review. Three additional studies were found from searching references of the included articles, resulting in 37 articles for discussion: 26 retrospective cohort studies, 2 prospective cohort studies and 9 cross-sectional studies. The overall consensus in the literature is that reproductive health disparities based on race and ethnicity impact fertility, access to care, and fertility treatment outcomes. Conclusions Racial and ethnic differences in access to full spectrum reproductive care, including infertility evaluation and treatment, remain. Despite access to infertility treatment, disparate treatment outcomes persist. Intrinsic and extrinsic factors, such as the institutionalization of racism and discrimination within medicine, remain influential in the diagnosis, care, and treatment outcomes of those with infertility. To address these inequities, we must mitigate provider bias, fund high-quality health disparity research, improve patient reproductive health knowledge, and advocate for increased access to treatment for all.