ArticleAmerican journal of obstetrics and gynecology2026
The fertility cascade: infertility prevalence, access to treatment, and successful live birth.
Article in American journal of obstetrics and gynecology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Human pyriform sperm heads in infertile men and assisted reproductive technology outcomes: a retrospective cohort study based on propensity score matching.Asian journal of andrology · 2026Article
- Potential increase of the U.S. total fertility rate resulting from restorative treatment of unresolved subfertility: a simulation study.Frontiers in reproductive health · 2026Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundAccess to fertility care in the United States is limited by availability of services, inadequate insurance coverage, restrictive legislation, and social determinants of health. Despite increasing demand for fertility services, national estimates of fertility care utilization and outcomes-particularly across sociodemographic groups-remain poorly characterized.
objectiveTo quantify infertility awareness, treatment access, and live birth using a cascade of care framework, overall and by sociodemographic characteristics. STUDY
designWe used a cascade of care framework to estimate infertility awareness, treatment access, and live birth outcomes. We used data from 3 sources: lifetime infertility prevalence from the World Health Organization (1991-2021), self-reported infertility and treatment access from the National Health and Nutrition Examination Survey (2013-2020), and live births conceived with fertility treatment from US birth certificates (2016-2021). Disparities were examined by race, ethnicity, education, insurance, and age.
resultsAmong US women aged 20 to 44 years in the National Health and Nutrition Examination Survey, 12% (95% confidence interval, 11-13) reported infertility. Among those, mean age was 34 years; 13.1% self-identified as Black and 19.7% as Hispanic. While infertility awareness was high (70%; 95% confidence interval, 60-74), access to fertility treatment (39%; 95% confidence interval, 33-45) and live births resulting from fertility treatment (10%; 95% confidence interval, 8%, 12%) were low. Live births were highest among Asian (17%; 95% confidence interval, 10-27) and White (13%; 95% confidence interval, 10-18) women and lowest among Hispanic (4%; 95% confidence interval, 2-6) and Black (3%; 95% confidence interval, 2-5) women. Higher education and private insurance were associated with increased treatment access and live birth.
conclusionFewer than half of US women with infertility report accessing treatment, and only 1 in 10 achieve a live birth, with striking disparities across the fertility care cascade. Black, Hispanic, and socioeconomically disadvantaged women face the greatest barriers to successful outcomes. These inequities may worsen as more restrictive fertility legislation emerges, highlighting the need for health systems and policymakers to prioritize equitable access to fertility care.
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