ArticleJournal of assisted reproduction and genetics2026
Cumulative adverse social determinants of health, prolonged unsuccessful conception, and infertility-related healthcare contact among U.S. women: NHANES 2013-2016.
Article in Journal of assisted reproduction and genetics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo examine whether cumulative adverse social determinants of health (SDOH) were associated differently with self-reported prolonged unsuccessful conception, infertility-related healthcare contact, and healthcare contact among women reporting prolonged unsuccessful conception.
methodsWe analyzed women aged 20-59 years from the 2013-2016 National Health and Nutrition Examination Survey (NHANES). The final Model 2 cohort included 3145 participants. An eight-domain adverse SDOH score was calculated only when every domain was determinable. Survey-weighted logistic regression estimated associations per 1-point higher score. Model 1 adjusted for flexible age and race/ethnicity; Model 2 additionally adjusted for smoking, alcohol use, and BMI category; Model 3 additionally adjusted for cardiovascular disease, hypertension, diabetes, and hyperlipidemia. Sensitivity analyses evaluated reproductive eligibility, exposure construction, survey cycle, and selection.
resultsIn Model 2, each 1-point higher SDOH score was associated with lower odds of reporting at least 12 months of unsuccessful conception (OR 0.91, 95% CI 0.85-0.98), infertility-related healthcare contact (OR 0.86, 95% CI 0.80-0.92), and healthcare contact among women reporting prolonged unsuccessful conception (OR 0.81, 95% CI 0.69-0.94). The unsuccessful conception estimate attenuated toward the null under several stricter reproductive eligibility restrictions and after omission of the marital/social domain. The healthcare contact associations were more directionally consistent. Pregnancy history interactions did not provide clear evidence of heterogeneity, and age heterogeneity was specification-sensitive.
conclusionGreater cumulative social disadvantage was associated with lower odds of reporting a ≥ 12-month unsuccessful conception history and, more consistently, lower odds of infertility-related healthcare contact. These cross-sectional patterns may reflect reproductive opportunity, partnership and social context, recognition/reporting, and access to care; they should not be interpreted as evidence that social disadvantage improves biological fecundability.
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