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Michigan is a member of a three-state collaborative, States Monitoring Assisted Reproductive Technology (SMART), which links Assisted Reproductive Technology (ART) surveillance data with that of vital records, hospital discharge, birth defects and cancer registries. While the SMART collaborative provides information on perinatal outcomes for a population-based sample of infants conceived with ART, the findings are restricted to women who gave birth to a live infant; thus men, women who either were unable to become pregnant or to carry an infant to term, and individuals who used non-ART cannot be evaluated. From the 2011 Michigan Behavioral Risk Factor Surveillance System (MIBRFSS), an estimated 10% of Michigan adults 18-50 years who are married or an unmarried couple reported treatment for infertility. Those treated were predominately white, college-educated, insured and reported a high income. This likely underestimates the true prevalence of infertility as financial barriers limit access to diagnostics, evaluation and treatment. Social and racial disparities exist in health status, risk factors and in preventable causes of infertility, disproportionately affecting minorities and low income individuals. With continued economic challenges, barriers to access are likely; non-ART use may increase as it can be provided at a lower cost compared to ART. Improved surveillance of infertility, its treatment and outcomes among Michigan residents is needed.
METHODS: The MIBRFSS is a landline and cellphone based survey that is representative of all Michigan adults and has been used to estimate the prevalence of infertility treatment (including non-ART). For 2012, an expanded infertility module was developed to address limitations of existing infertility surveillance.
RESULTS:
Based on field testing and to provide an estimate of lifetime infertility prevalence, the upper age limit of the sampling frame was increased to 75 years. Lifetime experience of infertility and sub-fecundity were asked of all Michigan adults regardless of relationship status and were modified to be gender appropriate. To improve the estimated prevalence of non-ART treatment, a more comprehensive list of non-ART infertility treatments was developed. An outcomes question was added to estimate live births and failure to carry an infant to term or achieve pregnancy. An expanded analysis to evaluate infertility, sub-fecundity, and treatment with regard to healthcare access, comorbidities, and disparities will be conducted once the 2012 MIBRFSS data set has been finalized.
CONCLUSIONS:
By leveraging the MIBRFSS, a more comprehensive depiction of infertility, its treatment outcomes, disparities, and the potential demand for medical services, can be provided.