Assisted reproductive technology use in the United States: a population assessment.

Objective: To study social and demographic differentiation of assisted reproduction technology (ART) use at the population level in the United States.

Design: Population-based study.

Setting: Not applicable.

Patient(s): Women 15-49 years old in the American Community Survey and National Vital Statistics Birth Certificate data from 2010-2017.

Interventions: Not applicable.

Main Outcome Measure(s): Birth rate after ART by major sociodemographic categories and likelihood of having an ART birth.

Result(s): Net of education, age, period, and marital status, the incidence rates of ART births are lower for black women (0.57 times; 95% CI, 0.52-0.62) and Hispanic women (0.67 times; 95% CI, 0.57-0.62) relative to white women's rates; for Asian women, the incidence rates are 1.21 times that of white women's rates. Further, the incidence rates of ART births are higher for women with more than a 4-year degree (2.08 times; 95% CI, 1.90-2.27) relative to women with a 4-year degree, and are lower for women with less education. Women who are married have an incidence rate of ART that is 5.72 times (95% CI, 5.37-6.09) that of unmarried women. The incidence rates for 2013-2016 are statistically significantly higher than for 2010 by a factor of 1.16 (95% CI, 1.02-1.31), 1.16 (95% CI, 1.03-1.31), 1.27 (95% CI, 1.12-1.43), and 1.51 (95% CI, 1.43-1.82), respectively. The educational differences in ART exist across all age groups from 20 to 49, but are the largest among the 35-39 and 40-44 age groups.

Conclusion(s): Large differences in the risk of an ART birth and the proportion of births and the total fertility rate due to ART exist across period, age, race, education, and marital status groups in the United States. Current measures of ART births may disguise an unmet need for ART.