Access to assisted reproductive technology (ART) centers in the USA. are ART centers rationally located?

Abstract

To describe the spatial disparity of ART centers based on their location in relation to the populations in the reproductive years. To identify an association between state-mandated coverage for infertility services and number and location of ART centers. Cross sectional study. 2000 U.S. Census estimates by sex and age groups for population in the reproductive years (women 20–44 and men 20–49) were calculated. ART centers registered with the Society for Assisted Reproductive Technology (SART) in 2005 were retrieved (www.sart.org). Sixty minute travel distances from the ART addresses were calculated and graphed using Geographic Information Systems software (ArcGIS 9.1). Populations within the 60 min catchment area served by in- state and neighboring state ART centers were calculated. Proximity of the study populations to ART centers was stratified by gender, female age, and 2005 state-mandated coverage for ART. 390 ART centers were identified, with service areas for 386 calculated. 14 states had some form of mandated coverage. Distribution of the population studied and 60 min driving distance around each ART center is shown. Underserved states (≤25% of study population within 60 mins of any center) included Alaska, Montana, Wyoming and West Virginia. States with the highest coverage (≥95% of study population within 60 mins jointly covered by in state and neighboring state centers) included Connecticut, New Jersey and District of Columbia. Study populations within 60 mins of an ART center in their own state were higher in mandated vs. non mandated states (P<0.025). Female age stratification showed the highest age group (35–44) per state in Maine, New Hampshire and Vermont with the youngest in Utah and District of Columbia. Disparity of access to care for infertility services exists when analysed from the standpoint of potential population in need, service areas for ART centers and state-mandated coverage. Female age stratification may help anticipate future need for services with existing resource distribution.