Assisted reproductive technology (ART) has transformed the landscape of infertility treatment, providing a ray of hope to countless couples trying to conceive. In-vitro fertilization (IVF) is one of the most commonly used ART methods, accounting for over 99% of all ART cycles performed in the United States. However, despite the progress made in this field, disparities in IVF outcomes and access persist, and racial factors play a significant role in exacerbating these disparities.
What is DEI?
Diversity, equity, and inclusion (DEI) are crucial components of any healthcare system, including IVF clinics. DEI practices help ensure that all patients are treated equitably, regardless of their race, ethnicity, gender, sexual orientation, or socioeconomic status. By adopting DEI practices, IVF clinics can better serve and advocate for patients and their loved ones, leading to better outcomes and a higher quality of life.
One of the key benefits of DEI practices is that they promote patient-centered care. Patient-centered care is an approach to healthcare that places the patient at the center of their care experience. This approach emphasizes listening to patients’ needs and preferences, involving them in decision-making, and providing care that is respectful of their values, beliefs, and cultural background. When IVF clinics adopt DEI practices, they create an environment that is welcoming and supportive of all patients, which can improve patient satisfaction and outcomes.
Cultural sensitivity is another important aspect of DEI practices in IVF clinics. Cultural sensitivity refers to the ability to understand and appreciate the cultural backgrounds of patients and how these backgrounds may affect their healthcare experiences. For example, a patient from a different cultural background may have different beliefs about fertility treatment, and IVF clinics that are culturally sensitive can adapt their services to better meet these patients’ needs.
In addition to promoting patient-centered and culturally sensitive care, DEI practices can also improve health outcomes for patients. Studies have shown that patients who receive care that is culturally sensitive and responsive have better health outcomes than those who do not. For example, a study of African American women undergoing infertility treatment found that those who received culturally sensitive care had higher pregnancy rates than those who did not.
Finally, DEI practices can help IVF clinics attract and retain a diverse and talented workforce. When IVF clinics prioritize DEI, they create an environment that is welcoming and supportive of all employees, regardless of their background. This can help attract and retain employees who are representative of the communities they serve, which can improve the quality of care and outcomes for patients.
There are several reasons why racial disparities in IVF outcomes and access exist. One of the most significant factors is the cost of treatment. IVF is an expensive procedure that can cost tens of thousands of dollars per cycle, making it out of reach for many individuals and families, especially those without insurance coverage. Unfortunately, insurance coverage for infertility treatment is not mandated in most states, and even in states where it is mandated, the scope and extent of coverage may vary significantly. This lack of access to affordable IVF treatment disproportionately affects low-income individuals and people of color, who are more likely to be uninsured or underinsured.
Another factor contributing to disparities in IVF outcomes is the quality of care. Studies have shown that Black women have lower success rates with IVF, even after controlling for age, infertility diagnosis, and other confounding factors. This disparity may be due in part to differences in the quality of care provided to Black women. For example, Black women may be less likely to receive appropriate preconception counseling, have longer wait times for appointments, and receive lower-quality care during the IVF process.
Finally, there is a significant lack of diversity in the field of reproductive medicine. Black individuals and other people of color are significantly underrepresented in the field, both as patients and as practitioners. This lack of diversity may contribute to the disparities in care and outcomes seen in IVF treatment. For example, a study found that Black women who received care from Black physicians were more likely to have successful IVF outcomes than those who received care from non-Black physicians.
Disparities in IVF outcomes and access are complex and multifactorial, with racial factors playing a significant role. Addressing these disparities will require a comprehensive approach that includes addressing the cost of treatment, improving the quality of care provided, and increasing diversity in the field of reproductive medicine. Legislation such as the ACA presents an opportunity to expand coverage for infertility treatment and improve disparities in fertility prevention, but more needs to be done to ensure that all individuals have access to the care they need to build their families.
DEI and Inclusive and Accurate Medical Language
The use of medical language has a significant impact on the way we think about and understand health conditions. Historically, medical language has been focused on gender, with certain conditions and symptoms being attributed exclusively to either male or female bodies. However, this approach can be problematic as it ignores the fact that gender is not binary and fails to account for individuals whose gender identity does not align with their biological sex.
As such, a more inclusive and accurate approach to medical language would be to shift the focus from gender to anatomy, conditions, and symptoms. This means using language that describes specific body parts and functions, rather than assuming that certain conditions or symptoms are exclusive to one gender or another.
For example, instead of using terms like “male infertility” or “female infertility,” medical professionals can use terms like “sperm count” or “ovulation problems” to describe specific conditions or symptoms. Similarly, rather than using gendered terms like “menstrual cramps” medical professionals can use more specific language like “dysmenorrhea” to describe the symptoms.
By shifting the focus of medical language from gender to anatomy, conditions, and symptoms, we can ensure that all individuals receive accurate and inclusive healthcare. This approach also acknowledges that individuals may have a range of gender identities and expressions, and that these identities do not necessarily correspond to their biological sex.
It is important to note that shifts in medical language are not just a matter of political correctness, but rather a crucial step in providing equitable healthcare. Inaccurate or exclusionary medical language can lead to misdiagnosis, delayed treatment, and a lack of access to appropriate care for marginalized communities. In contrast, more inclusive and accurate medical language can help ensure that all individuals receive the care and support they need to maintain their health and well-being.
DEI and LGBTQIA+
Diversity, equity, and inclusion (DEI) practices can greatly improve fertility outcomes and create a more welcoming environment for LGBTQIA patients in several ways:
Access to Care: DEI practices ensure that all patients have equal access to fertility care, regardless of their gender identity or sexual orientation. This includes providing education and resources to LGBTQIA patients about their fertility options, as well as making fertility services more affordable and accessible.
Culturally Sensitive Care: Fertility clinics that adopt DEI practices can provide culturally sensitive care to LGBTQIA patients. This involves understanding the unique challenges that LGBTQIA individuals face when seeking fertility treatment and developing care plans that are tailored to their specific needs.
Inclusive Language: Fertility clinics that use inclusive language can create a more welcoming environment for LGBTQIA patients. This involves using gender-neutral language and avoiding assumptions about gender and sexual orientation.
Provider Diversity: DEI practices promote provider diversity, which is essential in creating a more welcoming and inclusive environment for LGBTQIA patients. Clinics should strive to hire providers who are representative of the diverse patient population they serve.
Patient Advocacy: Fertility clinics can serve as patient advocates by advocating for policies that promote DEI in healthcare. This includes supporting legislation that protects the rights of LGBTQIA patients, as well as advocating for insurance coverage for fertility treatments.
The table below gives a sample DEI plan, and provides space to record a point person on the executive team, DEI group members who might participate, and a strategy to include staff from the whole company.
|DEI Initiative by|
|Activities||Executive Staff||DEI Group Members||Strategy to include all staff|
|Human Resources||Recruiting – all levels|
|Talent Pipeline – Bridging the gap to local schools and Universities|
|Diversity Survey: What is does the diverse make-up of your company look like?|
More than two options (MANY options)
• Sexual orientation
• Parental status
• Marital status
• Disability (physical or otherwise)
• Salary equity
• Equitable promotions and raises
• Diversity in leadership positions?
Inclusion: Understanding the employee experience.
• “I can voice a contrary opinion without fear of negative consequences”
• “people from all backgrounds have equal opportunities to succeed ”
• “perspectives like mine are included in the decision-making at my company”
|Marketing||Analyze your social media feeds for each clinic. Does your social media feed display a range of skin tones? A range of relationships? A spectrum of genders?|
|Your ads and creative content should show diversity. Captions and posts should use inclusive language.|
|Amplify publications related to disparity in outcomes, eduction, or access. Show you care about these issues.|
|“Like,” follow, and occasionally share (amplify) the content of diverse creators.|
|Ask physicians and scientists to participate in diverse infertility events and share. Ask them to use inclusive language in social media posts. Educate them on inclusive language.|
|Can you create sections on the IVF Clinic website that speaks to the lived experience of BIPOC, LGBTQI+. Can you use inclusive language whenever possible “Pregnant persons” People with a uterus” “Birthing person” “Chest Feeder”?|
|Clinical||Change all paper or electronic forms to use inclusive language (LGBTQ, race, and ethnicities). Patient and Partner (instead of female and male)|
|Increase visual representation in waiting rooms, magazines, pictures, baby pictures|
|Attendance at Men Having Babies or other diverse conferences or symposia|
|Can you parse your SART data or EMRs and strategize for one abstract / publication a year on a topic related to diversity? |
What are the IVF success rates of BIPOC at your IVF clinic?
What are the ethnic backgrounds of the internal donor egg banks? (Can you recruit more diverse backgrounds?)
Do the patients reflect the diversity of the area surrounding your IVF clinic?
Does your patient satisfaction surveys have queries for culturally sensitive and competent, or LGBTQI+ specific care?
|IVF Laboratory||Seminar on lab handling of HIV+ sperm and embryos. Education about SPAR processing.|
|Changes in lab protocols to accommodate egg donor splits for male:male couples.|
|Coordinate with clinic for abstracts and papers related to DEI|
|Internal Network||Mission, Vision, Contract with executive team|
|DEI newsletter, 2x per year posted on HR staff management platform and emailed to staff|