# Estimating population level infertility and fertility treatment rates

> **NIH NIH R03** · UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA · 2020 · $75,364

## Abstract

Abstract
Infertility is more than a quality of life issue and is recognized as a disease of the reproductive system by the
World Health Organization along with the American Society for Reproductive Medicine, and is is a disability 
under the Americans with Disabilities Act. The right to procreate is considered a fundamental human right, yet large
racial, ethnic, and geographic disparities persist in risk factors for infertility and for individuals who seek access to
diagnostic and treatment services. Public health programs rely on accurate estimates to not only target services
to vulnerable subpopulations, but also to identify strategies for prevention and for the provision of quality care and
services for infertility. Thus, methodologies that enable researchers and public health programs to more 
accurately estimate the magnitude of the problem and differentiate risk factors related to prevention versus access to
care are needed. The current duration approach is a novel statistical methodology for estimating the distribution
of time-to-pregnancy (TTP), which can be used to assess fecundity (the biologic capacity for reproduction) and
infertility (a TTP of 12+ months). It uses cross-sectional data, which has advantages to other data sources 
including the ability to be nationally representative, and quality public data sources like the National Survey of Family
Growth (NSFG) are available. These advantages are tempered by the inability of current biostatistical methods
to appropriately handle women that had undergone infertility treatment before sampling. Current methods rely on
ad hoc fixes, which we show can bias results and lead to inconsistent inferences, particularly with the increased
availability of infertility treatments. The objective of this application is to develop statistical methods that can be
used to estimate the distribution of TTP and time-to-fertility-treatment (TTFT), then apply those methods to 
determine trends in infertility and fertility treatment, and identify subgroups with higher rates of infertility and low
access to fertility treatment. Overall, the Specific Aims of the proposal are (A1) develop semi-competing risk 
current duration methodology for estimation of the distribution of TTP and TTFT from cross-sectional data, including
the incorporation of covariate data, (A2) obtain nationally-representative prevalence estimates of infertility over
time in the United States by applying the methodology from Aim 1 to NSFG cycles from 2002, 2006-2010, and
2011-2015, and (A3) examine subgroups and risk factors associated with prolonged TTP or TTFT using the most
recent NSFG cycle (2011-2015). The significance of this contribution lies in the findings on the current trends in
infertility, and risk-factors associated with infertility and low access to fertility treatment. These findings can be
used by clinicians and public health programs to target interventions and address barriers in access to care. We
will further the field ...

## Key facts

- **NIH application ID:** 9852333
- **Project number:** 5R03HD097287-02
- **Recipient organization:** UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
- **Principal Investigator:** Alexander C McLain
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $75,364
- **Award type:** 5
- **Project period:** 2019-01-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9852333

## Citation

> US National Institutes of Health, RePORTER application 9852333, Estimating population level infertility and fertility treatment rates (5R03HD097287-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9852333. Licensed CC0.

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