Use of fertility treatment modalities in a large United States cohort of professional women

Objective To evaluate the use of fertility treatments among a large cohort of women in the United States. Design Cohort study. Setting Nurses' Health Study II. Patient(s) Ten thousand thirty-six women who reported having used fertility treatment on biennial questionnaires from 1993-2009. Intervention(s) None. Main Outcome Measure(s) Data on patterns of treatment modality were collected via self-report from validated mailed questionnaires. Information on clomiphene, gonadotropin injections alone, and gonadotropin injections as part of intrauterine insemination (IUI) and in vitro fertilization (IVF) was queried. Result(s) Most women who reported fertility treatment used clomiphene (94%), with a large majority reporting clomiphene as their only form of treatment (73%). Of women who reported treatment more advanced than clomiphene, 13% had used gonadotropin injections alone, 11% IUI treatment, and 11% IVF. Several subgroups were more likely to use multiple treatment modalities and to initiate treatment with gonadotropins rather than clomiphene, including women living in states with insurance coverage of fertility procedures, with higher household income, younger in age, who remained nulliparous at the study close, and treated after 2000. Conclusion(s) Results should be interpreted cautiously, but to our knowledge, this represents the first study of fertility treatment patterns in the United States and could inform public health planning.