New Research Highlights Barriers, Disparities, and Emerging Challenges in Fertility Care

BALTIMORE, MD — New research presented at American Society for Reproductive Medicine’s (ASRM) 2026 Scientific Congress & Expo examines the factors shaping who can access fertility care and the quality of information and support patients receive.

Across 11 featured studies, researchers explored disparities tied to socioeconomic status, race and ethnicity, geography, insurance coverage, sexual orientation, and health system practices, as well as barriers to fertility preservation for cancer patients.The research also examines emerging challenges, including social media misinformation and the growing use of artificial intelligence. Together, the findings highlight opportunities to expand access to timely, evidence-based fertility care and ensure reproductive technologies are meaningfully accessible to patients.

Among the research presented at this year’s Congress, 11 studies highlight these challenges and emerging trends across four key areas:

Socioeconomic and Geographic Disparities

• Social Determinants of Male Fertility: The Impact of Socioeconomic Deprivation on Semen Quality in a Nationwide Cohort, by Juan P. Varela et al.: In a nationwide study of more than 29,000 men, researchers found that living in neighborhoods with greater socioeconomic disadvantage was significantly associated with lower sperm concentration and total motile sperm count, highlighting a link between social and economic conditions and male reproductive health.
• Individual and Area-Level Variation in Access to Assisted Reproductive Technology Among Female Cancer Patients in the United States, by Isabel Beshar et al.: Researchers found significant disparities in access to fertility treatment among female cancer patients. Hispanic and non-Hispanic Black patients, those with public insurance, and those living in lower-income, less-educated areas or farther from fertility clinics were significantly less likely to use assisted reproductive technology after a cancer diagnosis.
• Availability Without Access: Global Disparities in Public ART Coverage Across World Health Organization Regions, by Yinny Chan et al.: A global analysis found significant disparities in public funding for assisted reproductive technology, even in regions where ART services are widely available. The findings suggest that affordability and public coverage, rather than the availability of the technology itself, remain major barriers to equitable fertility care worldwide.
  
  

Insurance Coverage and Financial Barriers

• Costs Associated with Health Insurance Coverage for In Vitro Fertilization (IVF) from the Perspective of Employers, by James M. Dupree et al.: A nationwide analysis found that employers offering IVF coverage spent an average of $1.12 per member per month on IVF services. Costs were lower for larger and self-insured employers, providing new data to help employers and policymakers assess the financial impact of expanding IVF coverage.
• Employer-Sponsored Fertility Benefit Coverage Among 100 Large Self-Funded Employers in the United States, by Christina Agostino et al.: An analysis of 100 large self-funded employers found wide variation in fertility benefits. While 60% of plans covered IVF, roughly one-third explicitly excluded it, highlighting significant differences in access to fertility care depending on an employer’s benefit design.
• In Vitro Fertilization (IVF) Coverage in Name Only: A Qualitative Analysis of Hidden Barriers in Insurance Benefit Design, by Hannah Glick et al.: Among employer health plans that covered IVF, 65% included at least one barrier that could limit patients’ ability to use the benefit. These included eligibility requirements, administrative hurdles, waiting periods, and exclusions affecting donor-assisted reproduction, surrogacy, and same-sex couples.
• Layered Inequities in Infertility Coverage: Heteronormative Definitions, Unequal Pathways, and Financial Barriers for Same-Sex Couples, by Rakasa Pattanaik et al.: An analysis of U.S. infertility mandates found that many policies create barriers to IVF access for same-sex couples through definitions based on heterosexual intercourse, limited coverage for different family-building pathways, and significant out-of-pocket costs. The disparities are particularly pronounced for male same-sex couples.
  
  

Artificial Intelligence, Social Media and Patient Information

• How Does ChatGPT Answer Common Patient Questions About Assisted Reproductive Technology? A Comparative Analysis with Established Patient Education Materials, by Nicole Mercado Fischer et al.: Researchers found that ChatGPT provided generally accurate and easy-to-read answers to common IVF questions but performed below ASRM patient education materials in accuracy, completeness, safety, and overall quality. Half of ChatGPT responses included unsupported claims, underscoring the importance of grounding AI-generated reproductive health information in authoritative sources.
• Clinical Misinformation and Care-Delay Framing in Fertility-Related Content on TikTok: A Content Analysis, by Madison Tyle et al.: An analysis of popular fertility-related TikTok videos found misinformation in 37% of content, most commonly involving unproven fertility interventions. Misinformation was substantially more common among non-clinical creators, and higher-severity misinformation was often linked to messaging that could delay fertility evaluation or evidence-based treatment.
• AI Can't Hear the Hurt: Sentiment Analysis Misclassifies Over a Third of Patient-Reported Harmful Statements in Infertility Care, by Steven Palter et al.: Researchers found that an AI sentiment analysis tool misclassified nearly 38% of statements that fertility patients identified as hurtful as neutral or positive. The findings highlight limitations in using automated sentiment analysis to assess patient experiences when harm depends heavily on clinical and emotional context.

Gaps in Fertility Care Delivery

• Identifying Gaps in Oncofertility Care Delivery Within the Military Health System, by Carissa J. Pekny et al.: Interviews across seven military medical facilities found inconsistent screening, counseling, referrals, and navigation of fertility preservation benefits for cancer patients. Researchers identified standardized workflows, clearer TRICARE processes, and stronger patient navigation as opportunities to improve timely access to fertility preservation.

Together, these studies illustrate how access to fertility care extends beyond the availability of treatment. From insurance design and socioeconomic conditions to health system practices and the growing influence of AI and social media, the research underscores the need to address persistent barriers and ensure patients can access timely, evidence-based reproductive care.