Table 1.

Common barriers to care and solutions in place at Bellevue Hospital

Barrier	Solution
Language	Language line offering telephone translation services in > 100 languages, 24 h day/7 days a week. Also includes American sign language and face-to-face interpretation
- > 100 number of languages spoken at Bellevue
Cost	- Sliding scale pricing for HSG
- HSG cost $290–700	- Patient-friendly management – HSG only performed in the context of unexplained infertility or 3 failed OI cycles among anovulatory patients
	- Outside referral for competitively-priced HSG
- IUI cost $100	- IUI semen wash performed at reduced cost; first IUI wash often also utilized as initial SA
Ovulation induction monitoring	- Clinic Team Approach: Performed by OB/GYN residents and faculty either in clinic (weekdays) or on labor and delivery (weekends)
	- New resident continuity approach: dedicated ultrasound room for daily drop in monitoring, 2 h daily (7 days/week), REI resident on rotation M-F, OBGYN call team on weekends. Remote REI fellow precepting
	- Same day endocrine monitoring reserved only for special circumstances
No access to ART through Bellevue hospital	- Referral to local centers with sliding scale IVF programs or low-cost IVF
	- Perform all bloodwork, imaging and testing required for ART at HHC prior to referral
	- Same options for fertility preservation patients
Preconception carrier screening	- Limit testing to ACOG recommended testing