Table 1.

Barriers encountered by socioculturally diverse, lower-income patient populations seeking infertility care.

Barrier type	Barriers encountered
Accessibility	•Bureaucracy of health care systems •Legal status of immigrants and fear of deportation •Difficulty accessing infertility specialists •Difficulty scheduling appointments •Transportation •Lack of childcare •Lack of social support
Biases	•Racism and discrimination •Implicit bias and false perceptions by health care professionals •Lack of diversity in the REI field •Cultural stigmatization of infertility •Deprioritization of infertility by health care systems •Patient distrust of health care institutions
Communication	•Language barriers •Availability of interpreters •Health literacy •Lack of language and literacy appropriate educational materials •Lack of cultural understanding by providers
Cost	•High cost of health care •Limited or lack of insurance coverage •Lack of public health insurance coverage •Financial transparency •Inability to qualify for discount programs
Efficiency	•Resource-constrained clinics •Lack of clinic infrastructure for providing infertility care •Onsite availability of diagnostic testing (e.g., SA, HSG) •Lack of streamlined protocols for diagnostic evaluation and treatment •Lack of referral pathways for subspecialty care and ART •Lack of provider continuity •Delays in follow-up

Note: Primary barriers to infertility care among minority, immigrant, and lower resource patients. ART = assisted reproductive technologies; HSG = hysterosalpingogram; REI = reproductive endocrinology and infertility; SA = semen analysis.