Practice Committee of the American Society for Reproductive Medicine (2025). Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion. Fertility and sterility, 124(5 Pt 2), 974-984. https://doi.org/10.1016/j.fertnstert.2025.08.003
Practice Committee of the American Society for Reproductive Medicine. Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion. Fertility and sterility. 2025;124(5 Pt 2):974-984. doi:10.1016/j.fertnstert.2025.08.003
Practice Committee of the American Society for Reproductive Medicine. "Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion." Fertility and sterility, vol. 124, no. 5 Pt 2, 2025, pp. 974-984.
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Abstract
It has been estimated that only a quarter of persons with infertility in the United States can sufficiently access infertility care. Against this backdrop of disparity, specific populations, including persons of color, sexual and gender minorities, immigrants, and lower-income persons, face barriers that further constrain access to care. This document outlines these communities' barriers and reviews best practice recommendations to extend inclusive access to care for marginalized populations. This reference is intended to support health professionals with knowledge of barriers that limit access to care and to provide practical strategies to improve access and optimize healthcare delivery.
Practice Committee of the American Society for Reproductive Medicine, 2026·Fertility and Sterility
Current strategies for the assessment and treatment of recurrent pregnancy loss are discussed. This replaces the previous document, titled, "Evaluation and treatment of recurrent pregnancy loss: a committee opinion," last published in 2012.
Guidelines by Clinical Area · Fertility and Infertility Guidelines
Practice Committee of the American Society for Reproductive Medicine, 2024·Fertility and Sterility
In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use. Although the negative impact of tobacco use in pregnancy is well documented, the impact of tobacco and marijuana on fertility and reproduction is less clear. This committee opinion reviews the potential deleterious effects of tobacco, nicotine, and marijuana use on conception, ovarian follicular dynamics, sperm parameters, gamete mutations, early pregnancy, and assisted reproductive technology outcomes. It also reviews the current status of tobacco smoking cessation strategies. This document replaces the 2018 American Society for Reproductive Medicine Practice Committee document entitled Smoking and Infertility: a committee opinion (Fertil Steril 2018).
Guidelines by Clinical Area · Fertility and Infertility Guidelines
Practice Committee of the American Society for Reproductive Medicine, 2024·Fertility and Sterility
Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology. This systematic review aims to identify who is at high risk for developing ovarian hyperstimulation syndrome, along with evidence-based strategies to prevent it and replaces the document of the same name last published in 2016.
Guidelines by Clinical Area · Fertility and Infertility Guidelines
Practice Committee of the American Society for Reproductive Medicine, 2022·Fertility and Sterility
This committee opinion provides practitioners with suggestions for optimizing the likelihood of achieving pregnancy in couples or individuals attempting conception who have no evidence of infertility. This document replaces the document of the same name previously published in 2013 (Fertil Steril 2013;100:631-7).
Related research
Policy and Regulation · Access and Coverage Policy
Van Der Poel S et al., 2018·Fertility and Sterility
There are reports that define the significant unmet need for access to fertility care and infertility interventions for heterosexual couples - those who experience involuntary childlessness and who desire a biological child. This need for access to care rarely measures those couples in non-heterosexual relationships, single individuals or in key/neglected populations. This disparity in recognition of need, and resultant lack of access to care is glaring. Universal access and attainment of the highest standard of care requires the provision of high-quality information and services that fulfills, protects and respects all individuals. The objective of this study was to identify the key principles that support access to fertility care and infertility interventions, and to provide a human rights framework to guide processes during the development of draft recommendations to the World Health Organization (WHO) for clinical practice. To evaluate the public health and human rights and gender impact on infertility, a literature review and systematic analysis were conducted to look at the following questions. What are the existing policies, public health directives and research evidence gaps impacting gender and human rights in the context of involuntary childlessness and infertility; and, What human rights principles guide the development and implementation of fertility care and infertility related laws, policies and systems? A detailed search strategy in collaboration with the WHO-HQ librarian, introducing various combinations of a predetermined set of terms was undertaken to identify primary literature, systematic reviews and gray literature, including documentation regarding current status of human rights and gender equality within policy and practices. Using the search strategy defined, we were able to identify 488 articles and documents, of which 102 were found appropriate. They were then categorized using 9 principles previously identified by WHO and used to address the topic of contraception. From this process, we generated a list of 12 principles which will be presented that cover issues such as non-discrimination, non-stigmatization as well as informed-decision making and autonomy, sharing of benefits and ensuring provision of care that includes the recognition of the health and well-being of the parent or parents as well as the children born. During the systematic review of the published data and evidence for the development of draft clinical recommendations to be presented to and for the World Health Organization consideration, it was clear that a human rights framework was required. Our systematic review process used research and policy evidence to support the development of a framework of principles that can better ensure different human rights dimensions are clearly and systematically integrated into the provision of fertility care information and fertility interventions and services.
Ethics Committee of the American Society for Reproductive Medicine, 2015·Fertility and sterility
In the United States, economic, racial, ethnic, geographic, and other disparities exist in access to fertility treatment and in treatment outcomes. This opinion examines the factors that contribute to these disparities and proposes actions to address them.
Mackay A et al., 2023·Pharmacy·Free full text on PubMed Central
Infertility impacts millions of people of reproductive age worldwide, with approximately 10–15% of couples affected. When infertility is present, there are many potential barriers to treatment, leading to inequity of access. Assisted reproductive technologies (ART) are the mainstay of medical treatment for infertility and include procedures such as in vitro fertilisation. This scoping review aims to explore the barriers to accessing assisted reproductive technologies to highlight a potential role for the pharmacist in addressing these barriers. Five databases, including CINAHL, Emcare, Medline, Scopus, and Web of Science, were searched using keywords that resulted in 19 studies that explored barriers to initially accessing or continuing ART. Studies identified more than one barrier to accessing ART, with the most mentioned barrier being the geographic location of the patient, with others themed as psychological, financial, minority groups, educational level, and the age of the patient. Recommendations were made to address barriers to accessing ART, which included changes to government regulations to increase health education and promotion of infertility. Pharmacists’ accessibility, even in geographically remote locations, places them in an ideal position to address many of the challenges experienced by people accessing infertility treatment to improve outcomes for these people.
Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, 2021·Fertility and sterility
In the United States, economic, racial, ethnic, geographic, and other disparities prevent access to fertility treatment and affect treatment outcomes. This opinion examines the factors that contribute to these disparities, proposes actions to address them, and replaces the document of the same name, last published in 2015.
Clinical Guidelines and Standards › Guidelines by Clinical Area › Fertility and Infertility Guidelines · Ethics and Policy › Reproductive Ethics › Access to Treatment · Ethics and Policy › Reproductive Ethics › LGBTQ Rights
Clarisa Gracia, Rebecca Flyckt, Madeline Brooks, Micah Hill, Tarun Jain, Denny Sakkas, Bruce Pier, Anne Steiner, Jake Anderson, Cigdem Tanrikut, Belinda Yauger, Karl Hansen, Suleena Kalra, Robert Brannigan, Elizabeth Ginsburg, Jared Robins, Chevis Shannon, Jessica Goldstein, Benjamin Peipert, Denise Asafu-Adjei, Tolulope Bakare, Jacob Christ, Heather Hipp, Tia Jackson-Bey, Quinton Katler, Holly Mehr, Jerrine Morris, Michelle Vu
C Gracia, Becky Flyckt, R Flyckt, M Brooks, M Hill, T Jain, D Sakkas, B Pier, A Steiner, J Anderson, C Tanrikut, B Yauger, K Hansen, S Kalra, Bob Brannigan, Rob Brannigan, Bobby Brannigan, R Brannigan, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, J Robins, C Shannon, Jess Goldstein, J Goldstein, Ben Peipert, B Peipert, D Asafu-Adjei, T Bakare, J Christ, H Hipp, T Jackson-Bey, Q Katler, H Mehr, J Morris, M Vu
PMID 40914668 40914668 DOI 10.1016/j.fertnstert.2025.08.003 10.1016/j.fertnstert.2025.08.003 Practice Committee of the American Society for Reproductive Medicine et al. 2025, Practice Committee of the American Society for Reproductive Medicine 2025
Cite this article
Practice Committee of the American Society for Reproductive Medicine (2025). Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion. Fertility and sterility, 124(5 Pt 2), 974-984. https://doi.org/10.1016/j.fertnstert.2025.08.003
Practice Committee of the American Society for Reproductive Medicine. Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion. Fertility and sterility. 2025;124(5 Pt 2):974-984. doi:10.1016/j.fertnstert.2025.08.003
Practice Committee of the American Society for Reproductive Medicine. "Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion." Fertility and sterility, vol. 124, no. 5 Pt 2, 2025, pp. 974-984.
Keywords
Infertility, access to care, health disparities, inequities, minoritized race and ethnicity