Infertility care: Examining geographic gaps in access

In this video, Elie Kaplan-Marans, MD, an andrology fellow at Northwestern University, discusses research examining geographic and structural disparities in access to infertility care across the US, with a focus on the distribution of reproductive urologists compared with reproductive endocrinology and infertility (REI) specialists. These data were presented at the 27th Annual Fall Scientific Meeting of the SMSNA in Orlando, Florida and published in Urology Practice.^1,2

The study used national provider directories from the American Society for Reproductive Medicine to assess the geographic distribution of both specialties across states and counties and evaluate the association between state fertility insurance mandates and provider density. Investigators identified 625 REI specialists and just 80 reproductive urologists, representing a nearly 8-to-1 work force imbalance. Additionally, 28 states had no listed reproductive urologist, compared with 5 states without a listed REI specialist. At the county level, reproductive urologists were represented in just 51 of 3143 counties (1.6%), compared with 177 counties (5.6%) for REI specialists.

The study also found that stronger state fertility insurance mandates were associated with greater reproductive urologist density (P = .007) and REI density (P = .010), suggesting a potential relationship between insurance policy and access to specialized care.

Kaplan-Marans discusses how these work force disparities may affect the delivery of infertility care, particularly the evaluation of male partners. Limited access to reproductive urologists at fertility clinics may contribute to delayed or overlooked male infertility evaluations, potentially resulting in missed opportunities to identify treatable causes of infertility. He also notes that proceeding with assisted reproductive technologies without a comprehensive evaluation of the male partner may place additional emotional and medical burdens on female partners.

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REFERENCE

1. Kaplan-Marans E, Menken O, Brannigan R. Imbalance and Geographic Disparities in the U.S. Fertility Workforce: Reproductive Endocrinology, Reproductive Urology, and Insurance Mandates. Presented at: 27th Annual Fall Scientific Meeting of SMSNA. October 8-11, 2026. Orlando, Florida. Abstract 368

2. Kaplan-Marans E, Menken O, Deebel N, Bennet N, Brannigan R. Advancing Male Reproductive Health: Geographic and Structural Gaps in Infertility Care. Urol Pract. 2026:101097UPJ0000000000001073. doi:10.1097/UPJ.0000000000001073