Impact of native language on the pursuit of fertility care.

RESEARCH QUESTION: Are there any differences in the demographics, diagnostic work-up, fertility treatments attempted, and clinical pregnancy rate between patients whose native language is English compared with those whose native language is not English at a reproductive endocrinology and infertility (REI) clinic within an urban safety-net hospital in the USA?

DESIGN

This retrospective cohort study included 321 patients who presented at the REI clinic between 2016 and 2022 with concern of infertility. The exposure of interest was native language spoken: English versus non-English. The primary outcome measure was attempt at any type of fertility treatment. Secondary outcome measures included completion of infertility diagnostic work-up, clinical pregnancy, and discontinuation of care.

RESULTS

Among patients evaluated for infertility, 106 (33%) reported a native language other than English. Of 266 patients who underwent fertility testing, 218 (82%) completed sufficient diagnostic work-up to determine the type of infertility. Types of infertility were similar between the two groups, except for tubal factor infertility which was more common in native-English-speaking patients [62 (29%) versus 15 (14%); P = 0.003]. Fifty-six percent (149/266) of patients who underwent diagnostic testing for infertility attempted fertility treatment. Patients whose native language is not English were significantly more likely to attempt fertility treatment (adjusted risk ratio 1.44, 95% CI 1.09-1.91; P = 0.011) and to achieve clinical pregnancy (adjusted risk ratio 1.72, 95% CI 1.07-2.76; P = 0.025) compared with native-English-speaking patients. In total, 141 (44%) patients discontinued care.

CONCLUSIONS

Patients whose native language is not English were more likely to attempt fertility treatment and achieve clinical pregnancy compared with native-English-speaking patients. This suggests that, in a setting in the USA which aimed to reduce disparities and improve access to care, patients can overcome language barriers to pursue fertility care and undergo treatment.