Demographic Shifts of Women Receiving Insurance-Covered Fertility Services Using the National Survey of Family Growth (NSFG) 2017-2019 vs. 2022-2023

Objective: To evaluate whether the demographic profile of women in the United States receiving insurance-covered fertility services has shifted amid expanding state insurance mandates and post-pandemic care delivery changes. Design: This is a cross-sectional analysis of two cycles of the National Survey of Family Growth (NSFG), a nationally representative probability survey of women aged 15-49 conducted by the National Center for Health Statistics. Materials and Methods: We analyzed female respondents in the NSFG 2017-2019 and 2022-2023 public-use files who reported ever receiving medical help to become pregnant and indicated that any portion of those services was covered by insurance. Demographic variables included race, Hispanic ethnicity, highest completed education, total household income, age at first medical visit for fertility help, and self-reported history of cancer. All estimates incorporated NSFG sampling weights to produce nationally representative point estimates with 95% confidence intervals (CIs) computed using the Delta method. Results: The analytic sample included 311 women in 2017-2019 (representing 4.3 million U.S. women) and 378 in 2022-2023 (4.7 million). The proportion identifying as Hispanic rose from 8.8% (95% CI 5.7-13.4) to 12.6% (9.1-7.2) (p = 0.05); race/ethnicity composition was otherwise stable (p = 0.22 for combined comparison). Educational attainment shifted upward (p = 0.002): respondents with no college degree fell from 31.7% to 22.7%, while doctoral or professional degree holders more than tripled, from 2.7% to 9.8%. Household income also rose (p = 0.01): family income ≥$100,000 increased from 46.5% to 59.7%, and income below $50,000 fell from 25.3% to 16.0%. Weighted mean age at first medical visit for fertility help (30.2 vs. 30.4 years; p = 0.71) and history of cancer (5.7% vs. 5.8%; p = 0.96) were unchanged. Conclusions: Despite expanding state insurance mandates and growth in employer-sponsored fertility benefits, access to insurance-covered fertility care in the U.S. continued to concentrate among more highly educated and higher-income women between 2017-2019 and 2022-2023 cohorts. Identifying structural and non-financial barriers that persist beyond coverage is essential to advancing equitable access to family-building care.