The American Society for Reproductive Medicine (ASRM) is passionate about promoting diversity within our membership and leadership, as well as promoting access to quality reproductive care for all patients without regard to race or ethnicity. ASRM acknowledges systemic racism interferes with and represents pervasive barriers to equal access and quality of care. As part of ASRM’s continued and unambiguous commitment to diversity, equity, and inclusion (DEI), in July 2020 a task force was established to address and produce tangible recommendations on how to best address health disparities and noninclusivity in our field and organization and remain on the cutting edge of nationwide DEI initiatives. In December 2021, the task force was converted to a standing ASRM DEI Working Committee.

The DEI Taskforce was charged with a 2-prong approach evaluating workforce and patient experience:

• Enhancing opportunities to increase and support DEI of underrepresented minority populations in the profession and leadership of reproductive medicine; and
• Reducing and, eventually, eliminating health disparities in access and outcomes to reproductive care

On November 30, 2020, the DEI Task Force released specific recommendations to the ASRM leadership that focused on (1) diversification of the reproductive medicine workforce and (2) providing equity in access and outcomes in reproductive care. Subsequently, the DEI Working Committee has continued to address the identified issues and execute sustainable solutions to these issues. An environment scan revealed data on the racial/ethnic diversity of reproductive care practitioners, including practicing reproductive endocrinology and infertility gynecologists (REIs), reproductive care nurses, mental health professionals, laboratory personnel, or laboratory directors, was largely absent. The task force’s recommendations included prioritizing enhanced research and data collection in this area. In December 2018, evaluation of 50 ACGME (Accreditation Council for Graduate Medical Education)-approved REI fellowships reported of 156 fellows’ demographics; only 7% identified as Black/African American (AA), 3.2% Hispanic/Latino, 14.1% Asian, and 3.8% Multiracial. From 2022 to 2023, evaluation of 49 ACGME-approved REI fellowships reported that of 173 fellows’ demographics it remains that 7% identified as AA, a slight increase, with 4.6 % Hispanic/Latino, a significant increase to 22% Asian, and those identifying as Multiracial remained at < 4% (Figure).¹

Figure. Number of active residents by specialty and subspecialty and race/ethnicity. Reprinted with permission from the Accreditation Council for Graduate Medical Education, Data Resource Book Academic Year 2022-2023.¹

An ASRM Ethics Committee opinion noted that disparities in access to reproductive health care include economic and noneconomic barriers.² Chief among noneconomic barriers are cultural and societal factors, such as stigma of infertility, bad experiences with the health care system, religious influences, and language barriers. Even in states with mandated insurance coverage for fertility treatment, racial and socioeconomic barriers persisted, hindering access to treatment.³ Barriers have resulted in Black women entering care a year or more later than White women, which can have significant negative implications because age is an important predictor of successful treatment. Barriers to care for single women, same-sex couples, and women of color exist as physicians may consciously or unconsciously make assumptions or possess biases about who deserves to be a parent and who wants or deserves treatment.⁴ In vitro fertilization outcomes and race/ethnicity, including 3 studies using data collected by the Society for Assisted Reproductive Technologies, suggest that when AA, Asian, and Hispanic women attain access to assisted reproductive technology they experience lower success rates compared with non-Hispanic White women.³

ASRM’s DEI Working Committee’s workforce subcommittee has created a virtual mentoring platform to raise awareness and increase the number of underrepresented (URM) residents successfully applying to REI fellowship. A small grant from EMD Serono funded development of the UpSquad ASRM mentoring platform, administered through an ASRM partnership with the Morehouse School of Medicine. Additionally, the grant included small research pilot grants for selection of a Serono DEI Fellow and faculty mentor, as well as 2 additional small research grants. Obstetrics and gynecology residents were recruited from programs without REI fellowships. Mentorship and sponsorship, critical factors in career success, are frequently lacking for URM groups. URM residents are not often mentored or sponsored and do not have research opportunities. The fellowship director’s survey from the National Resident Match Program cited demonstrated involvement and perceived interest in research 100% of the time and weight of importance was 4.5/5.⁵ The 2023 National Resident Match Program reports 40 REI fellowship programs, 48 positions, 1.6 applicants per position, and a 61% match rate (declined from 70% in 2022).⁶ REI fellowship programs have become more competitive, and research involvement and interest are heavily weighted. Our ASRM DEI mentoring program is designed to provide research experience for URM residents and increase their competitiveness. The residents were paired with an REI faculty to provide the opportunity to conduct a research project and possible clinical rotation at the mentor’s program. Faculty will mentor residents in career, research, work-life balance, and other areas of needs. We have also created an online learning community delivering a didactic curriculum covering REI clinical topics and research for residents. Additionally, we have recruited URM college and medical students, inviting them to attend sessions at the ASRM annual meeting and join our virtual community. A simulation lab was hosted to pique their curiosity about REI as a career.

Ultimately, to improve reproductive care for women of color clinicians must engage in evidence-based efforts to develop a diverse reproductive medicine workforce, optimize pathways of treatment, and mitigate cultural and financial barriers to care. Taken together, these important strategies can improve the lived experiences that women of color face as they navigate the difficult journey to parenthood.