Male Factor Infertility and the Rural-Urban Continuum

To examine the association between male factor infertility and the Rural-Urban continuum.

Single institution retrospective cohort study using the Utah Population Database, which combines demographic, medical, and residential data for patients residing in Utah and links to the Subfertility Health Assisted Reproduction and Environment database, which houses fertility data from 1998 to 2017. The data was divided by metropolitan (metro-) (large, medium, small) and non-metropolitan (non-metro-) (urban, rural) status, based on United States Department of Agriculture rural-urban continuum codes.

Non-metro urban/rural males were less likely to be a racial/ethnic minority (92.3% non-Hispanic white vs 86.2%) or use assisted reproductive technology (13.5% vs 18.5%). Multivariate regression controlling for race/ethnicity, age, semen analysis category (oligozoospermic vs normozoospermic), previous successful fertility outcome, and use of assisted reproductive technology, demonstrated complete rurality was associated with decreased likelihood of successful fertility outcome (Hazard Ratio [HR] 0.60, 95% CI 0.41-0.87, n = 49, P = 0.007). Non-metro urban individuals trended towards lower likelihood of successful fertility outcome ([HR] 0.90, 95% CI 0.82-0.98, P = 0.02). Complete rurality was associated with longer time for 50% cohort successful fertility outcome (>60 months vs approximately 34 months both metro), P = .007.

Across the rural-urban continuum, residing in a metro area was associated with higher rates of racial/ethnically diversity, fertility treatment utilization, and successful fertility outcomes (live births). Given approximately 18% of the United States resides with a rural community (12% in Utah), these findings can provide more informed infertility care.