Exploring Socio-Economic Characteristics Associated with Having a Live Birth Using Assisted Reproductive Technology Compared to Conceiving Naturally: Evidence from the UK Household Longitudinal Survey 2009-2022

Background: In England, the National Institute for Health and Care Excellence (NICE) guidance recommends that women under 43 years old are offered 3 cycles of in vitro fertilisation (IVF) on the publicly funded healthcare system if they have not conceived after two years. However, regional commissioners decide the funding allocated for IVF. Our study aims to assess socio-economic and regional factors associated with having a live birth after using IVF over time to determine if decreases in funding for IVF increase regional inequalities in live birth success rates. Methods: We use Understanding Society Survey data from 2009-2022 employing a random effects probit model to estimate the determinants associated with a live birth via IVF among women having given birth in the previous year. Next, we estimate a random effects probit model to compare the determinants of live birth from IVF between 2009-2018 and 2019-2022 to assess the impact of unequal decreases in funding across different regions of England. Results: Between 2009-2022, living in London, being older, in employment, degree level or higher education, and owning/mortgage home are positively and statistically significantly associated with a live birth using IVF. Comparing 2009-2018, to 2019-2022 with less generous funding we find that in Yorkshire and Humber, there is a decrease in women successfully conceiving using IVF. Married/cohabiting women are three percentage points more likely to have a live birth with IVF compared to single women in 2019-2022 compared to 2009-2018. Women living in a middle deprivation quintile area (3) are three percentage points more likely to have a live birth from IVF in 2019-2022 compared to 2009-2018. Conclusion: Lack of individual resources in conjunction with regional difference in in IVF funding contribute to inequalities in reproductive autonomy by reducing opportunities to access IVF.