18 million US women of reproductive age live in 'fertility deserts' with zero access to a local IVF clinic

Approximately 18 million reproductive-aged women in the United States lack any regional access to assisted reproductive technology (ART), and an additional 7 million have access to only a single IVF clinic, while 80% of fertility clinics are concentrated in metropolitan areas with high median incomes. Why it matters: women in rural and remote areas must travel long distances for monitoring appointments that IVF requires every 2-3 days during a cycle, so the time burden and travel costs (flights, hotels, time off work) add thousands of dollars to already expensive treatment, so women in these areas are more likely to receive less effective oral medications (like Clomid) rather than IVF, so geographic location becomes a primary determinant of fertility treatment quality and outcomes, so the 300,000 IVF cycles performed annually in the US represent only 10% of the estimated 3 million cycles needed to meet actual demand. The structural root cause is that reproductive endocrinology fellowship programs produce only about 50-60 new specialists per year nationally, fertility clinics cluster in wealthy metro areas because the uninsured cost model requires a high-income patient base to be profitable, and the monitoring-intensive nature of IVF protocols (requiring frequent ultrasounds and blood draws) has not been redesigned for remote delivery despite telehealth advances in other medical fields.