Factors associated with disparate outcomes among Black women undergoing in vitro fertilization

Luwam Ghidei; Ashley Wiltshire; Christina Raker; Archana Ayyar; Lynae M Brayboy

doi:10.1016/j.xfre.2021.12.002

Factors associated with disparate outcomes among Black women undergoing in vitro fertilization

F S Rep. 2021 Dec 10;3(2 Suppl):14-21. doi: 10.1016/j.xfre.2021.12.002. eCollection 2022 May.

Authors

Luwam Ghidei¹, Ashley Wiltshire², Christina Raker³, Archana Ayyar⁴, Lynae M Brayboy^{5

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Affiliations

¹ Department of Obstetrics and Gynecology, Brown University Alpert Medical School and Women & Infants Hospital, Providence, Rhode Island.
² Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, 660 1st Ave, New York City, New York.
³ Department of Obstetrics and Gynecology, Division of Research, Brown University Alpert Medical School and Women & Infants Hospital, 101 Dudley Fl 1, Providence, Rhode Island.
⁴ Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
⁵ Division of Reproductive Endocrinology and Infertility, Brown University Alpert Medical School and Women & Infants Hospital, 101 Dudley Fl 1, Providence, Rhode Island.
⁶ Clue by Biowink, Berlin, Germany.
⁷ Department of Molecular Biology, Cell Biology & Biochemistry Alpert Medical School of Brown University Providence, Rhode Island.
⁸ Department of Neuropediatrics Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Abstract

Objective: To determine if Black women have worse in vitro fertilization (IVF) outcomes than women of other races/ethnicities, and to establish which factors are associated with the IVF outcomes of Black women.

Design: Retrospective cohort study.

Setting: Not applicable.

Patients: All patients undergoing IVF.

Interventions: Not applicable.

Main outcome measures: Spontaneous abortion rate, clinical pregnancy rate, and live birth rate.

Results: A total of 71,389 patient cycles were analyzed. Of the 40,545 patients who were included, 6.4% of patients were Black, 62% were White, 7.3% were Hispanic/Latino, and 15% were Asian. After IVF, Black women had significantly more miscarriages than White but not Hispanic or Asian patients (8.0% Black vs. 6.9% White, 7.4% Hispanic, and 7.5% Asian). Clinical pregnancy rates were significantly lower for Black women compared with all other races (45% Black vs. 52% White, 52% Hispanic, and 53% Asian). The odds ratio (OR) of live birth from all cycles were 30% less than that for White women (OR, 1.00 Black vs. 1.43 White) and 22% less than that for Hispanic women (OR, 1.00 Black vs. 1.29 Hispanic). This statistically significant difference in the live birth rate persisted even after adjusting for patient characteristics (OR, 1.00 Black vs. 1.32 White, 1.23 Hispanic, and 1.18 Asian).

Conclusions: Black women have worse IVF outcomes than women of all other racial backgrounds undergoing IVF. The factors associated with the disparate outcomes of Black women undergoing IVF outcomes include older age starting IVF, higher body mass index, tubal factor infertility, and diabetes.

Keywords: Assisted reproductive technology; health care disparity; in vitro fertilization; racial disparity.