Effect of race and ethnicity on utilization and outcomes of assisted reproductive technology in the USA

Alice J Shapiro,Norbert Gleicher,Sarah K Darmon,David H Barad,David F Albertini,Vitaly A Kushnir

doi:10.1186/s12958-017-0262-5

Abstract

BackgroundThe purpose of this study was to determine the utilization and live birth rates of assisted reproductive technology (ART) modalities among various racial and ethnic groups in recent years.MethodsWe reviewed ART data reported to the Society for Assisted Reproductive Technologies Clinic Outcome Reporting System (SART CORS) for autologous ART and third-party ART (3ART) cycles which involved donor oocytes, sperm, embryos and gestational carrier, performed in the U.S. between 2004 and 2013. To gauge demand by various racial/ethnic groups for ART services, we examined fertility rates and demographics of the entire U.S. birth cohort over the same time interval.ResultsOf 1,132,844 autologous ART cycles 335,462 resulted in a live birth (29.6%). An additional, 217,030 3ART cycles resulted in 86,063 live births (39.7%). Hispanic and Black women demonstrated high fertility and lower utilization rates of autologous ART and 3ART. Caucasian and Asian women exhibited lower fertility rates and higher autologous ART and 3ART utilization. Autologous ART resulted in higher live birth rates among Caucasian and Hispanic women and lower rates among Asian and especially Black women. 3ART improved live birth rates in all races/ethnicities, though Black women experienced lower live birth rates with most modalities. Spontaneous abortion rates were higher among Black women following autologous ART and some 3ART modalities than those among Caucasian women.ConclusionUtilization of ART is inversely related to fertility rates. Autologous ART produces lower live birth rates among Asian and Black women. 3ART results in relatively low live birth rates among Black women.Trial registrationSART CORS #57, Registered 5/14/2015

Highlights

The purpose of this study was to determine the utilization and live birth rates of assisted reproductive technology (ART) modalities among various racial and ethnic groups in recent years
We found that the proportion of cycles which did not report racial/ethnic data have somewhat decreased in more recent years, this highlights the importance of reporting race and ethnicity information by individual practices when submitting data to Society for Assisted Reproduction (SART)
Utilization of ART is inversely related to fertility rates in the general population

Summary

Introduction

The purpose of this study was to determine the utilization and live birth rates of assisted reproductive technology (ART) modalities among various racial and ethnic groups in recent years. It has been reported that non-Hispanic Black women have 24–38% lower live birth rates than non-Hispanic Whites in fresh non-donor ART cycles, even when adjusting for confounders [3]. They reportedly experience more spontaneous abortions, defined as pregnancy loss prior to 20 weeks. This difference may be attributable in part to a higher prevalence of uterine leiomyomas in the non-Hispanic Black population [4], as they are significantly more likely to have uterine factor infertility than non-Hispanic White women [5].

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