Ethnicity and In Vitro Fertilization Outcomes in an Equal Access to Care Setting [ID 2683634

Abstract

INTRODUCTION: Many studies report racial disparities in assisted reproductive technology (ART) outcomes, specifically, lower pregnancy rates and higher miscarriage rates in Black women. In an equal access to care setting, we wanted to delineate causes of this ongoing racial disparity. METHODS: This is a retrospective review of ART cycles at Brooke Army Medical Center (BAMC) from 2013 to 2021 via the Society for Assisted Reproductive Technology database. This study received a nonresearch designation from the BAMC IRB. RESULTS: A total of 1,211 in vitro fertilization (IVF) cycles were reviewed, comparing outcomes by race from first-time embryo transfers, fresh or frozen after “freeze-all” IVF cycles. Black women (19% of all cycles) experienced a lower live birth rate (27.3% versus 34.6%; risk ratio [RR] 0.75; 95% CI 0.6–0.94), but did not experience a statistically significant increase in pregnancy loss (36.8% versus 30.6%; RR 1.26; 95% CI, 0.94–1.68] compared to all other patients. Black women were found to have a higher prevalence of uterine factor infertility (RR 2.87; 95% CI, 2.24–3.66) and tubal factor infertility (RR 1.79; 95% CI, 1.51–2.12). When controlling for uterine factor infertility, Black racial identity was no longer a risk factor for decreased live birth rate (adjusted RR 0.85; 95% CI, 0.69–1.07). CONCLUSION: Recent literature demonstrates poorer ART outcomes for Black women. Our study suggests that this may be attributable to uterine fibroids, and an increased research focus on uterine fibroid treatment in patients desiring fertility may improve ART outcomes in Black women.