Leiomyoma May Explain Racial Differences in ART Outcome Between African American and Caucasian Women

Abstract

ObjectiveAfrican American (AA) women have a lower overall success rate with ART compared with Caucasian (Cau) women. The reasons for such disparities remain unclear although some have suggested unequal access to care may be causative. Since access to care is similar across racial groups in the military, our program is uniquely suited to identify other factors that might cause differences in ART outcome. The objective of this study was to compare ART outcome between AA and Cau in order to identify factors that might influence outcome.DesignRetrospective cohort study in a university-based ART programMaterials and methodsIRB approved review of all ART cycles between 1999-2003. Only women undergoing their first cycle of fresh, non-donor ART were included for analysis. Racial information was self-reported and obtained from patient records. Prior to cycle start, all patients underwent saline sonography and any cavitary lesions were identified and surgically corrected. A transvaginal ultrasound at the baseline visit was used to score the presence or absence of leiomyoma. Primary endpoints of clinical pregnancy rate (CPR), spontaneous abortion rate (SAR) and live birth rate (LBR) were compared between AA and Cau patients. Pertinent cycle variables were analyzed. Statistical analysis was performed by χ2 and Student t-test as appropriate.ResultsTabled 1ConclusionIn the absence of leiomyoma, there were no significant differences in ART outcomes between Cau and AA. Leiomyoma were three fold more prevalent in AA women and reduced the likelihood of ART success regardless of race. Racial disparities in ART outcomes may be explained, at least in part, by the increased prevalence of leiomyoma in African American women. ObjectiveAfrican American (AA) women have a lower overall success rate with ART compared with Caucasian (Cau) women. The reasons for such disparities remain unclear although some have suggested unequal access to care may be causative. Since access to care is similar across racial groups in the military, our program is uniquely suited to identify other factors that might cause differences in ART outcome. The objective of this study was to compare ART outcome between AA and Cau in order to identify factors that might influence outcome. African American (AA) women have a lower overall success rate with ART compared with Caucasian (Cau) women. The reasons for such disparities remain unclear although some have suggested unequal access to care may be causative. Since access to care is similar across racial groups in the military, our program is uniquely suited to identify other factors that might cause differences in ART outcome. The objective of this study was to compare ART outcome between AA and Cau in order to identify factors that might influence outcome. DesignRetrospective cohort study in a university-based ART program Retrospective cohort study in a university-based ART program Materials and methodsIRB approved review of all ART cycles between 1999-2003. Only women undergoing their first cycle of fresh, non-donor ART were included for analysis. Racial information was self-reported and obtained from patient records. Prior to cycle start, all patients underwent saline sonography and any cavitary lesions were identified and surgically corrected. A transvaginal ultrasound at the baseline visit was used to score the presence or absence of leiomyoma. Primary endpoints of clinical pregnancy rate (CPR), spontaneous abortion rate (SAR) and live birth rate (LBR) were compared between AA and Cau patients. Pertinent cycle variables were analyzed. Statistical analysis was performed by χ2 and Student t-test as appropriate. IRB approved review of all ART cycles between 1999-2003. Only women undergoing their first cycle of fresh, non-donor ART were included for analysis. Racial information was self-reported and obtained from patient records. Prior to cycle start, all patients underwent saline sonography and any cavitary lesions were identified and surgically corrected. A transvaginal ultrasound at the baseline visit was used to score the presence or absence of leiomyoma. Primary endpoints of clinical pregnancy rate (CPR), spontaneous abortion rate (SAR) and live birth rate (LBR) were compared between AA and Cau patients. Pertinent cycle variables were analyzed. Statistical analysis was performed by χ2 and Student t-test as appropriate. ResultsTabled 1 ConclusionIn the absence of leiomyoma, there were no significant differences in ART outcomes between Cau and AA. Leiomyoma were three fold more prevalent in AA women and reduced the likelihood of ART success regardless of race. Racial disparities in ART outcomes may be explained, at least in part, by the increased prevalence of leiomyoma in African American women. In the absence of leiomyoma, there were no significant differences in ART outcomes between Cau and AA. Leiomyoma were three fold more prevalent in AA women and reduced the likelihood of ART success regardless of race. Racial disparities in ART outcomes may be explained, at least in part, by the increased prevalence of leiomyoma in African American women.