P-510 Low neighbourhood socioeconomic status is associated with lower cumulative ongoing pregnancy rate after in vitro fertilization treatment

Abstract

Abstract Study question Is there an association between neighbourhood socioeconomic status (SES) and cumulative ongoing pregnancy after 2.5 years of in vitro fertilization (IVF) treatment? Summary answer Low and middle neighbourhood SES is associated with lower odds of an ongoing pregnancy within 2.5 years of IVF treatment than high neighbourhood SES. What is known already Low SES is known to have a negative impact on general health and a variety of medical conditions, including perinatal health. However, not much data is available on the impact of SES on IVF treatment outcome. Study design, size, duration This is a retrospective observational study of 3720 couples undergoing IVF or IVF-ICSI treatment between 2006 and 2020. Participants/materials, setting, methods Neighbourhood SES was assigned to each couple based on the postal code of residence. Subsequently, SES was categorized into low (<p20), medium (p20-p80), and high (>p80). Multivariable logistic regression analyses were performed with cumulative ongoing pregnancy within 2.5 years as outcome variable, SES category, female age, BMI, smoking status (yes/no), and interaction terms for age*SES and BMI*SES were used as covariates. Main results and the role of chance There was no difference in ongoing pregnancy rates between SES groups after the first fresh embryo transfer or in the average number of IVF treatment cycles performed. However, the cumulative ongoing pregnancy rates differ significantly between SES groups (Low; 43.6%, medium; 50.9%, high; 54.1%). Low SES had significantly lower odds for achieving an ongoing pregnancy within 2.5 years (OR = 0.06 (95%CI 0.02-0.22)). The interaction terms age*SES and BMI*SES showed attenuation of this association with increasing age and BMI (OR = 1.07 (95%CI 1.022 – 1.12) and OR = 1.61 (95%CI 1.25 – 2.09), respectively). The associations with medium SES were similar, but less pronounced (OR = 0.16 (95%CI 0.05 – 0.50) with OR = 1.04 (95%Cl 1.00 – 1.09) and OR = 1.41 (1.12 – 1.77) for the interaction terms with female age and BMI respectively. Limitations, reasons for caution We were not able to perform additional analysis on individual characteristics like educational level, ethnicity or language proficiency due to lack of data. Wider implications of the findings In the Netherlands, health insurance is mandatory. Our study showed that even with equal access to fertility care, patients living in a low SES neighbourhood are disadvantaged. This underlines the importance of taking the whole wellbeing of the patient into account, before starting an IVF treatment. Trial registration number not applicable