WHO IS FREEZING EGGS, Y’ALL? DESCRIPTIVE CHARACTERISTICS OF WOMEN UNDERGOING OOCYTE CRYOPRESERVATION AT TWO URBAN FERTILITY CLINICS IN THE SOUTH, WITH A FOCUS ON RACE/ETHNICITY

Abstract

To describe trends and characteristics of oocyte cryopreservation (OC) cycles at two fertility clinics in an urban, diverse city in the South, and to compare the racial/ethnic backgrounds of women pursuing OC compared to the racial demographic of this city. Retrospective chart review of all OC cycles from 2014-2019 from two Atlanta fertility clinics (one academic and one private). Patient demographics and cycle characteristics were compared between the two clinics using chi-squared analyses for categorical variables and student’s t-tests for continuous variables. A total of 592 patients undergoing OC were included (668 total OC cycles). The majority of patients underwent 1 cycle (n=529, 89.4%), whereas 51 patients did 2 cycles (8.6%), 11 patients did 3 cycles (1.8%), and 1 patient did 5 cycles (0.2%); there was no statistical difference in the number of cycles performed per patient based on the clinic type. The total number of OC cycles increased annually at both clinics; the largest increase in OC use was seen between 2016 to 2018. Mean ovarian reserve testing parameters (AMH, antral follicle count) was similar between clinics. The average age at cryopreservation was 34.8 (private) and 34.0 (academic), with a majority of cycles occurring in women under age 35 (46.8%). The average BMI was similar between clinics (academic 26.5 kg/m2, private 25.2 kg/m2). There was an overall low utilization of frozen oocytes at both clinics; a total of 34 embryo transfer attempts using thawed autologous oocytes were performed. Atlanta is unique in its racial and ethnic diversity and has been used as a model for investigating issues surrounding access to care. Atlanta’s resident census data from 2019 is as follows: 48% black, 39% white, 5% Asian, 5% Hispanic. When compared against the background demographic of Atlanta, OC cycles at both clinics were disproportionately seen in white patients (60.3%), whereas 20.8% of OC cycles were in black patients. OC use among other ethnic groups made up a small percentage of overall cycles, including those in Asian patients (8.3%) and Hispanic patients (3.0%), however this proportion paralleled the racial demographic of Atlanta for these minority residents. When the demographics of Atlanta OC cycles were compared to nationally reported OC trends, the proportion of minorities undergoing OC in Atlanta was greater than the proportion in the national cohort. OC patient demographics were similar at each the private and academic clinics with respect to age, number of OC cycles, race/ethnicity, ovarian reserve testing and BMI. National SART data for race/ethnicity is not available for 47% of OC cycles as previously reported (1), which makes the accuracy of our data unique. Despite the increasing number of OC cycles at both clinics from 2014-2019, there was a disproportionate use of OC among Atlanta’s minority ethnic groups when compared to white patients.