Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting.
OBJECTIVE
Racial disparity in assisted reproductive technology (ART) outcomes has been reported but remains controversial. Reasons for the disparity are unclear, and access to care has been suggested as a causative factor. In this study, we sought to examine minority utilization of ART in the Department of Defense (DoD) compared with minority utilization in the U.S. ART population. Outcomes from ART were compared between Caucasian (Cau) and African American (AA) patients, and etiologies of disparity were examined.


METHODS
Retrospective cohort study.


METHODS
University-based ART program.


METHODS
A total of 1,457 patients undergoing first-cycle fresh, nondonor ART.


METHODS
None.


METHODS
Clinical pregnancy rate, live birth rate, implantation rate, spontaneous abortion rate.


RESULTS
Within the DoD population, AA women had a fourfold increase in utilization of ART services relative to the U.S. ART population. In this equal-access-to-care setting, AA women experienced a clinically significant decrease in live birth rate that did not reach statistical significance (29.6% vs. 35.8%, risk ratio [RR] 0.83, 95% confidence interval [CI] 0.67-1.02) and a statistically significant increase in spontaneous abortions compared with Cau women (25% vs. 15.9%, RR 1.57, 95% CI 1.05-2.36). This might be explained, in part, by a higher prevalence of uterine leiomyomas in AA women (30.8% AA vs. 10.7% Cau, RR 2.85, 95% CI 2.06-3.95). For both AA and Cau women, the presence of fibroids at baseline ultrasound was associated with reductions in clinical pregnancy rates (35% with leiomyomas vs. 43.2% without leiomyomas, RR 0.74, 95% CI 0.51-0.98), live birth rates (26.2% vs. 36.0%, RR 0.63, 95% CI 0.44-0.90), and implantation rates (25.6% vs. 31.1% RR 0.82, 95% CI 0.69-0.98).


CONCLUSIONS
Utilization of ART services among AA women increased when access to care was improved. A clinically significant reduction in live birth rate and statistically significant increase in spontaneous abortion rate was observed in AA women compared with Cau women. Leiomyomas were three times more prevalent in AA women and reduced ART success, regardless of race. The persistence of racial differences in an equal-access-to-care environment might be explained, in part, by the increased prevalence of leiomyomas in AA women.
Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, NIH, Bethesda, Maryland 20892, USA.
Eve C
EC
Feinberg
Frederick W
FW
Larsen
William H
WH
Catherino
Jun
J
Zhang
Alicia Y
AY
Armstrong
D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007247:Infertility, Female / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011247:Pregnancy; D018873:Pregnancy Rate / Q000208:ethnology; D027724:Reproductive Techniques, Assisted / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People / Q000208:ethnology*