Poor prognosis with in vitro fertilization in Indian women compared to Caucasian women despite similar embryo quality.
BACKGROUND
Disease prevalence and response to medical therapy may differ among patients of diverse ethnicities. Poor outcomes with in vitro fertilization (IVF) treatment have been previously shown in Indian women compared to Caucasian women, and some evidence suggests that poor embryo quality may be a cause for the discrepancy. In our center, only patients with the highest quality cleavage stage embryos are considered eligible for extending embryo culture to the blastocyst stage. We compared live birth rates (LBR) between Indian and Caucasian women after blastocyst transfer to investigate whether differences in IVF outcomes between these ethnicities would persist in patients who transferred similar quality embryos.


RESULTS
In this retrospective cohort analysis, we compared IVF outcome between 145 Caucasians and 80 Indians who had a blastocyst transfer between January 1, 2005 and June 31, 2007 in our university center. Indians were younger than Caucasians by 2.7 years (34.03 vs. 36.71, P = 0.03), were more likely to have an agonist down regulation protocol (68% vs. 43%, P<0.01), and were more likely to have polycystic ovarian syndrome (PCOS), although not significant, (24% vs. 14%, P = 0.06). Sixty eight percent of Indian patients had the highest quality embryos (4AB blastocyst or better) transferred compared to 71% of the Caucasians (P = 0.2). LBR was significantly lower in the Indians compared to the Caucasians (24% vs. 41%, P<0.01) with an odds ratio of 0.63, (95%CI 0.46-0.86). Controlling for age, stimulation protocol and PCOS showed persistently lower LBR with an adjusted odds ratio of 0.56, (95%CI 0.40-0.79) in the multivariate analysis.


CONCLUSIONS
Despite younger age and similar embryo quality, Indians had a significantly lower LBR than Caucasians. In this preliminary study, poor prognosis after IVF for Indian ethnicity persisted despite limiting analysis to patients with high quality embryos transferred. Further investigation into explanations for ethnic differences in reproduction is needed.
Shahine
Lora K
LK
Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Stanford University, Stanford, California, United States of America. lora@shahine.com
Lamb
Julie D
JD
Lathi
Ruth B
RB
Milki
Amin A
AA
Langen
Elizabeth
E
Westphal
Lynn M
LM
D000328:Adult; D044466:Asian People; D001723:Birth Rate; D001755:Blastocyst / Q000378:metabolism*; D015331:Cohort Studies; D004624:Embryo Transfer / Q000379:methods*; D005006:Ethnicity; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007194:India; D007247:Infertility, Female / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D044465:White People