title: Influence of race and ethnicity on in vitro fertilization outcomes: systematic review.
abstract: OBJECTIVE
  We conducted a systematic review to evaluate the influence of race and ethnicity on clinical pregnancy and live birth outcomes after in vitro fertilization (IVF).
  
  
  METHODS
  We searched PubMed, EMBASE, Web of Science, CINAHL, POPLINE, and Cochrane Central, and hand-searched relevant articles published through July 22, 2015.
  
  
  METHODS
  Two reviewers independently evaluated abstracts to identify studies that compared clinical pregnancy rates and live birth rates for ≥2 racial and/or ethnic groups after nondonor IVF cycles.
  
  
  RESULTS
  Twenty-four studies were included. All 5 US registry-based studies showed that black, Hispanic, and Asian women had lower clinical pregnancy rates and/or live birth rates after IVF, compared with white women. Similarly, most clinic-specific studies reported significant disparities in these primary outcomes, potentially attributable to differences in infertility diagnosis, spontaneous abortion, and obesity. Studies varied with respect to definitions of race/ethnicity, inclusion of first cycles vs multiple cycles for individual women, and collected covariates. Most studies were limited by sample size, inadequate adjustment for confounding, selection bias, and extensive missing data.
  
  
  CONCLUSIONS
  Although current evidence points to race and ethnicity, especially black race, as strong predictors of poorer outcomes after IVF, the utility of results is constrained by the limitations described.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Humphries
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Boston IVF, Waltham, MA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Humm
authors.affiliation: Boston IVF, Waltham, MA.
authors.forename: Denny
authors.initials: D
authors.lastname: Sakkas
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA. Electronic address: mhacker@bidmc.harvard.edu.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
mesh_terms: D000022:Abortion, Spontaneous / Q000208:ethnology; D001741:Black or African American; D001213:Asian; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D007246:Infertility / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D018873:Pregnancy Rate / Q000208:ethnology*; D016896:Treatment Outcome; D014481:United States; D044465:White People
keywords: in vitro fertilization; racial disparities