title: Racial Disparities in Fertility Care: an Analysis of 4537 Intrauterine Insemination Cycles.
abstract: Studies suggest that race may affect access to fertility treatments and their outcomes. We examined whether race affects the following: duration of infertility prior to seeking evaluation, diagnosis, treatment cycle characteristics, and outcomes.
  
  
  
  Design: Retrospective cohort.
  
  
  
  Academic fertility center.
  
  
  
  4537 intrauterine insemination ± ovulation induction (IUI ± OI) cycles/1495 patients.
  
  
  
  IUI following: (i) OI with either clomiphene citrate or gonadotropins and (ii) ultrasound-monitored natural cycles.
  
  
  
  Duration of infertility prior to seeking treatment, SART diagnosis, treatment cycle characteristics and outcomes (spontaneous abortion (SABR), clinical (CPR) and multiple pregnancy rates (MPR)).
  
  
  
  Asians and Hispanics compared to Caucasians waited significantly longer prior to seeking fertility evaluation (p < 0.01). The mean age of patients seeking infertility evaluation did not differ between groups nor did the type of treatment initially chosen by the patients. Idiopathic infertility was more common among Caucasians (p < 0.05, compared to all others) while PCOS and tubal factor infertility were more frequent among Hispanics (p < 0.05, compared to Caucasian, Asian, and mixed ancestry women) and decreased ovarian reserve was more common among African-Americans (p < 0.01, compared to Caucasians, Asians, and Hispanics). Gonadotropin cycle characteristics including dosing and duration of treatment, follicular recruitment, peak estradiol levels, and endometrial lining thickness differed between certain groups. However, no difference was found in CPR, MPR, and SABR between groups.
  
  
  
  Race affects timely access to infertility care, diagnosis, and treatment cycle characteristics but not outcomes. Considering the nation's growing multiracial population, understanding the effect of race on fertility care becomes increasingly important.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Harvard Medical School/Massachusetts General Hospital Fertility Center, Yawkey 10-A, 55 Fruit Street, Boston, MA, 02114, USA. idimitriadis@tuftsmedicalcenter.org.|Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Box 232, Boston, MA, 02111, USA. idimitriadis@tuftsmedicalcenter.org.
authors.forename: Irene
authors.initials: I
authors.lastname: Dimitriadis
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Harvard Medical School/Massachusetts General Hospital Fertility Center, Yawkey 10-A, 55 Fruit Street, Boston, MA, 02114, USA.|Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Batsis
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Harvard Medical School/Massachusetts General Hospital Fertility Center, Yawkey 10-A, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Petrozza
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Harvard Medical School/Massachusetts General Hospital Fertility Center, Yawkey 10-A, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Souter
mesh_terms: D000022:Abortion, Spontaneous / Q000208:ethnology*; D000046:Academic Medical Centers; D000328:Adult; D001741:Black or African American; D001213:Asian; D002996:Clomiphene / Q000627:therapeutic use; D005006:Ethnicity; D005184:Fallopian Tube Diseases / Q000150:complications / Q000208:ethnology; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use; D054625:Healthcare Disparities / Q000208:ethnology*; D000066505:Help-Seeking Behavior; D006630:Hispanic or Latino; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000628:therapy*; D007315:Insemination, Artificial / Q000706:statistics & numerical data*; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D065851:Ovarian Reserve; D010062:Ovulation Induction / Q000706:statistics & numerical data*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000208:ethnology; D011247:Pregnancy; D018873:Pregnancy Rate / Q000208:ethnology*; D011272:Pregnancy, Multiple / Q000208:ethnology*; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging; D044465:White People
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene
keywords: Race; infertility; intrauterine insemination; ovulation induction