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Racial Disparities in Fertility Care: an Analysis of 4537 Intrauterine Insemination Cycles

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Abstract

Background

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.

Materials and Methods

Design: Retrospective cohort. Settings: Academic fertility center. Patients: 4537 intrauterine insemination ± ovulation induction (IUI ± OI) cycles/1495 patients. Interventions: IUI following: (i) OI with either clomiphene citrate or gonadotropins and (ii) ultrasound-monitored natural cycles. Outcome measures: Duration of infertility prior to seeking treatment, SART diagnosis, treatment cycle characteristics and outcomes (spontaneous abortion (SABR), clinical (CPR) and multiple pregnancy rates (MPR)).

Results

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.

Conclusion

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.

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Author information

Authors and Affiliations

  1. 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

    Irene Dimitriadis, Maria Batsis, John C. Petrozza & Irene Souter

  2. Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Box 232, Boston, MA, 02111, USA

    Irene Dimitriadis

  3. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Maria Batsis

Authors
  1. Irene Dimitriadis
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  2. Maria Batsis
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  3. John C. Petrozza
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  4. Irene Souter
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Corresponding author

Correspondence to Irene Dimitriadis.

Ethics declarations

This study was reviewed and approved by the Massachusetts General Hospital (MGH) Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Funding

No financial support was required for this study.

Conflict of Interest

J.C.P is a consultant to Interlace Medical, Framingham, MA, owned by Hologic, Inc., Bedford, MA. The authors, ID, MB, and IS, declare that they have no conflict of interest.

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Dimitriadis, I., Batsis, M., Petrozza, J.C. et al. Racial Disparities in Fertility Care: an Analysis of 4537 Intrauterine Insemination Cycles. J. Racial and Ethnic Health Disparities 4, 169–177 (2017). https://doi.org/10.1007/s40615-016-0215-2

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  • DOI: https://doi.org/10.1007/s40615-016-0215-2

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