There are racial disparities for miscarriage and live birth incidence after in vitro fertilization (IVF), according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- The study highlights significant differences in miscarriage and live birth rates among racial groups undergoing in vitro fertilization (IVF) treatment, with Black patients experiencing notably lower success rates compared to White patients.
- Researchers examined how neighborhood-level socioeconomic factors influence IVF outcomes, emphasizing the importance of considering broader social contexts in understanding reproductive health disparities.
- Findings suggest that Black women face structural barriers in accessing infertility services, including longer wait times and potentially inadequate support within the reproductive healthcare system.
- The study utilized the Neighborhood Deprivation Index to gauge neighborhood deprivation levels, revealing correlations between socioeconomic status and certain health indicators.
- The study underscores the need for additional research into the impact of various neighborhood-level factors beyond demographics on IVF outcomes, highlighting the complexity of addressing racial disparities in reproductive health effectively.
Research has indicated disparities in IVF outcomes based on race, with Black women experiencing decreased live birth rates and increased spontaneous abortion and cycle cancellation rates. However, this data has remained limited to patient-level health status or sociodemographic variables.
Factors other than demographics may impact reproductive health, including social, political, and physical environments. Black women often experience a longer wait time for infertility services, indicating structural barriers within the reproductive health care system.
Investigators conducted a study to evaluate the impact of neighborhood-level socioeconomic factors on IVF outcomes across racially diverse populations. Participants included patients who initiated an IVF cycle at Emory Reproductive Center between 2014 and 2019.
Exclusion criteria included utilization of gestational carriers or donor oocytes for cycle completion and cycle completion for embryo or oocyte banking. Patient medical records were assessed to determine addresses, while geocoding was accomplished using Texas A&M’s GeoServices database.
Since they are stable statistical subdivisions of a county, census tracts were used for the analysis. Community levels of material wealth were measured using the Neighborhood Deprivation Index (NDI).
NDI subcomponents include households in poverty, female-headed households with dependents, households earning under $35,000, households on public assistance, management or professional occupations, crowded housing, unemployed, and percent earning less than a high school education.
Higher NDI quintiles are associated with increased neighborhood deprivation. Live birth, determined by delivery of 1 or more infant after 24 weeks’ gestation, was measured as the primary outcome of the analysis.
Miscarriage was defined by spontaneously losing pregnancy before 20 weeks’ gestation after achieving clinical intrauterine gestation, and cycle cancellation as a cycle initiated to transfer embryos but not proceeding to transfer. Covariates included race and ethnicity, age, body mass index (BMI), infertility diagnosis, parity, and cycle characteristics.
There were 1110 patients and 2254 cycles included in the final analysis. Of the 557 census tracts included, NDIs ranged from -0.04 to 1.16. Of participants, 48.1% were White, 27.7% Black, 16.5% Asian, and 6.9% Other. Black patients were more often older and had a higher BMI compared to White patients.
The median distance to clinic was also higher among Black patients, at 19.9 miles vs 14.6 miles for White patients. Insurance coverage for fertility treatment was reported in 37.3% vs 25.8%, respectively, tubal factor infertility in 45.6% vs 14.6%, respectively, and uterine factor infertility in 29% vs 6.9%, respectively.
Transferring only one embryo and receiving preimplantation genetic testing was more common in White patients, at 45.9% and 7.9%, respectively, vs 33.3% and 2.2%, respectively, in Black patients. Cleavage-stage embryo transfer was reported in 60.6% of Black patients and 47.4% of White patients, and blastocyst-stage transfers in 34.4% and 45.3%, respectively.
Residing in census tracts in the highest NDI quintile was reported in 34.2% of Black patients vs 14.6% of White patients. A correlation was found between NDI quintile and median BMI, at 23.8 kg/m2 in Q1 vs 27.0 kg/m2 in Q5. NDI was also associated with male factor and tubal factor infertility, but not with distance to clinic or insurance coverage.
Cycle cancellation was reported in 10.9% of cycles. Live birth was reported in 50.6% of White patients with embryo transfer vs 40.3% of Black patients. Miscarriage was reported in 13.7% and 18.2%, respectively. NDI was not significantly associated with cycle cancellation, miscarriage, or live birth.
These results indicated racial disparities in miscarriage and live birth rates among patients receiving IVF. Investigators recommended further research about the impact of other neighborhood-level factors on reproductive outcomes.
Reference
Andre KE, Hood RB, Gaskins AJ, et al. Neighborhood deprivation and racial differences in in vitro fertilization outcomes. Am J Obstet Gynecol. 2024;230:352.e1-18. doi:10.1016/j.ajog.2023.11.003
