Race, not neighborhood deprivation, predicts IVF success
Click Here to Manage Email Alerts
ANAHEIM, Calif. — Although race and neighborhood deprivation were closely related, neighborhood deprivation was not associated with IVF outcomes, data presented here suggest.
“Compared with white women, Black women experience lower live birth rates, higher rates of spontaneous abortion, higher cycle cancelation rates and decreased implantation rates,” Kerri E. Andre, MD, a fourth-year medical student at Emory University School of Medicine in Atlanta, said during a presentation. “Exploration of these inequities through a health disparities lens has so far mainly focused on individual-level sociodemographic factors, such as household income, educational attainment and personal knowledge of fertility.”
Andre and colleagues retrospectively analyzed the success of 2,254 autologous IVF cycles among 1,110 women who attended an academic fertility center from 2014 to 2019. They used patients’ addresses and linked census information to determine each patient’s neighborhood deprivation index (NDI). The NDI accounted for poverty, occupation, household information, education, federal public assistance and residential turnover.
Using the NDI, the researchers determined the risk for cycle cancelation, miscarriage and live birth and accounted for race as both a confounder and an effect modifier in analyses.
The cohort comprised 48.1% white patients, 27.7% Black patients, 16.5% Asian patients, 6.9% patients of another race and 0.8% patients with missing information on race.
Comparisons between white and Black patients revealed that Black patients were more likely to have IVF insurance coverage, to live farther from the clinic and to live in areas with greater neighborhood deprivation.
Overall, 10.9% of cycles were canceled. The live birth rate was 47.2%, and the miscarriage rate was 15.2%.
Among white patients, the live birth and miscarriage rates were 50.6% and 13.7%, respectively. Among Black patients, the rates were 40.3% and 18.2%, respectively.
Analyses showed that NDI was not associated with cycle cancelation, live birth or miscarriage. However, higher NDI was associated with increased prevalence of tubal and uterine factor infertility.
“The results from this study show the need for future studies to continue to explore ways to create positive IVF outcomes for Black people regardless of their neighborhood characteristics,” ASRM President Michael Thomas, MD, said in a press release.
References:
- Andre KE, et al. Neighborhood deprivation and Black-white differences in in vitro fertilization outcomes. Presented at: ASRM Scientific Congress & Expo; Oct. 22-26, 2022; Anaheim, California.
- Neighborhood deprivation and black-white differences in in vitro fertilization outcome. Published Oct. 25, 2022. Accessed Nov. 3, 2022.
Perspective
Back to Top
Access to health care services is often highly localized. This study used an index of neighborhood deprivation to examine the relationship between racial disparities and infertility. The NDI includes multiple factors that can affect access to care, including income, residential turnover and receipt of federal public assistance. For the three main outcomes of the study — cycle cancelation, miscarriage and live birth — there were no statistically significant differences. However, the researchers did identify differences in factors that affect fertility by neighborhood deprivation score. These findings highlight the need for health services researchers to consider not only differences in race and ethnicity, but other structural factors that may affect both access to care and underlying needs for treatment.
Collapse
Andre KE, et al. Neighborhood deprivation and Black-white differences in in vitro fertilization outcomes. Presented at: ASRM Scientific Congress & Expo; Oct. 22-26, 2022; Anaheim, California.
Click Here to Manage Email Alerts