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Effect of race and ethnicity on live birth rates in third-party ART cycles in the U.S.
Table 1. Group Characteristics (N¼492)
Mean Age (SD) Mean Day 3 FSH (SD) Mean AMH (SD) Mean BMI (SD) Smoker Mean Peak Estradiol Level (SD) Mean # Oocytes Retrieved (SD) % Cycles Cancelled a
White (N¼410)
Black (N¼18)
Asian (N¼36)
Hispanic (N¼28)
26.7 (3.7) 4.7 (3.9) 3.1 (1.9) 22.5 (3.1) 6.8% 2662 (1069.4) 19.7 (8.1) 7.8%
26.0 (2.8) 4.9 (2.8) 4.7 (4.5) 22.6 (4.4) 0% 3032 (940.2) 22.3 (7.2) 0%
26.5 (3.8) 4.0 (2.8) 4.9 (2.1) 21.5 (2.1) 0% 3069 (1193.6) 17.6 (7.1) 5.6%
26.0 (2.8) 3.0 (3.4) 2.5 (1.5) 23.9 (3.1) 10.7% 2489 (1183.3) 18.0 (9.2) 10.7%
p-value 0.74a 0.20a 0.01a 0.03a 0.28b 0.71a 0.16a 0.63b
Calculated by ANOVA bCalculated by Fisher’s exact test *<0.05 referenced to White
responsiveness and the number of oocytes retrieved from oocyte donors to assess whether racial disparities were present. DESIGN: Retrospective analysis. MATERIALS AND METHODS: IRB approval was obtained. All women undergoing oocyte donation at Fertility Centers of Illinois between January 2010-December 2012 were included. Only the first oocyte donation cycle per subject occurring within this time frame was included. Information was collected on baseline characteristics as well as IVF cycle parameters and outcomes. Race was self-reported. Outcomes in each racial group were compared to White women. Continuous variables were compared with a student’s t-test or ANOVA and categorical variables were compared with Fisher’s exact test. RESULTS: 492 oocyte donors were included: 410 White (83.3%), 18 Black (3.7%), 36 Asian (7.3%) and 28 Hispanic (5.7%). Demographics were compared between groups (Table 1). Asian donors had a higher mean AMH compared to White donors, while Hispanic donors had a lower day 3 FSH compared to White donors. Ovarian responsiveness as measured by peak estradiol was not different between groups. In addition, there were no significant differences in cancellation rates between groups. There were no significant differences in the mean number of oocytes retrieved: 19.7 (SD 8.1) in White donors, 22.3 (SD 7.2) in Black donors, 17.6 (SD 7.1) in Asian donors and 18.0 (SD 9.2) in Hispanic donors, P¼0.16. CONCLUSIONS: There were no differences in ovarian responsiveness or number of oocytes retrieved between different racial groups. This information can be used clinically to reassure donor oocyte recipients regarding overall excellent prognosis with oocyte donation cycles. References: 1. McQueen DB, Schufreider A, Lee SM, Feinberg EC, Uhler ML. Racial disparities in in vitro fertilization outcomes. Fertil Steril 2015; 104(2): 398-402. 2. Humphries LA, Chang O, Humm K, Sakkas D, Hacker MR. Influence of race and ethnicity on in vitro fertilization outcomes: systematic review. Am J Obstet Gynecol 2016; 214(2): 212.e1-212.e17. P-692 Wednesday, October 19, 2016 EFFECT OF RACE AND ETHNICITY ON LIVE BIRTH RATES IN THIRD-PARTY ART CYCLES IN THE U.S. A. Shapiro,a,b D. H. Barad,b,c S. Darmon,b D. Albertini,b,d N. Gleicher,b,e V. A. Kushnir.b,f aRutgers New Jersey Medical School, West New York, NJ; bCenter for Human Reproduction, New York, NY; cAlbert Einstein College of Medicine, Bronx, NY; dUniversity of Kansas Medical Center, Kansas City, KS; eRockefeller University, New York, NY; fWake Forest School of Medicine, Winston-Salem, NC. OBJECTIVE: To examine live birth rates for third-party Assisted Reproduction Technologies (ART) among different ethnic and racial groups in the United States. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We reviewed ART data reported to the Society for Assisted Reproductive Technology (SART) on all donor oocyte, sperm, embryo and gestational carrier cycles performed in the USA between 2005 and 2013. We compared live birth rates for each third-party ART modality based on the intended mothers’ ethnicity and race. The SART database is de-identified and represents more than 90% of all ART cycles in the United States. RESULTS: 150,537 third-party ART cycles which reported race/ethnicity resulted in 59,724 live birth. Non-Hispanic (NH) white women achieved the highest pregnancy rates (48.5%) and live birth rates (40.5%), while NH black
FERTILITY & STERILITYÒ
women had the lowest pregnancy rates (38.8%) and live birth rates (30.2%) for all third-party ART modalities combined. NH white women had the highest live birth rates with oocyte donation, use of a gestational carrier and multiple third-party reproduction techniques. Sperm donation produced highest live birth rates among Hispanics (31.5%). Embryo donation live birth rates were highest (37%) among Asian women. CONCLUSIONS: While outcome differences with IVF have been widely reported, this is the first study reporting that live birth rates of all third-party ART procedures vary greatly based on race/ethnicity of the intended mother. Further studies are needed to elucidate the underlying mechanisms. Race/ Ethnicity Non-Hispanic White Non-Hispanic Black Asian/Pacific Islander Hispanic Other
Oocyte Sperm Embryo Gestational Multiple Donation Donation Donation Carrier Third-Party 43.1%
29.9%
33.9%
33.6%
48.4%
32.0%
22.1%
27.7%
25.4%
41.9%
42.3%
24.3%
37.0%
33.3%
46.9%
41.6% 43.5%
31.5% 24.2%
36.0% 36.0%
33.0% 35.1%
48.1% 49.3%
Supported by: Intramural funds from The Center for Human Reproduction and grants from The Foundation for Reproductive Medicine. P-693 Wednesday, October 19, 2016 EFFECT OF RACE AND ETHNICITY ON FERTILITY RATES AND UTILIZATION OF ART IN THE USA. V. A. Kushnir,a,b A. Shapiro,a,c D. H. Barad,a,d S. Darmon,a D. Albertini,a,e N. Gleicher.a,f aCenter for Human Reproduction, New York, NY; bWake Forest School of Medicine, Winston-Salem, NC; cRutgers New Jersey Medical School, New Ark, NJ; dAlbert Einstein College of Medicine, Bronx, NY; eUniversity of Kansas Medical Center, Kansas City, KS; fRockefeller University, New York, NY. OBJECTIVE: To examine fertility rates and utilization of Assisted Reproduction Technology (ART) for the treatment of infertility among different ethnic and racial groups in the United States. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We compared the ethnic and racial demographics of the entire birth cohort in the USA between 2005 and 2013 (National Vital Statistics Report Vol 64, No. 1, 01/15/15) to ART data reported to the Society for Assisted Reproductive Technology (SART) over the same time period. ART data were stratified as routine ART or third-party ART (including all donor oocyte, sperm, embryo and gestational carrier cycles). SART data are de-identified and represent more than 90% of all ART cycles performed in the US. RESULTS: As the table demonstrates, overall fertility rates are relatively high for Hispanic and Black women while utilization of both routine and third-party ART among these groups are relatively low. Conversely White and Asian women have relatively low fertility rates and relatively high utilization of both routine and third-party ART. Routine ART results in the highest live birth rates among White and Hispanic women and relatively low live birth rates among Asian and especially Black women. Third-party ART results in improved live birth rates for all groups; however, Black women still experience the lowest live birth rates.
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Mean Age (SD) Mean Day 3 FSH (SD) Mean AMH (SD) Mean BMI (SD) Smoker Mean Peak Estradiol Level (SD) Mean # Oocytes Retrieved (SD) % Cycles Cancelled a
White (N¼410)
Black (N¼18)
Asian (N¼36)
Hispanic (N¼28)
26.7 (3.7) 4.7 (3.9) 3.1 (1.9) 22.5 (3.1) 6.8% 2662 (1069.4) 19.7 (8.1) 7.8%
26.0 (2.8) 4.9 (2.8) 4.7 (4.5) 22.6 (4.4) 0% 3032 (940.2) 22.3 (7.2) 0%
26.5 (3.8) 4.0 (2.8) 4.9 (2.1) 21.5 (2.1) 0% 3069 (1193.6) 17.6 (7.1) 5.6%
26.0 (2.8) 3.0 (3.4) 2.5 (1.5) 23.9 (3.1) 10.7% 2489 (1183.3) 18.0 (9.2) 10.7%
p-value 0.74a 0.20a 0.01a 0.03a 0.28b 0.71a 0.16a 0.63b
Calculated by ANOVA bCalculated by Fisher’s exact test *<0.05 referenced to White
responsiveness and the number of oocytes retrieved from oocyte donors to assess whether racial disparities were present. DESIGN: Retrospective analysis. MATERIALS AND METHODS: IRB approval was obtained. All women undergoing oocyte donation at Fertility Centers of Illinois between January 2010-December 2012 were included. Only the first oocyte donation cycle per subject occurring within this time frame was included. Information was collected on baseline characteristics as well as IVF cycle parameters and outcomes. Race was self-reported. Outcomes in each racial group were compared to White women. Continuous variables were compared with a student’s t-test or ANOVA and categorical variables were compared with Fisher’s exact test. RESULTS: 492 oocyte donors were included: 410 White (83.3%), 18 Black (3.7%), 36 Asian (7.3%) and 28 Hispanic (5.7%). Demographics were compared between groups (Table 1). Asian donors had a higher mean AMH compared to White donors, while Hispanic donors had a lower day 3 FSH compared to White donors. Ovarian responsiveness as measured by peak estradiol was not different between groups. In addition, there were no significant differences in cancellation rates between groups. There were no significant differences in the mean number of oocytes retrieved: 19.7 (SD 8.1) in White donors, 22.3 (SD 7.2) in Black donors, 17.6 (SD 7.1) in Asian donors and 18.0 (SD 9.2) in Hispanic donors, P¼0.16. CONCLUSIONS: There were no differences in ovarian responsiveness or number of oocytes retrieved between different racial groups. This information can be used clinically to reassure donor oocyte recipients regarding overall excellent prognosis with oocyte donation cycles. References: 1. McQueen DB, Schufreider A, Lee SM, Feinberg EC, Uhler ML. Racial disparities in in vitro fertilization outcomes. Fertil Steril 2015; 104(2): 398-402. 2. Humphries LA, Chang O, Humm K, Sakkas D, Hacker MR. Influence of race and ethnicity on in vitro fertilization outcomes: systematic review. Am J Obstet Gynecol 2016; 214(2): 212.e1-212.e17. P-692 Wednesday, October 19, 2016 EFFECT OF RACE AND ETHNICITY ON LIVE BIRTH RATES IN THIRD-PARTY ART CYCLES IN THE U.S. A. Shapiro,a,b D. H. Barad,b,c S. Darmon,b D. Albertini,b,d N. Gleicher,b,e V. A. Kushnir.b,f aRutgers New Jersey Medical School, West New York, NJ; bCenter for Human Reproduction, New York, NY; cAlbert Einstein College of Medicine, Bronx, NY; dUniversity of Kansas Medical Center, Kansas City, KS; eRockefeller University, New York, NY; fWake Forest School of Medicine, Winston-Salem, NC. OBJECTIVE: To examine live birth rates for third-party Assisted Reproduction Technologies (ART) among different ethnic and racial groups in the United States. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We reviewed ART data reported to the Society for Assisted Reproductive Technology (SART) on all donor oocyte, sperm, embryo and gestational carrier cycles performed in the USA between 2005 and 2013. We compared live birth rates for each third-party ART modality based on the intended mothers’ ethnicity and race. The SART database is de-identified and represents more than 90% of all ART cycles in the United States. RESULTS: 150,537 third-party ART cycles which reported race/ethnicity resulted in 59,724 live birth. Non-Hispanic (NH) white women achieved the highest pregnancy rates (48.5%) and live birth rates (40.5%), while NH black
FERTILITY & STERILITYÒ
women had the lowest pregnancy rates (38.8%) and live birth rates (30.2%) for all third-party ART modalities combined. NH white women had the highest live birth rates with oocyte donation, use of a gestational carrier and multiple third-party reproduction techniques. Sperm donation produced highest live birth rates among Hispanics (31.5%). Embryo donation live birth rates were highest (37%) among Asian women. CONCLUSIONS: While outcome differences with IVF have been widely reported, this is the first study reporting that live birth rates of all third-party ART procedures vary greatly based on race/ethnicity of the intended mother. Further studies are needed to elucidate the underlying mechanisms. Race/ Ethnicity Non-Hispanic White Non-Hispanic Black Asian/Pacific Islander Hispanic Other
Oocyte Sperm Embryo Gestational Multiple Donation Donation Donation Carrier Third-Party 43.1%
29.9%
33.9%
33.6%
48.4%
32.0%
22.1%
27.7%
25.4%
41.9%
42.3%
24.3%
37.0%
33.3%
46.9%
41.6% 43.5%
31.5% 24.2%
36.0% 36.0%
33.0% 35.1%
48.1% 49.3%
Supported by: Intramural funds from The Center for Human Reproduction and grants from The Foundation for Reproductive Medicine. P-693 Wednesday, October 19, 2016 EFFECT OF RACE AND ETHNICITY ON FERTILITY RATES AND UTILIZATION OF ART IN THE USA. V. A. Kushnir,a,b A. Shapiro,a,c D. H. Barad,a,d S. Darmon,a D. Albertini,a,e N. Gleicher.a,f aCenter for Human Reproduction, New York, NY; bWake Forest School of Medicine, Winston-Salem, NC; cRutgers New Jersey Medical School, New Ark, NJ; dAlbert Einstein College of Medicine, Bronx, NY; eUniversity of Kansas Medical Center, Kansas City, KS; fRockefeller University, New York, NY. OBJECTIVE: To examine fertility rates and utilization of Assisted Reproduction Technology (ART) for the treatment of infertility among different ethnic and racial groups in the United States. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: We compared the ethnic and racial demographics of the entire birth cohort in the USA between 2005 and 2013 (National Vital Statistics Report Vol 64, No. 1, 01/15/15) to ART data reported to the Society for Assisted Reproductive Technology (SART) over the same time period. ART data were stratified as routine ART or third-party ART (including all donor oocyte, sperm, embryo and gestational carrier cycles). SART data are de-identified and represent more than 90% of all ART cycles performed in the US. RESULTS: As the table demonstrates, overall fertility rates are relatively high for Hispanic and Black women while utilization of both routine and third-party ART among these groups are relatively low. Conversely White and Asian women have relatively low fertility rates and relatively high utilization of both routine and third-party ART. Routine ART results in the highest live birth rates among White and Hispanic women and relatively low live birth rates among Asian and especially Black women. Third-party ART results in improved live birth rates for all groups; however, Black women still experience the lowest live birth rates.
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