Ethnicity Can Impact Outcomes in Fertility Treatment

Success of live birth can be influenced by genetic factors during in vitro fertilization therapy.

Ethnicity was found to be a contributing factor to the success of live births in women undergoing fertility treatments.

A study published in BJOG: An International Journal of Obstetrics and Gynecology (BJOG) found that certain ethnic groups using fertility treatments have significantly lower chances of live births compared with other groups.

Researchers used data from the Human Fertilization and Embryology Authority (HFEA) to examine nearly 39,000 women undergoing their first cycle of in vitro fertilization (IVF) or intra cytoplasmic sperm injection (ICSI) between 2000 and 2010.

The average age of patients ranged from 29.7- to 35.8-years-old, and the cohort included women of the follow ethnicities: White British, White Irish, White European, South Asian Indian, South Asian Bangladeshi, South Asian Pakistani, Chinese, Black British, Black African, Black Caribbean, Mediterranean European, Middle Eastern, Mixed Race, and other Asian.

Several fertility outcomes were analyzed, including the number of eggs retrieved, the number fertilized, the number of embryos created, and implantation rates. The main outcome measure of the study was live birth rate.

Researchers adjusted for factors such as the age of patient at the time of treatment, cause of female or male infertility, and type of treatment (ICSI versus IVF). The results of the study showed that White Irish, South Asian Indian, South Asian Bangladeshi, South Asian Pakistani, Black African, and other Asian women had significantly lower odds of live births compared with White British women.

For White British women, the live birth rate was 26.4% compared with 17.2% for White Irish women and 17.4% for Black African women.

Additional study findings revealed that certain groups of women, including Black African, Middle Eastern, and South Asian Bangladeshi, had a significantly lower amount of eggs collected compared with White British women.

Furthermore, Black British, Black African, Black Caribbean, South Asian Bangladeshi, South Asian Indian, South Asian Pakistani, and Middle Eastern women were found to be at higher risk for not reaching the embryo transfer stage.

Some potential factors for the findings could be variations in environmental exposures relating to lifestyle, dietary factors, and socioeconomic and cultural factors that could be influencing egg and sperm quality, accessibility of fertility treatment, and behavior towards seeking medical care, and consequently reproductive outcomes, according to the study. The increased prevalence of polycystic ovary syndrome (PCOS) in South Asian women may also impact lower implantation rates and egg quality.

“The data suggests that ethnicity is a major independent factor determining the chances of IVF or ICSI treatment success,” said senior study author Kanna Jayaprakasan. “While the reason for this association is difficult to explain, the potential factors could be the observed differences in cause of infertility, ovarian response, fertilization rates, and implantation rates, which are all independent predictors of IVF success.”

Jayaprakasan noted that, although the main strengths of the study were the use of the UK HFEA national database, the numbers of some of the sub-ethnic minorities, such as Bangladeshi women, were low in the study.

“This study will be helpful for future treatment and could aid tailored treatment for women to maximize success rates,” said Deputy Editor-in-Chief of BJOG, Patrick Chien. “Further research is needed to understand the reasons behind the variation in treatment outcome between ethnic groups and future studies should incorporate ethnicity as a major determinant factor.”