Racial Disparity in Healthcare

Racial disparity in the U.S. healthcare system is prevalent problem that affects the lives of many minorities as well as the outcomes of various procedures, including IVF. Black and hispanic populations are more likely to receive poorer healthcare from their providers than are white people, which can lead to an increased amount of negative health conditions and death. Studies have shown that black populations are more likely to receive older and more conservative treatments than white people, which can have a profound effect on their lives. It appears this is not just a poverty issue either, as minorities continue to be affected by biases regardless of insurance status, age, and income.

This is partly due to implicit bias held by physicians in all specializations, including those fertility clinics. A recent study funded by a New England Fertility Society grant looked at what is causing  black women to experience such disparate outcomes in their IVF treatment.

In this article, we’re going to examine:

• What is causing black women’s varying degrees of success with IVF?
• What can be done to create better chances of IVF success?
  

Methods of the Study

How researchers examined this issue

There are many reasons that women choose to undergo IVF treatment, but regardless of why, all of them are focused on the same result-- to become pregnant and deliver successfully. The success of an IVF cycle depends on a variety of factors, including the age of the woman, and whether or not she is able to use her own eggs or not. If a woman in her mid-30s chooses to undergo IVF and is using her own eggs, there is a greater chance of pregnancy than if a 40 year old woman underwent the same procedure but was using donated eggs. As women age, the chance for a miscarriage also increases, further lowering the chances of a viable pregnancy.

But what if age and egg viability were not the only main factors influencing the success of an IVF treatment? This study looked at the factors that determine the IVF outcomes of black women. In order to do so, researchers utilized the data from eIVF database and subjects were chosen if they at least had one embryo transferred during IVF. The outcomes that were examined were: spontaneous abortion rate, clinical pregnancy rate, and live birth rate.

Results and Conclusions

Black women are less successful with IVF

Out of the 175,796 patients examined, 2.6% patients were Black, 26% were White, and 3% were Hispanic/Latina. The study found that Black women in this data group were more likely to be over 35 when starting their IVF treatment-- 61% Black to 50% White. Knowing that age is a major factor in IVF success, this is an interesting observation. Black women in the study were also significantly more likely to be obese when beginning treatment. Thirty six percent of the Black women were considered obese according to their BMI, compared to 22% of White women. Diet and exercise are extremely important to pregnancy overall, and obesity can decrease a woman’s chances of a successful pregnancy.

Another area where researchers saw a disparity with the Black women in the study was with their rates of a tubal or uterine factor. Black women had over 50% greater chance of a tubal factor with 19.8% experiencing this issue compared to 8.6% of White women experiencing the same. Black women also experienced a greater rate of uterine factor compared to White women, with a 7.4% chance compared to 3.1%.

An interesting finding in this study was that Black women were more likely than White women to be under more psychological stress. Just like maintaining a healthy weight, reducing stress is an important component to pregnancy.

When compared to all races examined, Black women had the lowest percentage of clinical pregnancies with 46% of women in the data group. White women had a 55% clinical pregnancy rate, Hispanic/Latina had 60%, and Asian was at 62%. Coupled with the fact that the live birth rate for Black women was 45% less than White women and 30% less than Hispanic/Latina women, and we can further see that there is a significant disparity here. The lower percentage of live birth rate for Black women continued even when the patient characteristics (BMI, infertility diagnosis, diabetes, etc.) were changed.

Conclusions

This data lead the researchers to conclude that Black women can expect less chance of a successful IVF treatment. This is not only the result of disparity and bias in the healthcare system, but it is also due to their older age starting IVF, higher BMI, greater chance of tubal or uterine factors, stress, hypertension, and diabetes.

In order to increase the chances of a successful IVF treatment, it is important to maintain a healthy weight and look for ways to reduce stress. This lifestyle changes can reduce the risk of diabetes and hypertension and may increase the chances of pregnancy.

Publication

Factors associated with disparate outcomes among African American women undergoing IVF

Fertility and Sterility, September 2018, Volume 110, Issue 4, Supplement, Pages e276–e277