FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2316173491> ?p ?o ?g. }

• W2316173491 endingPage "1123" @default.
• W2316173491 startingPage "1119" @default.
• W2316173491 abstract "Infertility is a global problem affecting all ethnic, racial, and religious groups. Nevertheless, only a minority of the U.S. population has access to treatment. Additionally, for those who do engage in treatment, outcomes are disparate among various ethnic and racial groups. This article addresses racial and ethnic disparities regarding rates of fecundity and infertility, access to care, and assisted reproductive technology outcomes. Infertility is a global problem affecting all ethnic, racial, and religious groups. Nevertheless, only a minority of the U.S. population has access to treatment. Additionally, for those who do engage in treatment, outcomes are disparate among various ethnic and racial groups. This article addresses racial and ethnic disparities regarding rates of fecundity and infertility, access to care, and assisted reproductive technology outcomes. Discuss: You can discuss this article with its authors and with other ASRM members at http://fertstertforum.com/quinnm-racial-ethnic-disparities-art-access/ Discuss: You can discuss this article with its authors and with other ASRM members at http://fertstertforum.com/quinnm-racial-ethnic-disparities-art-access/ Infertility is a global problem affecting all ethnic, racial, and religious groups. The precision of assisted reproductive technology (ART) has improved dramatically over the past few decades, affording many infertile couples the opportunity to fulfill their dream of having a family. Nevertheless, evidence suggests that only a minority of the U.S. population has access to treatment (1Chandra A. Copen C.E. Stephen E.H. Infertility service use in the United States: data from the National Survey of Family Growth, 1982–2010.Natl Health Stat Rep. 2014; 22: 1-21Crossref Scopus (229) Google Scholar). Furthermore, among those who are able to receive treatment, duration of infertility, underlying diagnosis, and treatment outcomes differ (2Lamb J.D. Huddleston H.G. Purcell K.J. Modan A. Farsani T.T. Dingeldein M.A. et al.Asian ethnicity is associated with decreased pregnancy rates following intrauterine insemination.Reprod Biomed Online. 2009; 19: 252-256Abstract Full Text PDF PubMed Scopus (27) Google Scholar, 3Seifer D.B. Frazier L.M. Grainger D.A. Disparity in assisted reproductive technologies outcomes in black women compared with white women.Fertil Steril. 2008; 90: 1701-1710Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar, 4Jain T. Socioeconomic and racial disparities among infertility patients seeking care.Fertil Steril. 2006; 85: 876-881Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar, 5Seifer D.B. Zackula M.A. Grainger D.A. Trends of racial disparities in assisted reproductive technology outcomes in black women compared with white women: Society for Assisted Reproductive Technology 1999 and 2000 vs. 2004–2006.Fertil Steril. 2010; 93: 626-635Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar). As a result, infertility and treatment with ART has been identified as a field with a significant health disparity. A health disparity exists when a treatment gap disproportionately affects a disadvantaged subgroup of the population (6Braveman P. Health Disparities and health equity: concepts and measurement.Annu Rev Public Health. 2006; 27: 167-194Crossref PubMed Scopus (796) Google Scholar). The American College of Obstetricians and Gynecologists cites the National Institutes of Health in defining health disparities more broadly as differences in “incidence, prevalence, mortality and burden of disease … among specific population groups” (7American College of Obstetricians and Gynecologists CommitteeOpinion no. 317: racial and ethnic disparities in women’s health.Obstet Gynecol. 2005; 106: 889-892Crossref PubMed Scopus (18) Google Scholar). However, it is important to acknowledge the distinction between differences observed in racially diverse populations as a result of biologic variances versus differences resulting from variation in environmental exposures, lifestyle factors, access to care, and treatment once care is accessed (8Huddleston H.G. Cedars M.I. Sohn S.H. Giudice L.C. Fujimoto V.Y. Racial and ethnic disparities in reproductive endocrinology and infertility.Am J Obstet Gynecol. 2010; 5: 413-419Abstract Full Text Full Text PDF Scopus (86) Google Scholar). This article addresses racial and ethnic disparities regarding rates of fecundity and infertility, access to care, and ART outcomes in black, Asian, Hispanic, and non-Hispanic white infertile populations. In contrast to popular opinion, infertility rates in the United States appear to have been declining in recent years. In the National Survey of Family Growth (NFSG), a multistage probability sample conducted by the National Center for Health Statistics of married women in the United States aged 15–44 years, the general population experienced a decline in 12-month infertility from 8.5% in 1982 to 7.4% in 2002 (n = 15,303 for pooled data across four survey years). In that study, infertility was defined as failure to achieve pregnancy after 12 months of unprotected intercourse with a husband or cohabiting partner. A multivariate analysis demonstrated that infertility was most common among older, nulliparous, non-Hispanic black or Hispanic women who did not have a college degree. In fact, although non-Hispanic white women experienced a decrease in self-reported 12-month infertility from 11.6% to 7.1% during those years, non-Hispanic black women had an increase in infertility from 7.8% to 11.6% despite a stable ethnic cohort (9Stephen E.H. Chandra A. Declining estimates of infertility in the United States: 1982–2002.Fertil Steril. 2006; 86: 516-523Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar). Clearly, those data are limited because factors such as marital status, contraceptive practices, risk of sexually transmitted disease, and aggressiveness of pursuit of infertility treatment may vary by population subgroups and dramatically affect self-reported rates of infertility (10Thornton K.L. Goldman M.B. Impact of subgroup analysis on estimates of infertility.Fertil Steril. 2006; 86: 531-533Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar). For example, during the 5 years before the NSFG survey, 35.6% of births were to unmarried women. Seventy percent of non-Hispanic black women, 44.7% of Hispanic women, and 21.4% of non-Hispanic white women who delivered were not married (10Thornton K.L. Goldman M.B. Impact of subgroup analysis on estimates of infertility.Fertil Steril. 2006; 86: 531-533Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar). Thus, estimates of infertility limited to self-report of married women may not reflect the population as a whole given overall prevalence of nonmarital birth (10Thornton K.L. Goldman M.B. Impact of subgroup analysis on estimates of infertility.Fertil Steril. 2006; 86: 531-533Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar). Given ethnic variances in prevalence of nonmarital birth, the NFSG study introduces ethnic bias, and the validity of its conclusions is called into question. Miscarriage rates are challenging to study given the dependency of estimates of risk on gestational age. However, given the association of non-white race with adverse obstetrical outcomes, including preterm delivery and fetal growth restriction, it is reasonable to hypothesize that race may be associated with early adverse pregnancy outcomes such as miscarriage. In one analysis of spontaneous abortion risk, race was treated as a confounder in assessing miscarriage risk. Black (or other) race was associated with an increased relative risk of miscarriage of 2.57 (95% confidence interval [CI] 1.54–4.30) among 2,848 total pregnancies (including only 164 black women) in southern Connecticut during 1998–1991 (11Zhang H. Bracken M.B. Tree-based, two-stage risk factor analysis for spontaneous aboprtion.Am J Epidemiol. 1996; 144: 989-996Crossref PubMed Scopus (57) Google Scholar). In a community-based prospective pregnancy cohort of 4,070 women in whom 537 subsequently underwent miscarriage, women who self-reported black race (23%; n = 932) had increased risk of miscarriage compared with whites (hazard ratio [HR] 1.57; 95% CI 1.27–1.93). When risk of loss before 10 weeks' gestational age was dichotomized, there was no difference between the groups, but black women had a greater risk of pregnancy loss between the 10th through 20th weeks of gestation (HR 1.93, 95% CI 1.48–2.51) (12Mukherjee S. Velez Edwards D.R. Baird D.D. Savitz D.A. Hartmann K.E. Risk of miscarriage among black women and white women in a U.S. prospective cohort study.Am J Epidemiol. 2013; 177: 1271-1278Crossref PubMed Scopus (74) Google Scholar). Interval to follow-up was not reported, but loss to follow-up might introduce bias toward later diagnosis of miscarriage and needs to be explored. Biologic mechanisms behind miscarriage differ in early compared with later losses, and it is noted that later losses may derive from pathophysiology similar to that of early preterm birth or stillbirth. Further research should investigate potential shared causes of preterm birth and late miscarriage within the black population. Studies looking specifically at miscarriage rates in Hispanic and Asian women are lacking. High-quality prospective studies are needed to analyze miscarriage risk in various racial and ethnic groups to further understand not only differences in outcomes, but also potential shared causes, as well as to provide individualized patient counseling. The American Society for Reproductive Medicine (ASRM) has declared that creation of a family is a basic human right. As such, the ASRM has proposed that “all ART stakeholders, including physicians, policy makers, and insurance providers, should address and lessen existing barriers to infertility care (13Ethics Committee of the American Society for Reproductive MedicineDisparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion.Fertil Steril. 2015; 104: 1104-1110Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar).” Although a goal for equal access to infertility care has been proposed, that goal has yet to be realized. In fact, data from the NSFG would suggest that access to infertility services may have actually declined in recent years. Among 22,682 women aged 25–44 surveyed by the NSFG during 2006–2010, 17% had ever used infertility services compared with 20% of 10,845 women surveyed in 1995. In nulliparous women aged 25–44 years who reported “fertility problems” during 2006–2010, only 38% had ever used infertility services. This compares unfavorably to the 56% of women who reported accessing fertility care in the setting of fertility challenges in 1982. Among all survey years, those who did report using fertility services to achieve pregnancy were disproportionally non-Hispanic white women with higher levels of education and household income. For example, during 2006–2010 ever using medical help to achieve pregnancy was significantly more common among non-Hispanic white women (15%) than among Hispanic (7.6%) or non-Hispanic black (8.0%) women. In a multivariate analysis of infertility service use including all survey years, ever using infertility services was significantly less likely among Hispanic women (adjusted odds ratio [AOR] 0.7) and non-Hispanic black women (AOR 0.77) (1Chandra A. Copen C.E. Stephen E.H. Infertility service use in the United States: data from the National Survey of Family Growth, 1982–2010.Natl Health Stat Rep. 2014; 22: 1-21Crossref Scopus (229) Google Scholar). Although understanding of challenges to access to infertility care is complex, involving the consideration of many sociodemographic factors, ethnic and racial disparities are clearly implicated in differential access both independently and in the relationship of these factors with others, including education level and income. The cost of care has been identified as the greatest barrier to access to infertility care in the U.S. and likely explains a significant amount of the shared contribution of ethnicity/race, education level, and income toward disparities in access. In the U.S., the majority of patients undergoing specialized infertility treatment, such as in vitro fertilization (IVF), pay out of pocket for their treatment owing to a lack of—or limited—insurance coverage of therapy. It has been suggested that the cost of a single IVF cycle in the U.S. may exceed 50% of the average individual's annual disposable income (14Chambers G.M. Sullivan E.A. Ishihara O. Chapman M.G. Adamson G.D. The economic impact of assisted reproductive technology: a review of selected developed countries.Fertil Steril. 2009; 91: 2281-2294Abstract Full Text Full Text PDF PubMed Scopus (234) Google Scholar). In one study, median per-person costs for 18 months of infertility treatment ranged from $1,182 (medications alone) to $38,015 (IVF–donor eggs) (15Katz P. Showstack J. Smith J.F. Nachtigall R.D. Millstein S.G. Wing H. et al.Costs of infertility treatment: results from an 18-month prospective cohort study.Fertil Steril. 2011; 95: 915-921Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar). In 2014, the U.S. Census Bureau reported median household income to be $53,657. Mean income was $60,256 among non-Hispanic whites, $42,491 among Hispanics, and $35,3989 among blacks (16DeNavas-Walt C. Proctor B.D. Income and poverty in the United States: 2014.https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60–252.pdfDate: 2015Google Scholar). Therefore, while non-IVF infertility treatment may be less expensive, it may also be above the reach of those in lower income categories which tend to disproportionately include ethnic and racial minorities. Although several states (Connecticut, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island) provide coverage for infertility treatment through state law mandates, these mandates have failed to achieve equal access for all. Mandates do not apply to those who obtain health coverage through government programs (such as Medicaid), are uninsured, or obtain their insurance from self-insured employers (13Ethics Committee of the American Society for Reproductive MedicineDisparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion.Fertil Steril. 2015; 104: 1104-1110Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar). As a result, even in mandated states, infertility care has been accessed disproportionately by non-Hispanic white women with higher educational training and socioeconomic status. For example, in Massachusetts, only 3.9% of infertility patients were Hispanic/Latino, compared with 6.8% of the state population being Hispanic/Latino. Furthermore, none of the infertility patients had less than a high school diploma, compared with 15.1% of the state population, and 49.6% of infertility patients had advanced degrees, compared with 12.4% in the state. Finally, more than 60% of infertility patients had an annual household income above $100,000, compared with only 17.7% of the state's population (17Jain T. Hornstein M.D. Disparities in access to infertility services in a state with mandated insurance coverage.Fertil Steril. 2005; 84: 221-223Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar). In the equal access to care setting of the military health care system also, ethnic and racial disparities have been identified. For example, in 2005, Hispanics composed 9% of the Department of Defense but only 4% of patients seeking infertility treatment in the military health care system during 1999–2003 (18Feinberg E.C. Larsen F.W. Wah R.M. Alvero J. Armstrong A.Y. Economics may not explain underutilization of assisted reproductive technology services.Fertil Steril. 2007; 88: 1440-1441Abstract Full Text Full Text PDF Scopus (44) Google Scholar). Of note, in another publication, the African-American infertility population at Walter Reed Army Medical Center's ART program was representative of the demographic of the Department of Defense: 17.4% of Walter Reed's assisted reproduction patients identified as African American and the Department of Defense was composed of 19.1% African Americans (19Feinberg E.C. Larsen F.W. Catherino W.H. Zhang J. Armstrong A.Y. Comparison of assisted reproductive technology uitlization and outcomes between Caucasian and African American patients in an equal-access-to-care setting.Fertil Steril. 2006; 85: 888-894Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar). Nevertheless, disparities in accessing care within settings with mandates for universal care or equal access suggest that economic barriers may not be the only impediments and that additional cultural and societal factors may be at play. Some of these factors may include concern regarding the stigma of infertility delaying initiation of treatment in some ethnic or racial groups (20Missmer S.A. Seifer D.B. Jain T. Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States.Fertil Steril. 2011; 95: 143-149Abstract Full Text Full Text PDF Scopus (80) Google Scholar). Among infertile couples who pursue assisted reproduction, a disparity in duration of infertility before presentation has been reported among minority ethnic groups. Asian women have been demonstrated to have longer duration of infertility at consultation compared with white women (2Lamb J.D. Huddleston H.G. Purcell K.J. Modan A. Farsani T.T. Dingeldein M.A. et al.Asian ethnicity is associated with decreased pregnancy rates following intrauterine insemination.Reprod Biomed Online. 2009; 19: 252-256Abstract Full Text PDF PubMed Scopus (27) Google Scholar). Furthermore, in a state where assisted reproduction is covered by insurance, the duration of infertility was reported to be 6 months longer for black compared with white women on presentation for infertility treatment (3Seifer D.B. Frazier L.M. Grainger D.A. Disparity in assisted reproductive technologies outcomes in black women compared with white women.Fertil Steril. 2008; 90: 1701-1710Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar). This suggests that sociocultural barriers in access to infertility care among these communities exist and offers a potential avenue for decreasing disparity through education and policy. Differences in access to general medical care may also have an impact on fertility rates by leading to decreased treatment of precursors of infertility, such as chlamydia. Indeed, studies have shown an increased rate of tubal-factor infertility in black and Hispanic women (4Jain T. Socioeconomic and racial disparities among infertility patients seeking care.Fertil Steril. 2006; 85: 876-881Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar, 21Sharara F.I. McClamrock H.D. Differences in in vitro fertilization outcome between white and black women in an inner-city, university-based IVF program.Fertil Steril. 2000; 73: 1170-1173Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 22Dayal M. Gindoff P. Dubey A. Spitzer T.L. Bergin A. Peak D. et al.Does ethnicity influence in vitro fertilization (IVF) birth outcomes?.Fertil Steril. 2009; 91: 2414-2418Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar). Furthermore, geographic distribution of obstetrician-gynecologists and IVF centers varies, and these services may not be physically accessible to many groups. Improving fertility education in underserved communities and promoting advancements in health care infrastructure that lead to enhanced access may lead to a reduction in these disparities. Finally, ethnic minorities have been demonstrated to have increased challenges with receiving infertility services related to communication barriers (understanding diagnoses and treatments, communicating concerns to physicians), difficulty participating in not only complex but time-consuming treatments (discomfort with or inability of requesting time away from work), and sociocultural or religious beliefs about the acceptability of treatment for infertility (20Missmer S.A. Seifer D.B. Jain T. Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States.Fertil Steril. 2011; 95: 143-149Abstract Full Text Full Text PDF Scopus (80) Google Scholar, 23Nachtigall R.D. Castrillo M. Shah N. Turner D. Harrington J. Jackson R. The challenge of providing infertility services to a low-income immigrant Latino population.Fertil Steril. 2009; 92: 116-123Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar, 24Armstrong A. Plowden T.C. Ethnicity and assisted reproductive technologies.Clin Pract (Lond). 2012; 9: 651-658Crossref PubMed Scopus (29) Google Scholar). Effort should be focused on improving communication regarding topics related to infertility between health care providers and the underserved. Although equal access to infertility care is fraught with a multitude of obstacles, addressing the high price of treatment, lack of accessibility of medical care, improving health education, and focusing on infertility that can be prevented may decrease ethnic disparities in access to care. Initial studies seeking to understand differences in ART outcomes among ethnic groups were limited by small numbers of nonwhite subjects. However, recent studies using data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System online database (SART CORS) have provided evidence that within the U.S. ART population, women from the three major minority groups (black, Asian, and Hispanic) have poorer outcomes. Nevertheless, confidence in the identification of racial/ethnic disparities in IVF outcomes is tempered by limited reporting of race/ethnicity (25Wellons M.F. Fujimoto V.Y. Baker V.L. Barrington D.S. Broomfield D. Catherino W.H. et al.Race matters: a systematic review of racial/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes.Fertil Steril. 2012; 98: 406-409Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar). Data from an equal access to care setting have shown that black women experience a statistically significant increase in spontaneous abortions compared with white women and a trend toward a decreased live birth rate (LBR). Leiomyomas were three times more prevalent in black women and associated with reduced ART success independently from race. The authors concluded that persistence of racial differences in IVF outcomes in an equal access to care environment might be explained, in part, by the increased prevalence of leiomyomas in black women (19Feinberg E.C. Larsen F.W. Catherino W.H. Zhang J. Armstrong A.Y. Comparison of assisted reproductive technology uitlization and outcomes between Caucasian and African American patients in an equal-access-to-care setting.Fertil Steril. 2006; 85: 888-894Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar). In a university-based IVF program, black women undergoing initial fresh nondonor IVF–ET were also more likely to have leiomyomas and tubal-factor infertility but also had higher body mass index (BMI) and required increased gonadotropins compared with whites. Although black women in this study generated significantly fewer embryos compared with white women, despite having similar ages, day 3 FSH levels, peak E2, length of stimulation, and number of oocytes retrieved, biochemical pregnancy, clinical pregnancy, and LBRs did not significantly differ between the two groups (22Dayal M. Gindoff P. Dubey A. Spitzer T.L. Bergin A. Peak D. et al.Does ethnicity influence in vitro fertilization (IVF) birth outcomes?.Fertil Steril. 2009; 91: 2414-2418Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar). In contrast, in an inner-city university-based IVF program where black women composed 28% of the population and underwent 28% of total cycles, implantation and clinical pregnancy rates were significantly lower in black women than in white women despite similar age, basal FSH, number of ampules, and duration of stimulation (21Sharara F.I. McClamrock H.D. Differences in in vitro fertilization outcome between white and black women in an inner-city, university-based IVF program.Fertil Steril. 2000; 73: 1170-1173Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 26Bendikson K. Cramer D.W. Bitonis A. Hornstein M.D. Ethnic background and in vitro fertilization outcomes.Int J Gynaecol Obstet. 2005; 88: 342-346Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar). Similarly, according to data from SART CORS including 38,309 IVF cycles, miscarriage was increased and LBR decreased among black compared with white women (20.4% of blacks vs. 13.2% of whites reporting miscarriage, and LBR 20.7% in blacks vs. 28.4% in whites). After controlling for increased tubal- and uterine-factor infertility, black race was an independent risk factor for not achieving live birth. Notably, LBR was equivalent among these groups in cryopreserved embryo cycles (3Seifer D.B. Frazier L.M. Grainger D.A. Disparity in assisted reproductive technologies outcomes in black women compared with white women.Fertil Steril. 2008; 90: 1701-1710Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar), suggesting, perhaps, that there may be ethnic differences in endometrial receptivity in a hyperstimulated environment. In a subsequent study of 139,027 ART cycles from SART CORS, including 8,903 cycles in black women, black women had clinical pregnancy rates similar to white women after adjustment for maternal age, number of embryos transferred, and infertility diagnosis. However, an increased fetal loss rate among black women was seen, with black women experiencing a 21.8% miscarriage rate, significantly higher than the rates seen in other racial or ethnic groups (27Fujimoto V.Y. Luke B. Brown M.B. Jain T. Armstrong A. Grainger D.A. et al.Racial and ethnic disparities in assisted reproductive technology outcomes in the United States.Fertil Steril. 2010; 93: 382-390Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar). In summary, in the ART population, black women appear to have increased tubal-factor infertility, BMI, and leiomyomas. Although some studies have suggested increased incidence of miscarriage and decreased LBRs compared with whites undergoing IVF, others have not, suggesting a potential role for confounding socioeconomic factors. A study using the SART database drawing from 25,843 white and 1,429 Asian patients demonstrated decreased cumulative pregnancy rate (CPR) and LBR among Asian women undergoing IVF compared with white women (CPR 33.3% among Asians vs. 41.3% among whites, and LBR 26.8% for Asians vs. 34.9% for whites). A subsequent multivariate analysis including 370 white and 197 Asian patients from a site-specific clinic demonstrated that Asian ethnicity was an independent predictor of poor outcome after adjustment for other factors known to affect IVF outcome. Notably, Asians had increased E2 per follicle during ovarian stimulation, which is hypothesized to relate to differential distribution of FSH receptor polymorphisms in Asians and whites (28Purcell K. Schembri M. Frazier L.M. Rall M.J. Shen S. Croughan M. et al.Asian ethnicity is associated with reduced pregnancy outcomes after assisted reproductive technology.Fertil Steril. 2007; 87: 297-302Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar). Finally, several studies have attempted to understand the differences between Asian and white populations regarding infertility diagnosis. One study demonstrated that South Asian women with polycystic ovary syndrome have lower fertilization and clinical pregnancy rates than their white counterparts despite presenting at a younger age and requiring a lower dose of gonadotropins for stimulation. In this study, South Asian women with tubal-factor infertility had clinical pregnancy rates equivalent to whites with the same diagnosis. This suggests that ethnicity may be more of a factor in the setting of certain infertility diagnoses (29Palep-Singh M. Picton H.M. Vrotsou K. Maruthini D. Balen A.H. South Asian women with polycystic ovary syndrome exhibit greater sensitivity to gonadotropin stimulation with reduced fertilization and ongoing pregnancy rates than their Caucasian counterparts.Eur J Obstet Gynecol Reprod Biol. 2007; 134: 202-207Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar). The Asian population undergoing assisted reproduction within the U.S. contains many heterogeneous subpopulations, which suggests that further delineation of subgroups may identify populations at risk for reduced IVF outcomes. Furthermore, in the Asian population undergoing assisted reproduction, increased duration of infertility, lower BMI, and higher E2 response to gonadotropin stimulation call for further exploration of potential biologic origins for population-based differences in outcomes. Studies focused on investigating the Hispanic population are limited by small numbers of participants. In the general U.S. population, Hispanics compose 12.5% of the population but only 5.4% of the assisted reproduction population (18Feinberg E.C. Larsen F.W. Wah R.M. Alvero J. Armstrong A.Y. Economics may not explain underutilization of assisted reproductive technology services.Fertil Steril. 2007; 88: 1440-1441Abstract Full Text Full Text PDF Scopus (44) Google Scholar). Although some papers have demonstrated increased risk of tubal factor infertility within the Hispanic population (4Jain T. Socioeconomic and racial disparities among infertility patients seeking care.Fertil Steril. 2006; 85: 876-881Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar), others have not (18Feinberg E.C. Larsen F.W. Wah R.M. Alvero J. Armstrong A.Y. Economics may not explain underutilization of assisted reproductive technology services.Fertil Steril. 2007; 88: 1440-1441Abstract Full Text Full Text PDF Scopus (44) Google Scholar). In the military health care system, there was no significant difference in IVF cycle parameters nor outcomes between Hispanics and whites undergoing infertility treatment (18Feinberg E.C. Larsen F.W. Wah R.M. Alvero J. Armstrong A.Y. Economics may not explain underutilization of assisted reproductive technology services.Fertil Steril. 2007; 88: 1440-1441Abstract Full Text Full Text PDF Scopus (44) Google Scholar). However, in the SART Writing Group 2010 paper, which included 8,969 cycles in Hispanic women, LBRs from ART were 13% lower for Hispanic than for white women (27Fujimoto V.Y. Luke B. Brown M.B. Jain T. Armstrong A. Grainger D.A. et al.Racial and ethnic disparities in assisted reproductive technology outcomes in the United States.Fertil Steril. 2010; 93: 382-390Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar). Additional data are needed to confirm this disparity and elucidate potential underlying causes. The SART Writing Group study of 139,027 ART cycles during 2004–2006 in white, Asian, black, and Hispanic women used a logistic regression model of odds of pregnancy and live birth among these ethnic and racial groups. Compared with the white majority, a reduced odds of pregnancy was demonstrated for Asians (0.86) and reduced odds of live birth were reported for all minority groups: Asian (0.90), black (0.62), and Hispanic (0.87). Furthermore, obstetrical outcomes from ART pregnancies were affected disparately in the minority groups compared with whites. There was increased moderate and severe growth restriction among singleton deliveries resulting from IVF for all three minority groups compared with whites and increased preterm birth among black and Hispanic women (27Fujimoto V.Y. Luke B. Brown M.B. Jain T. Armstrong A. Grainger D.A. et al.Racial and ethnic disparities in assisted reproductive technology outcomes in the United States.Fertil Steril. 2010; 93: 382-390Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar). Notably, it has been reported that Asian, black, and Hispanic infants have increased rates of growth restriction among the general, non–ART-specific, population (30Alexander G.R. Kogan M. Bader D. Carlo W. Allen M. Mor J. US birth weight/gestational age-specific neonatal mortality: 1995–1997 rates for whites, Hispanics, and blacks.Pediatrics. 2003; 111: e61-e66Crossref PubMed Scopus (286) Google Scholar). Furthermore, in twin gestations resulting from IVF, the odds for moderate growth restriction were increased for Asian and black women, whereas severe growth restriction was increased among black women alone. Preterm birth in twin gestations was increased for black women but decreased for Asians (27Fujimoto V.Y. Luke B. Brown M.B. Jain T. Armstrong A. Grainger D.A. et al.Racial and ethnic disparities in assisted reproductive technology outcomes in the United States.Fertil Steril. 2010; 93: 382-390Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar). The etiology of lower birth weight in minority ART populations after adjustment for confounders such as maternal and gestational age is unclear. Although ART is generally associated with low birth weight, particularly among multiple gestations, and in the setting of fresh (vs. frozen) embryo transfer to a hyperstimulated uterine environment, it is difficult to attribute disparities in singleton birth weights in different racial or ethnic groups to the IVF process. The possibility exists that environmental exposures (e.g., to organic solvents) may influence birth weight of infants born to exposed women and that exposures may differ within race-based populations (31Ahmed P. Jaakkola J.K. Exposure to organic solvents and adverse pregnancy outcomes.Hum Reprod. 2007; 22: 2751-2757Crossref PubMed Scopus (32) Google Scholar). Further research is needed to elucidate potential mechanisms behind varying risk for poor pregnancy outcomes with minority racial and ethnic groups both within and outside assisted reproduction. Evidence is mounting that racial and ethnic disparities in access to assisted reproduction and treatment outcomes not only exist, but may be increasing (1Chandra A. Copen C.E. Stephen E.H. Infertility service use in the United States: data from the National Survey of Family Growth, 1982–2010.Natl Health Stat Rep. 2014; 22: 1-21Crossref Scopus (229) Google Scholar). Although access to care differs for infertile whites and racial minorities, it is unclear if IVF outcomes vary as a result of biologic differences with a host of other contributing factors, or if these outcomes truly represent a disparity in medical care. Of course, any study of racial and ethnic variation is complicated by social, cultural, nutritional, environmental, physical, metabolic, and genetic confounders." @default.
• W2316173491 created "2016-06-24" @default.
• W2316173491 creator A5038089382 @default.
• W2316173491 creator A5049136514 @default.
• W2316173491 date "2016-05-01" @default.
• W2316173491 modified "2023-10-12" @default.
• W2316173491 title "Racial and ethnic disparities in assisted reproductive technology access and outcomes" @default.
• W2316173491 cites W1967357748 @default.
• W2316173491 cites W1969716660 @default.
• W2316173491 cites W1970093198 @default.
• W2316173491 cites W1974670557 @default.
• W2316173491 cites W1982058944 @default.
• W2316173491 cites W1999238319 @default.
• W2316173491 cites W2005346792 @default.
• W2316173491 cites W2005569264 @default.
• W2316173491 cites W2007848905 @default.
• W2316173491 cites W2011717467 @default.
• W2316173491 cites W2014712831 @default.
• W2316173491 cites W2025056740 @default.
• W2316173491 cites W2032916530 @default.
• W2316173491 cites W2042534586 @default.
• W2316173491 cites W2057126098 @default.
• W2316173491 cites W2077260470 @default.
• W2316173491 cites W2079012448 @default.
• W2316173491 cites W2081636266 @default.
• W2316173491 cites W2087383793 @default.
• W2316173491 cites W2100343906 @default.
• W2316173491 cites W2108284037 @default.
• W2316173491 cites W2123133339 @default.
• W2316173491 cites W2124397305 @default.
• W2316173491 cites W2146947762 @default.
• W2316173491 cites W2149533068 @default.
• W2316173491 cites W2151130878 @default.
• W2316173491 cites W2172282904 @default.
• W2316173491 cites W4247946459 @default.
• W2316173491 cites W4250014453 @default.
• W2316173491 doi "https://doi.org/10.1016/j.fertnstert.2016.03.007" @default.
• W2316173491 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/27054308" @default.
• W2316173491 hasPublicationYear "2016" @default.
• W2316173491 type Work @default.
• W2316173491 sameAs 2316173491 @default.
• W2316173491 citedByCount "68" @default.
• W2316173491 countsByYear W23161734912016 @default.
• W2316173491 countsByYear W23161734912017 @default.
• W2316173491 countsByYear W23161734912018 @default.
• W2316173491 countsByYear W23161734912019 @default.
• W2316173491 countsByYear W23161734912020 @default.
• W2316173491 countsByYear W23161734912021 @default.
• W2316173491 countsByYear W23161734912022 @default.
• W2316173491 countsByYear W23161734912023 @default.
• W2316173491 crossrefType "journal-article" @default.
• W2316173491 hasAuthorship W2316173491A5038089382 @default.
• W2316173491 hasAuthorship W2316173491A5049136514 @default.
• W2316173491 hasBestOaLocation W23161734911 @default.
• W2316173491 hasConcept C137403100 @default.
• W2316173491 hasConcept C138816342 @default.
• W2316173491 hasConcept C144024400 @default.
• W2316173491 hasConcept C149923435 @default.
• W2316173491 hasConcept C159110408 @default.
• W2316173491 hasConcept C17744445 @default.
• W2316173491 hasConcept C199539241 @default.
• W2316173491 hasConcept C2250968 @default.
• W2316173491 hasConcept C2777688143 @default.
• W2316173491 hasConcept C2779234561 @default.
• W2316173491 hasConcept C500014431 @default.
• W2316173491 hasConcept C54355233 @default.
• W2316173491 hasConcept C71924100 @default.
• W2316173491 hasConcept C86803240 @default.
• W2316173491 hasConceptScore W2316173491C137403100 @default.
• W2316173491 hasConceptScore W2316173491C138816342 @default.
• W2316173491 hasConceptScore W2316173491C144024400 @default.
• W2316173491 hasConceptScore W2316173491C149923435 @default.
• W2316173491 hasConceptScore W2316173491C159110408 @default.
• W2316173491 hasConceptScore W2316173491C17744445 @default.
• W2316173491 hasConceptScore W2316173491C199539241 @default.
• W2316173491 hasConceptScore W2316173491C2250968 @default.
• W2316173491 hasConceptScore W2316173491C2777688143 @default.
• W2316173491 hasConceptScore W2316173491C2779234561 @default.
• W2316173491 hasConceptScore W2316173491C500014431 @default.
• W2316173491 hasConceptScore W2316173491C54355233 @default.
• W2316173491 hasConceptScore W2316173491C71924100 @default.
• W2316173491 hasConceptScore W2316173491C86803240 @default.
• W2316173491 hasIssue "5" @default.
• W2316173491 hasLocation W23161734911 @default.
• W2316173491 hasLocation W23161734912 @default.
• W2316173491 hasOpenAccess W2316173491 @default.
• W2316173491 hasPrimaryLocation W23161734911 @default.
• W2316173491 hasRelatedWork W172283860 @default.
• W2316173491 hasRelatedWork W1984201488 @default.
• W2316173491 hasRelatedWork W2049217636 @default.
• W2316173491 hasRelatedWork W2099510828 @default.
• W2316173491 hasRelatedWork W2121684991 @default.
• W2316173491 hasRelatedWork W2316173491 @default.
• W2316173491 hasRelatedWork W2519550798 @default.
• W2316173491 hasRelatedWork W3123328377 @default.
• W2316173491 hasRelatedWork W4283399047 @default.
• W2316173491 hasRelatedWork W4376630347 @default.
• W2316173491 hasVolume "105" @default.

• next