Race, ovarian responsiveness, and live birth following in vitro fertilization.

To determine if ovarian responsiveness to gonadotropin stimulation differs by race/ethnicity and whether this predicts live birth rates (LBRs) in non-White patients undergoing in vitro fertilization (IVF) DESIGN: Retrospective cohort study SUBJECTS: White, Asian, Black, and Hispanic patients undergoing ovarian stimulation for IVF at an academic infertility clinic EXPOSURE: Self-reported race and ethnicity MAIN OUTCOME MEASURES: The primary outcome was ovarian sensitivity index (OSI), defined as the number of oocyte retrieved / total gonadotropin dose x 1000 as a measure of ovarian responsiveness, adjusting for age, BMI, infertility diagnosis, and cycle number. Secondary outcomes included live birth and clinical pregnancy after first retrievals, adjusting for age, infertility diagnosis, and history of fibroids, as well as miscarriage rate per clinical pregnancy, adjusting for age, BMI, infertility diagnosis, duration of infertility, history of fibroids, and use of preimplantation genetic testing for aneuploidy (PGT-A).The primary analysis of OSI included 3360 retrievals (70.2%) from White, 704 (14.7%) from Asian, 553 (11.6%) from Black, and 168 (3.5%) from Hispanic patients. Black and Hispanic patients had higher OSIs than White patients after accounting for those with multiple retrievals and adjusting for confounders (6.08 in Black, p=0.001, and 6.27 in Hispanic, p=0.03, compared to 5.25 in White). There was no difference in OSI between Asian and White patients. The pregnancy outcomes analyses included 2299 retrievals. Despite greater ovarian responsiveness, Black and Hispanic patients had lower LBRs compared to White patients, though these differences were not statistically significant after adjusting for confounders (adjusted odds ratio 0.83, 95% confidence interval [CI] 0.63-1.09, for Black; 0.93, 95% CI 0.61-1.43, for Hispanic). OSI was modestly predictive of live birth in White and Asian patients but not in Black (area under the curve [AUC] 0.51, 95% CI 0.38-0.64) and Hispanic (AUC 0.50, 95% CI 0.37-0.63) patients.Black and Hispanic patients have higher ovarian responsiveness to stimulation during IVF but do not experience a consequent increase in LBR. Exploration of factors beyond differences in responsiveness to ovarian stimulation will be required to address the racial/ethnic disparity established in prior literature.Copyright © 2023. Published by Elsevier Inc.

Citation

Iris T Lee, Dara S Berger, Nathanael Koelper, Suneeta Senapati, Monica Mainigi. Race, ovarian responsiveness, and live birth following in vitro fertilization. Fertility and sterility. 2023 Aug 05

PMID: 37549835

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