Search

Purpose: The purpose of the study was to determine whether diagnosis of endometriosis or endometriosis with endometrioma influences in vitro fertilization (IVF) outcomes in an ethnically diverse population., Methods: Women undergoing a first IVF cycle (n = 717) between January 1, 2008 and December 31, 2009, at a university-affiliated infertility clinic, were retrospectively assessed for an endometriosis diagnosis. Differences in prevalence of endometriosis by ethnicity were determined, as well as differences in IVF success by ethnicity, with a focus on country of origin for Asian women. A multivariate model was generated to assess the relative contributions of country of origin and endometriosis to chance of clinical pregnancy with IVF., Results: Endometriosis was diagnosed in 9.5% of participants; 3.5% also received a diagnosis of endometrioma. Endometriosis prevalence in Asian women was significantly greater than in Caucasians (15.7 vs. 5.8%, p < 0.01). Women of Filipino (p < 0.01), Indian (p < 0.01), Japanese (p < 0.01), and Korean (p < 0.05) origin specifically were more likely to have endometriosis than Caucasian women, although there was no difference in endometrioma presence by race/ethnicity. Oocyte quantity, embryo quality, and fertilization rates did not relate to endometriosis. Clinical pregnancy rates were significantly lower for Asian women, specifically in Indian (p < 0.05), Japanese (p < 0.05), and Korean (p < 0.05) women, compared to Caucasian women, even after controlling for endometriosis status., Conclusions: The prevalence of endometriosis appears to be higher in Filipino, Indian, Japanese, and Korean women presenting for IVF treatment than for Caucasian women; however, the discrepancy in IVF outcomes was conditionally independent of the presence of endometriosis. Future research should focus on improving pregnancy outcomes for Asian populations whether or not they are affected by endometriosis, specifically in the form of longitudinal studies where exposures can be captured prior to endometriosis diagnoses and infertility treatment.

Disparities in assisted reproductive technologies (ARTs) outcomes have been identified among ethnic minorities when compared with their Caucasian counterparts. Minority ethnicity has been shown to be an independent predictor of lower clinical pregnancy and live birth rates in many studies. In this article, we seek to summarize the most recent literature on ethnic difference reported within ART outcomes. We will discuss potential reasons behind these disparities and further explore independent predictors and associations between ethnicity and ART success., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Asian women have significantly higher serum E(2) levels during treatment with transdermal E(2) compared with white women. This finding suggests altered metabolic clearance of this steroid hormone., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

This review examines racial and ethnic disparities in reproductive health focusing on 3 key topical areas: (1) infertility, (2) polycystic ovarian syndrome, and (3) reproductive aging. We report that an increasing body of knowledge points toward reduced infertility access and in vitro fertilization outcomes in Asian, black, and Hispanic women compared with white women. There are differences in the reproductive and metabolic phenotypes of Asian, black, and Hispanic women presenting with the polycystic ovarian syndrome compared with white women. Reproductive aging differences appear to exist in all racial and ethnic groups. Awareness of racial and ethnic disparities is critical to a complete understanding of the health issues facing women of reproductive age., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

We examined the published relationship between uterine fibroids and reproductive outcomes. Submucosal fibroids had the strongest association with lower ongoing pregnancy rates, odds ratio, 0.5; 95% confidence interval, 0.3-0.8, primarily through decreased implantation. Cumulative pregnancy rates appeared slightly lower in patients with intramural fibroids 36.9% vs 41.1%, which may reflect biases in the literature; however, patients with intramural fibroids also experienced more miscarriages, 20.4% vs 12.9%. Adverse obstetric outcomes are rare and may reflect age or other differences in fibroid populations. Increased risk of malpresentation (odds ratio, 2.9; 2.6-3.2), cesarean (odds ratio, 3.7; 3.5-3.9), and preterm delivery (odds ratio, 1.5; 1.3-1.7) are reported; however, the incidence of labor dystocia was low (7.5%). There was no conclusive evidence that intramural or subserosal fibroids adversely affect fecundity. More prospective, controlled trials are needed to assess the effects of myomectomy. Good maternal and neonatal outcomes are expected in pregnancies with uterine fibroids.

Objective: To determine whether success rates were similar in Asian and Caucasian women undergoing infertility treatment., Design: Secondary data analysis and multivariate modeling., Setting: Clinics reporting to the national Society for Assisted Reproductive Technology registry and a university-based clinic., Patient(s): Caucasian and self-identified Asian infertile women undergoing IVF. The study included 25,843 Caucasian and 1,429 Asian patients from the national registry; 370 Caucasian and 197 Asian patients were included from the site-specific clinic., Intervention(s): In vitro fertilization., Main Outcome Measure(s): Pregnancy rate and live-birth rate., Result(s): Infertile Asian women differed only minimally from their Caucasian counterparts in baseline characteristics and treatment response. Yet Asian women had a decreased clinical pregnancy rate (odds ratio, 0.71; 95% confidence interval 0.64-0.80) and a decreased live-birth rate (odds ratio, 0.69; 95% confidence interval 0.61-0.77). Subsequent multivariate analysis demonstrated that Asian ethnicity was an independent predictor of poor outcome., Conclusion(s): After treatment, infertile Asian women have significantly fewer pregnancies than do Caucasian women. Multivariate analysis indicates that this discrepancy cannot be accounted for by differences in baseline characteristics or by response to current therapeutic interventions.

Objective: Delaying ET to day 3 to optimize embryo selection is well accepted. However, in cases where there are not enough embryos to perform selection, it is not clear whether there is a difference in clinical outcomes with the day of ET., Design: Cohort study., Setting: Academic medical center., Patient(s): Two hundred forty-two fresh IVF/intracytoplasmic sperm injection (ICSI) cycles from 2002-2004, where all generated embryos were transferred irrespective of quality because of an extremely low number of available embryos., Intervention(s): In time period 1, ET was on day 3. In time period 2, ET was on day 2., Main Outcome Measure(s): Patient response to stimulation was analyzed along with pregnancy outcome and implantation rate., Result(s): Miscarriage rates were decreased, and ongoing pregnancy rates were increased with a day 2 ET in patients <40 years of age., Conclusion(s): In women <40 years of age, the day of transfer is a significant predictor of clinical outcome in cases in which a low number of embryos are available for transfer. The evidence suggests that limiting embryo culture to only 2 days reduces the incidence of miscarriage and increases ongoing pregnancy rates.