Black recipients of oocyte donation experience lower live birth rates compared with White recipients

The failure of gene-centrism

"Challenging the utility of polygenic scores for social science" is a compelling but limited critique. Phenotypic development is sensitive to both initial conditions and all subsequent states - from conception to senescence. Thus, gene-centric analyses are misleading (and often meaningless) because gene products are transformed, and their phenotypic 'effects' combined and attenuated with successive propagations from molecular and cellular contexts to organismal and social environments.

Inequities in Medically Assisted Reproduction: a Scoping Review

Infertility has a high prevalence in the USA and health inequities play a large role in access to medically assisted reproduction (MAR). The aim of this study was to identify gaps in research pertaining to inequities in MAR and propose suggestions for future research directions. Searches were performed using MEDLINE and Ovid Embase. Articles that reported on MAR inequities, published between 2016 and 2021 in the USA, and written in English were included. The inequities investigated were adapted from the NIH-designated health disparities populations. Each article's inequity findings were extracted and reported, along with frequencies of inequities. Our sample included 66 studies. The majority of the studies investigated MAR outcomes by race/ethnicity and found that historically marginalized populations had poorer outcomes. LGBTQ + populations were less likely to use MAR or seek infertility care. Most studies found positive correlations with MAR use with income and education. The least commonly studied inequities in our sample were sex and/or gender and rural/under-resourced populations; findings showed that men and people from rural/under-resourced populations were less likely to access MAR. Studies that examined occupational status had varying findings. We suggest that future research be targeted toward: (1) standardizing and diversifying race/ethnicity reporting regarding MAR, (2) the use of community-based participatory research to increase data for LGBTQ + patients, and (3) increasing access to infertility care for men.

Metabolic Inheritance and the Competition for Calories between Mother and Fetus

During the prenatal period, maternal and fetal cells compete for calories and nutrients. To ensure the survival of the mother and development of the fetus, the prenatal hormonal milieu alters the competitive environment via metabolic perturbations (e.g., insulin resistance). These perturbations increase maternal caloric consumption and engender increments in both maternal fat mass and the number of calories captured by the fetus. However, a mother's metabolic and behavioral phenotypes (e.g., physical activity levels) and her external environment (e.g., food availability) can asymmetrically impact the competitive milieu, leading to irreversible changes in pre- and post-natal development-as exhibited by stunting and obesity. Therefore, the interaction of maternal metabolism, behavior, and environment impact the competition for calories-which in turn creates a continuum of health trajectories in offspring. In sum, the inheritance of metabolic phenotypes offers a comprehensive and consilient explanation for much of the increase in obesity and T2DM over the past 50 years in human and non-human mammals.

Access to Fertility Care in Geographically Underserved Populations, a Second Look

Infertility has a prevalence of up to 16% worldwide and is on the rise in developed nations, largely due to pursuing childbearing at advanced reproductive ages. Advances in assisted reproductive technology have benefitted socioeconomically advantaged patients disproportionately. High costs of fertility care are largely responsible for this disparity; however, patients in rural areas also face barriers in accessing both gynecology and reproductive endocrinology subspecialty care. Here, focusing on the USA, we discuss fertility care in geographically underserved areas and low-resource settings, and the impact on reproductive outcomes. Increased innovation to improve patient access to fertility care such as assisted reproductive technology is critical for ensuring equity. Remote monitoring is frequently performed by fertility centers, but partnership with local gynecologists has also been demonstrated to be an effective assisted reproductive technology monitoring method. Telehealth is now in mainstream use and the continued application to reduce geographic barriers to infertility patients is imperative. Partnership between local gynecologists and reproductive endocrinology and infertility specialists may improve patient access to fertility care and provide the unique benefits of continuity and ongoing local social support.

Primary ovarian insufficiency: a glimpse into the racial and socioeconomic disparities found within third-party reproduction

Objective

To describe a unique case of primary ovarian insufficiency and review the systemic barriers in place that hinder reproductive autonomy for Black women who require third-party reproduction.

Design

Case report and review of the literature.

Setting

Safety-net hospital in an urban community.

Patient(s)

A 36-year-old Black woman, gravida 0, with primary ovarian insufficiency who desires future fertility but is restricted by systemic barriers.

Intervention(s)

Chromosome analysis.

Main Outcome Measure(s)

Not applicable.

Result(s)

Balanced reciprocal translocation between chromosomes 1 and 13: 46,XX,t(1;13)(q25;q14.1).

Conclusion(s)

The field of assisted reproductive technology has evolved at an exponential rate, yet it unfortunately benefits some and not all. It is imperative that when we advocate for full spectrum infertility care, that this encompasses everyone. As we continue to further study and develop assisted reproductive technology, we must not forget to consider the factors leading to racial and socioeconomic disparities in reproductive care access, utilization, and outcomes.

The Disparities in ART (DART) Hypothesis of Racial and Ethnic Disparities in Access and Outcomes of IVF Treatment in the USA

We propose the Disparities in ART (DART) hypothesis which identifies underlining causes that contribute to racial disparities in access and outcomes of ART treatment in the USA. Reasons for disparities in access and outcomes of ART treatment for infertility are derived from some relative contribution of four identified causes. They are simply stated as delays in obtaining treatment, higher dropout during and following unsuccessful ART treatment, provider factors, and differences in patient biological factors. Each of these causes has a subset of 4-6 factors that contribute to each of the 4 broad categorical causes that are discussed. This hypothesis may serve as a platform for better understanding the scope of the challenges and potential research inquiries that may lead to narrowing of racial/ethnic disparities in access and outcomes in ART.

A Comparison of Prostaglandin Profile in Human Follicular Fluid Between White and Black/Hispanic Women

The aim of the study is to compare prostaglandin (PG) profiles in human follicular fluid between White and Black/Hispanic women using data from a previously published study. A retrospective cohort study of 5 White and 5 Black/Hispanic women who underwent oocyte retrieval was conducted. Human follicular fluid was obtained from the first follicle entered at time of oocyte retrieval for patients undergoing in vitro fertilization cycles (IVF). PG levels were compared using mass spectroscopy with known standards to quantify PG levels. Five White women were matched with 5 Black/Hispanic women with diagnosis. Both cohorts had similar levels of age, body mass index, and IVF cycle characteristics. There were no statistical differences in PG profiles (PGE2, PGF1α, PGF2α, or 8 iso-PGF1α). In this small repeat analysis of previously studied data, there were no differences noted in PG profiles in follicular fluid. Larger studies are needed to verify this finding. This study further demonstrates the lack of representation of minority patients in studies.

Factors associated with disparate outcomes among Black women undergoing in vitro fertilization

Objective

To determine if Black women have worse in vitro fertilization (IVF) outcomes than women of other races/ethnicities, and to establish which factors are associated with the IVF outcomes of Black women.

Design

Retrospective cohort study.

Setting

Not applicable.

Patient(s)

All patients undergoing IVF.

Intervention(s)

Not applicable.

Main Outcome Measure(s)

Spontaneous abortion rate, clinical pregnancy rate, and live birth rate.

Result(s)

A total of 71,389 patient cycles were analyzed. Of the 40,545 patients who were included, 6.4% of patients were Black, 62% were White, 7.3% were Hispanic/Latino, and 15% were Asian. After IVF, Black women had significantly more miscarriages than White but not Hispanic or Asian patients (8.0% Black vs. 6.9% White, 7.4% Hispanic, and 7.5% Asian). Clinical pregnancy rates were significantly lower for Black women compared with all other races (45% Black vs. 52% White, 52% Hispanic, and 53% Asian). The odds ratio (OR) of live birth from all cycles were 30% less than that for White women (OR, 1.00 Black vs. 1.43 White) and 22% less than that for Hispanic women (OR, 1.00 Black vs. 1.29 Hispanic). This statistically significant difference in the live birth rate persisted even after adjusting for patient characteristics (OR, 1.00 Black vs. 1.32 White, 1.23 Hispanic, and 1.18 Asian).

Conclusion(s)

Black women have worse IVF outcomes than women of all other racial backgrounds undergoing IVF. The factors associated with the disparate outcomes of Black women undergoing IVF outcomes include older age starting IVF, higher body mass index, tubal factor infertility, and diabetes.

Body mass index, not race, may be associated with an alteration in early embryo morphokinetics during in vitro fertilization

OBJECTIVE

To assess the relationship between maternal body mass index (BMI) and embryo morphokinetics on time-lapse microscopy (TLM).

DESIGN

Retrospective cohort study.

METHODS

All IVF cycles between June 2015 and April 2017 were reviewed. Female BMI prior to egg retrieval was collected through chart review. BMI (kg/m2) classification included underweight (< 18.5), normal weight (18.5-25), overweight (25-30), and obese (≥ 30). Embryos' morphokinetic parameters were assessed with TLM and included time to syngamy, 2-cell, 3-cell, 4-cell, and 8-cell. A generalized linear mixed model was used to control for potential confounders and multiple embryos resulting from a single IVF cycle.

RESULTS

A total of 2150 embryos from 589 IVF cycles were reviewed and included in the analysis. Classification based on BMI was as follows: underweight (N = 56), normal weight (N = 1252), overweight (N = 502), and obese (N = 340). After adjusting for race and use of intracytoplasmic sperm injection, the mean time to the 8-cell stage in the underweight group was 4.3 (95% CI: - 8.31, - 0.21) h less than in the normal weight group (P = 0.025) and 4.6 (95% CI: - 8.8, - 0.21) h less than in the obese group (p = 0.022). No significant difference was noted between race and TLM after controlling for possible confounders.

CONCLUSIONS

Embryos from underweight women were demonstrated to have a faster time to the 8-cell stage than normal weight or obese women. No significant difference was noted for race. This study demonstrates that weight can be a factor contributing to embryo development as observed with TLM.

Factors contributing to persistent disparate outcomes of in vitro fertilization treatment

PURPOSE OF REVIEW

Disparate healthcare outcomes are ubiquitous and occur across all fields of medicine, specifically for racial and ethnic minorities. Within reproductive health, minority women face disparate access to care, particularly infertility services, poor outcomes of fertility treatment, alarmingly higher rates of maternal morbidity and mortality as well as higher rates of preterm birth, lower live birth rates when they conceive spontaneously or when they conceive with assisted reproductive technology. The objective of this review is to highlight factors contributing to the persistent racial/ethnic disparities in in vitro fertilization (IVF) outcomes.

RECENT FINDINGS

Recent studies document poorer outcomes after IVF treatment. Black women have been shown to have lower live birth rates following IVF treatment for more than 15 years.

SUMMARY

In an effort to better understand these negative outcomes, scientists and clinicians have investigated possible biological contributing factors including the vaginal microbiome, differences in oocyte quality, embryo viability, endometrial factors, and hormonal differences. Multiple social/cultural factors also play a role including access to care, particularly for people with low income, patient (mis)education, and medical racism/bias.