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Fertility for Black Families

Lesson 3 of 5

Success Rates for Black Patients

Video Lesson

Written Lesson

Intrauterine Insemination

Over the years, we’ve learned that fertility treatment success rates often vary by a patient’s race and ethnicity. The information below is to help Black patients recalibrate and discount the data (based mostly on Caucasian patients) that their clinic will show them.

For patients who do intrauterine insemination, or IUI, the data suggests, on average, each cycle is likely to work 1%—15% of the time. Most of the studies that have compared IUI success rates between Black and Caucasian women have found no meaningful difference. Similarly, studies comparing success rates using ovulation induction for patients with PCOS or unexplained infertility didn’t see a disparity between Black and Caucasian patients.

As you can see here in our lesson on IUI success rates, rates of success vary by patient type and the fertility drugs taken but there’s limited evidence that Black patients do better or worse than Caucasian patients in this process.

In-Vitro Fertilization

Unfortunately, it appears Black IVF patients have lower success rates than Caucasian women. Most, but not all studies, back this up: often larger, retrospective registries confirm the finding, whereas smaller, single center studies are less likely to record a disparity. As a result, Black women and couples may need to recalibrate, or even discount, the general success rates their clinic advertises.

To illustrate the point, we’ll look at one study that calculated success rates for all IVF cycles conducted in the United States between 2004 and 2006 and for which there is race data available on patients. While the analysis has drawbacks, a number of other studies arrived at a similar conclusion.

“Success rates” can be measured in many ways and so we’ll focus on 3: pregancy rate, miscarriage rate, and live birth rate.

Pregnancy Rate:

What It is: This is the percentage of women who start an IVF cycle and get pregnant from that cycle. A “cycle” starts when a woman takes hormones and has her eggs retrieved.

Study Observations: 38% of Caucasian women and 29% of Black women conceived after one IVF cycle. After adjusting for a few factors, investigators determined Black women were half as likely to get pregnant from one round of IVF.

Miscarriage Rate:

What It Is: The percentage of IVF pregnancies that end in miscarriage.

Study Observations: 13% of Caucasian women and 20% of Black women miscarried if they conceived through IVF.

Live Birth Rate:

What It Is: The percentage of women who start an IVF cycle and successfully deliver a live baby from that cycle.

Study Observations: 32% of Caucasian women delivered a child after one cycle. For Black women, success rates were closer to 22% or around a third lower than what Caucasian women recorded.

Fetal Death and Other Complications

There is data to suggest the odds of complications from fertility treatment is not uniform across racial and ethnic populations. While disparities exist when people conceive without treatment, they seemingly become more pronounced with treatment.

For instance, one well-regarded study in Pediatrics suggests that compared with Caucasian patients, those of Black, Asian (broadly defined) and Latinx heritage record higher rates of fetal death or preterm delivery. However, it’s important to keep in mind these issues occur in the low single digit percentages of all deliveries.

That’s true amongst patients who conceived with oral medication for ovulation induction and IUI—as you can see from the data below.

It’s also true amongst patients who conceived using in vitro fertilization, often at levels comparable to oral medication and IUI.

Contributing Factors

As we covered in the first lesson, Black patients tend to get treated at older ages and, as we’ll cover in the next lesson, other factors (like uterine fibroids) tend to disproportionately impact their fertility.

However, after “controlling” for these differences, investigators still observed a major difference in treatment outcomes.

One potential factor may be the observation Black patients are more likely to be treated at smaller clinics, or clinics with lower rates of success, as you can see in the data below.

Factors that contribute to these disparate outcomes for Black women go beyond medical and anthropometric differences. In fact, research shows that systemic racism and discrimination against Black and African American patients contributes significantly, and until these issues are properly addressed and rectified, closing the gap will remain beyond reach (Treder 2022; Jackson-Bey 2021)

Greater Context

This data could lead Black women or couples to wonder “why should I consider IVF if it works better for Caucasian patients.” We think it’s also relevant to ask, “amongst all of my options, which is most likely to lead to a birth for me personally?”

Indeed, IVF success rates may be higher for other populations, but compared with the alternatives (like doing no treatment at all), IVF success rates often rank favorably. Again, below is the data for the odds of conceiving naturally within the first year: unfortunately, the odds of conception gradually approach zero.

Age and Natural Fertility Decline