Expert's Perspective

Treating East Asian Women For Infertility

East Asian (including Chinese, Korean, Japanese, and Vietnamese) women have been demonstrated to have a longer duration of infertility by the time they reach consultation compared to white women which may influence their chance for success with ART (Assisted Reproductive Technology).

There is substantial evidence within the US ART population that East Asian women have poorer outcomes from fresh embryo transfers. A study utilizing the SART database drawing from 25,843 Caucasian and 1,429 Asian patients demonstrated decreased cumulative pregnancy (CPR) and live birth rates (LBR) among Asian women undergoing IVF compared to Caucasian women (CPR 33.3% among Asian as compared to 41.3% among Caucasians and 26.9% LBR for Asian and 34.9% for Caucasians). Generally speaking, East Asian women had 1/3 lower likelihood of pregnancy from a fresh embryo transfer compared to Caucasian women.

East Asian women appear to metabolize estrogen differently than Caucasian women. That matters because this drives higher estrogen levels during IVF stimulation, which during a fresh transfer (takes place shortly after the eggs are retrieved), may influence whether the woman’s endometrium is receptive to having the embryo implant.

Relatedly, at UCSF, we’ve also shown a lower pregnancy rate was seen in East Asian women as compared to Caucasians following stimulated intrauterine insemination (IUI) despite similar baseline characteristics between the two groups.

Interestingly, we do not see differences in success when the East Asian woman uses donated eggs during a fresh transfer or during frozen embryo transfers. These observations would lead us to believe that the reduced pregnancy success in East Asian women may be due to greater negative effects on the receptivity of the uterine environment during ovarian stimulation compared to Caucasian women. Further evidence demonstrating similar rates of embryo aneuploidy in East Asian women compared to Caucasian women, suggesting that the egg quality is not different between races.

While I recommend every patient closely weighs the benefits of a fresh versus frozen embryo transfer, an East Asian woman choosing a fresh embryo transfer should consider a protocol that calls for a reduction in the dose of gonadotropins leading up to her egg retrieval (even if it impacts the number of eggs harvested) in an effort to mitigate the effects of stimulation on her uterine environment.

That said, in the US Asian IVF population, heterogeneity of subpopulations prompt further delineation of at-risk populations for reduced IVF outcomes. Similarly, duration of infertility, lower BMI, and higher estradiol response to gonadotropin stimulation suggest biologic origins to differences in reproductive outcomes.

Related Courses
73k

Embryo Transfer

Learn More
We cover how many embryos to transfer, medicated vs. unmedicated cycles, fresh vs. frozen, and the do's and don'ts on transfer day itself.
Featuring experts from
Columbia, NYU, +3 more
27k

Acupuncture

Learn More
Does acupuncture & traditional Chinese medicine really make a difference for fertility? See the data on IVF, other fertility treatments, and trying naturally with acupuncture and Chinese herbs.
339k

IVF - In Vitro Fertilization

Learn More
The most complex fertility treatment, this course will help you do it right the first time.
Featuring experts from
CCRM, Cornell, +7 more
6k

Fertility 101

Learn More
You took sex ed, but now you need to understand fertility. Data to answer your questions about natural conception and diagnosing what might be wrong.
Featuring experts from
Mount Sinai, Stanford, +7 more
15k

Endometriosis

Learn More
Breaking down all the data and information on what endometriosis is, how to best diagnose it, and what the best treatment is depending on who you are
Featuring experts from
Stanford
13k

ICSI

Learn More
ICSI costs $3–$5k but only improves birth rates in specific circumstances (hint: it’s not as simple as “helps with male factor”). We break down when it’s truly helpful.
Featuring experts from
NYU, Cornell, +6 more
304k

IUI or "Artificial Insemination"

Learn More
Data on IUI success rates depending on who you are, what it costs, the risks, and how to decide between doing IUI and IVF.
Featuring experts from
Stanford, CCRM, +6 more
63k

Lifestyle Choices, From Diet To Supplements

Learn More
All the data on lifestyle choices and their impact on fertility, including decisions around diet, exercise, drinking alcohol, caffeine consumption, smoking, recreational drugs, and using supplements.
Featuring experts from
UCLA, Harvard, +4 more
43k

Male Factor Infertility

Learn More
Male factor infertility impacts anywhere between a third and half of a couple's difficulty in conceiving. The primary factors often end up being related to varicocele or some form of azoospermia. While a semen analysis can help characterize if there is an issue, the test can be inconsistent, difficult to interpret.
Featuring experts from
Mount Sinai, Cornell
37k

PGT (PGS) Genetic Screening

Learn More
Giving you the full picture: where it helps, where it doesn’t, and how you might think about this expensive add-on based on your specific priorities.
Featuring experts from
Cornell, Mount Sinai, +6 more
9k

The IVF Laboratory

Learn More
Lab quality determines success. This course explains how to vet a lab to give yourself the best chance of a good outcome.
Featuring experts from
Mount Sinai, Columbia, +6 more
67k

Egg Freezing

Learn More
Preparing you to be a confident self-advocate as you make decisions around fertility preservation.
Featuring experts from
Columbia, NYU, +3 more
Related Lessons