Expert's Perspective

How We Might Treat South Asian Women Differently

As a field, we’re beginning to understand that the causes of infertility and the effects of fertility treatment may vary somewhat depending on ethnicity. In my clinic at Stanford, we see a large number of women from South Asian heritage and we keep a close eye on how we might treat these patients uniquely.

A word of caution before we delve further, many of the studies here are done out of a single center and for many, many reasons their observations may not apply to your prospects. That said, let’s get going.

The first observation is there may be some differences in the way that polycystic ovarian syndrome (PCOS) affects South Asian women. Compared with Caucasians who have PCOS, South Asian women with PCOS tend to have higher insulin levels and higher testosterone levels, suggesting that it may be important to be sure that your health care provider checks these hormones by blood test if you have PCOS.

One study showed that when South Asian women with PCOS underwent ovarian stimulation (when we place women on injectable hormones to retrieve more eggs) for IVF, they required a lower dose of hormone injections and had a higher number of eggs retrieved compared with Caucasian women with PCOS.

The positive implication here is we might get comparably good numbers of eggs to work with while subjecting women to less hormone exposure. The possibly negative implication here is that it might be easier to accidentally overstimulate South Asian women, which can result in OHSS. That said, it’s still true that for now, the most important factors to consider in deciding on the starting dose of medication for a first IVF cycle is not ethnicity but your antral follicle count, AMH level, and weight.

Data from our clinic has shown that with fresh embryo transfer (when we inseminate the retrieved eggs, grow them to blastocyst stage and immediately transfer them back into the uterus), South Asians had a significantly lower live birth rate compared with Caucasians. This observation was made despite the fact that in this study, there was no difference in embryo quality based on ethnicity; both groups of women had transfer of good quality blastocysts.

However, with frozen embryo transfer, no difference in live birth rate was seen between South Asians and Caucasians.

These findings suggest that the uterine lining (also known as the endometrium) for at least some South Asians may not be optimal for the fresh IVF cycle, because the patient’s hormonal balance may still be impacted from the egg retrieval process. Although many physicians in the USA are already recommending freezing all embryos for couples of all ethnicities, these data suggest that freeze all cycles may be particularly beneficial for at least some South Asian women.

Unfortunately most clinics aren’t able to breakdown their success rates by ethnicity. So your personal success rate may differ from that reported on a fertility center’s website, unless the program you’re working with has a large percentage of patients who are of your ethnicity. The same likely goes for the national averages we record in SART, where the reality is the rates of success probably resemble those of Caucasian patients, to the degree there is a difference.

Finally, there are currently some limitations regarding any conclusions that can be made about ethnicity and fertility treatment for South Asian women. Partner ethnicity may matter, but there aren’t good data about this yet. Some categories such as “Asian” have been used in studies to include all Asian women. But it probably doesn’t make sense to group together South Asian women from India with women from China, Japan, Thailand, and other Asian countries because there are real differences in these populations. The good news is that research is ongoing which will allow treatment to be better individualized for couples depending on their ethnicity.

[Editor's note: You can now search for clinical reviews written by patients of specific ethnicities, including South Asian, here]

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