Racial Disparities in Fertility Care: an Analysis of 4537 Intrauterine Insemination Cycles

Studies suggest that race may affect access to fertility treatments and their outcomes. We examined whether race affects the following: duration of infertility prior to seeking evaluation, diagnosis, treatment cycle characteristics, and outcomes. Design: Retrospective cohort. Settings: Academic fertility center. Patients: 4537 intrauterine insemination ± ovulation induction (IUI ± OI) cycles/1495 patients. Interventions: IUI following: (i) OI with either clomiphene citrate or gonadotropins and (ii) ultrasound-monitored natural cycles. Outcome measures: Duration of infertility prior to seeking treatment, SART diagnosis, treatment cycle characteristics and outcomes (spontaneous abortion (SABR), clinical (CPR) and multiple pregnancy rates (MPR)). Asians and Hispanics compared to Caucasians waited significantly longer prior to seeking fertility evaluation (p < 0.01). The mean age of patients seeking infertility evaluation did not differ between groups nor did the type of treatment initially chosen by the patients. Idiopathic infertility was more common among Caucasians (p < 0.05, compared to all others) while PCOS and tubal factor infertility were more frequent among Hispanics (p < 0.05, compared to Caucasian, Asian, and mixed ancestry women) and decreased ovarian reserve was more common among African-Americans (p < 0.01, compared to Caucasians, Asians, and Hispanics). Gonadotropin cycle characteristics including dosing and duration of treatment, follicular recruitment, peak estradiol levels, and endometrial lining thickness differed between certain groups. However, no difference was found in CPR, MPR, and SABR between groups. Race affects timely access to infertility care, diagnosis, and treatment cycle characteristics but not outcomes. Considering the nation’s growing multiracial population, understanding the effect of race on fertility care becomes increasingly important.