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Black–White Inequality in Outcomes of In Vitro Fertilization: a Systematic Review and Meta-analysis

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Abstract

This study aims to systematically review disparities in outcomes of in vitro fertilization between Black and White patients. We searched CINAHL, Cochrane Library, EMBASE, Global Health, PsycINFO, PubMed, and Web of Science for observational studies published before August 2021. Outcomes included implantation, clinical pregnancy, spontaneous abortion, and live birth following in vitro fertilization in Black versus White patients. We used random-effects models for meta-analysis and the Mantel–Haenszel method to calculate unadjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between race and in vitro fertilization outcomes, comparing Black relative to White patients. We used the generic inverse variance method to calculate adjusted ORs. Nine observational studies met eligibility criteria, including 696 Black and 7,458 White patients. All were retrospective studies of US cohorts. In unadjusted meta-analyses, Black patients had a greater likelihood of spontaneous abortion (OR 2.08, 95% CI 1.59–2.71) and lower likelihood of live birth (OR 0.67, 95% CI 0.47–0.95) compared with White patients but no difference in implantation (OR 0.95, 95% CI 0.32–2.77) or clinical pregnancy (OR 0.78, 95% CI 0.54–1.12). In adjusted meta-analyses, Black patients had lower odds of live birth (OR 0.57, 95% CI 0.43–0.75) and no difference in clinical pregnancy (OR 0.87, 95% CI 0.51–1.48). This meta-analysis suggests that in vitro fertilization services achieve similar pregnancy rates in Black and White patients. However, Black patients have more spontaneous abortions and fewer live births, suggesting there may be disparities in the quality of achieved pregnancies or other factors associated with pregnancy loss. Systematic review registration: PROSPERO (ID CRD42021256250).

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Availability of Data and Material

Data can be accessed by submitting a request to N Auger.

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Funding

This study was funded by the Canadian Institutes of Health Research (PJT-162300). N Auger was supported by the Fonds de recherche de Québec-Santé (296785). The sponsors were not involved in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

    Paige Veira, Ugochinyere Vivian Ukah & Nathalie Auger

  2. Institut national de santé publique du Québec, Montreal, QC, Canada

    Paige Veira, Shu Qin Wei, Ugochinyere Vivian Ukah, Jessica Healy-Profitós & Nathalie Auger

  3. Department of Obstetrics and Gynecology, Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada

    Shu Qin Wei

  4. University of Montreal Hospital Research Centre, Montreal, QC, Canada

    Jessica Healy-Profitós & Nathalie Auger

  5. Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada

    Nathalie Auger

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  1. Paige Veira
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  2. Shu Qin Wei
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  3. Ugochinyere Vivian Ukah
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  4. Jessica Healy-Profitós
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  5. Nathalie Auger
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Contributions

All authors contributed to the development of the research question. PV and SQW performed the literature search and data analysis. PV and UVU drafted the manuscript. SQW, JHP, and NA critically revised the work.

Corresponding author

Correspondence to Nathalie Auger.

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This systematic review and meta-analysis only involved publicly available data and did not require IRB approval.

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The authors declare no competing interests.

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Veira, P., Wei, S.Q., Ukah, U.V. et al. Black–White Inequality in Outcomes of In Vitro Fertilization: a Systematic Review and Meta-analysis. Reprod. Sci. 29, 1974–1982 (2022). https://doi.org/10.1007/s43032-022-00928-9

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  • DOI: https://doi.org/10.1007/s43032-022-00928-9

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