Poor Prognosis with In Vitro Fertilization in Indian Women Compared to Caucasian Women Despite Similar Embryo Quality

Abstract

BackgroundDisease prevalence and response to medical therapy may differ among patients of diverse ethnicities. Poor outcomes with in vitro fertilization (IVF) treatment have been previously shown in Indian women compared to Caucasian women, and some evidence suggests that poor embryo quality may be a cause for the discrepancy. In our center, only patients with the highest quality cleavage stage embryos are considered eligible for extending embryo culture to the blastocyst stage. We compared live birth rates (LBR) between Indian and Caucasian women after blastocyst transfer to investigate whether differences in IVF outcomes between these ethnicities would persist in patients who transferred similar quality embryos.Methodology/Principal FindingsIn this retrospective cohort analysis, we compared IVF outcome between 145 Caucasians and 80 Indians who had a blastocyst transfer between January 1, 2005 and June 31, 2007 in our university center. Indians were younger than Caucasians by 2.7 years (34.03 vs. 36.71, P = 0.03), were more likely to have an agonist down regulation protocol (68% vs. 43%, P<0.01), and were more likely to have polycystic ovarian syndrome (PCOS), although not significant, (24% vs. 14%, P = 0.06). Sixty eight percent of Indian patients had the highest quality embryos (4AB blastocyst or better) transferred compared to 71% of the Caucasians (P = 0.2). LBR was significantly lower in the Indians compared to the Caucasians (24% vs. 41%, P<0.01) with an odds ratio of 0.63, (95%CI 0.46–0.86). Controlling for age, stimulation protocol and PCOS showed persistently lower LBR with an adjusted odds ratio of 0.56, (95%CI 0.40–0.79) in the multivariate analysis.Conclusions/SignificanceDespite younger age and similar embryo quality, Indians had a significantly lower LBR than Caucasians. In this preliminary study, poor prognosis after IVF for Indian ethnicity persisted despite limiting analysis to patients with high quality embryos transferred. Further investigation into explanations for ethnic differences in reproduction is needed.

Influence of race and ethnicity on in vitro fertilization outcomes: systematic review

“…White women may be more likely to have PCOS, endometriosis, and/or other ovulation disorders compared with black or Hispanic women, and there is conflicting evidence on whether PCOS is more common in Asians than whites undergoing IVF (19,21,24,37,(49)(50)(51)(52). Though unlikely to fully explain disparities, ethnic differences in the prevalence and metabolic/reproductive consequences of PCOS have been previously identified (14).…”

Effect of ethnicity on live birth rates after in vitro fertilisation or intracytoplasmic sperm injection treatment

“…In two separate studies, again in the USA, lower live birth rates were reported in South Asian Indian women compared with white women, despite their younger age and lower basal follicle stimulating hormone (FSH) levels 10,11. Less than a handful of studies reported no differences in assisted reproductive technology (ART) outcome between Hispanic and white women,12 or between African-American and white women 13,14.…”

Differences in Fertility and Assisted Reproduction in South Asian Women

“…There are little data on genital tuberculosis in the United States, as it is relatively uncommon except in immigrant populations. Shahine et al [ 15 ] and Sharara coworkers [ 16 ] showed no difference in the incidence of tubal factor between the South Asians and Caucasians in their studies.…”

“…In contrast to the study by Palep-Singh et al, the two groups had similar number of oocytes retrieved, fertilization rates, and mean number of blastocysts. Despite a younger average age, similar response to ovarian stimulation, and comparable embryo quality, the Indian patients had signifi cantly lower clinical pregnancy rates (36 % vs. 52 %) and LBR (24 % vs. 41 %) than the Caucasian patients [ 15 ]. Sharara et al performed a similar study in Virginia, comparing South Asian women to Caucasian women undergoing fresh blastocyst transfer (see Table 8.2 ).…”