Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Stanford University, Stanford, California, United States of America.
PLoS One. 2009 Oct 26;4(10):e7599. doi: 10.1371/journal.pone.0007599.
Disease 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 FINDINGS: In 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/SIGNIFICANCE: Despite 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.
不同种族的患者疾病发病率和对医学治疗的反应可能存在差异。与白人女性相比，印度女性接受体外受精（IVF）治疗的效果较差，有证据表明胚胎质量较差可能是造成这种差异的原因之一。在我们中心，只有质量最高的卵裂期胚胎的患者才被认为有资格将胚胎培养延长至囊胚阶段。我们比较了囊胚移植后印度和白人女性的活产率（LBR），以调查这些种族之间的 IVF 结果差异是否会在移植相似质量胚胎的患者中持续存在。
方法/主要发现：在这项回顾性队列分析中，我们比较了 2005 年 1 月 1 日至 2007 年 6 月 31 日在我们的大学中心进行囊胚移植的 145 名白人女性和 80 名印度女性的 IVF 结果。印度女性比白人女性年轻 2.7 岁（34.03 岁比 36.71 岁，P=0.03），更有可能使用激动剂下调方案（68%比 43%，P<0.01），并且更有可能患有多囊卵巢综合征（PCOS），尽管差异无统计学意义（24%比 14%，P=0.06）。68%的印度患者移植了质量最高的胚胎（4AB 囊胚或更好），而 71%的白人患者移植了质量最高的胚胎（P=0.2）。与白人女性相比，印度女性的活产率明显较低（24%比 41%，P<0.01），优势比为 0.63（95%CI 0.46-0.86）。在多变量分析中，控制年龄、刺激方案和 PCOS 后，活产率仍较低，调整后的优势比为 0.56（95%CI 0.40-0.79）。
结论/意义：尽管印度女性年龄较小，胚胎质量相似，但活产率明显低于白人女性。在这项初步研究中，尽管将分析仅限于移植高质量胚胎的患者，但印度人种 IVF 后预后较差的情况仍然存在。需要进一步研究生殖领域的种族差异的解释。
