Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA.
Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, AAT 2400, Oklahoma City, OK, 73126, USA.
J Racial Ethn Health Disparities. 2018 Oct;5(5):1077-1083. doi: 10.1007/s40615-017-0456-8. Epub 2018 Jan 9.
No research exists on American Indian pregnancy rates following infertility treatment. Most racial/ethnic fertility research has focused on pregnancy following in vitro fertilization, with only rare studies looking at intrauterine insemination (IUI). The objective of our study was to compare fecundability following IUI by race/ethnicity, with a special focus on American Indians.
This was a retrospective analysis of subjects undergoing IUI July 2007-May 2012 at a university-based infertility clinic. The primary outcome was positive pregnancy test, with a secondary outcome of ongoing pregnancy/delivery (OP/D). We calculated risk ratios (RR) and 95% confidence intervals (CI) using cluster-weighted generalized estimating equations method to estimate modified Poisson regression models with robust standard errors to account for multiple IUI cycles in the same patient.
A total of 663 females (median age 32) undergoing 2007 IUI cycles were included in the analysis. Pregnancy rates overall were 15% per IUI cycle. OP/D rates overall were 10% per IUI cycle. The American Indian patients had significantly lower pregnancy (RR 0.34, 95% CI 0.16-0.72) and OP/D rates (RR 0.33, 95% CI 0.12-0.87) compared to non-Hispanic whites when patient and cycle characteristics were controlled. Pregnancy and OP/D rates for blacks, Asians, and Hispanics did not differ from those of non-Hispanic whites.
Our finding of lower IUI treatment success among American Indian patients is novel, as no published studies of assisted reproductive technology or other fertility treatments have examined this subgroup separately. Further investigation of patient and clinical factors that may mediate racial/ethnic disparities in fertility treatment outcomes is warranted.
没有研究关注印第安人在接受不孕治疗后的妊娠率。大多数种族/族裔生育力研究都集中在体外受精后的妊娠，只有少数研究关注宫腔内人工授精（IUI）。我们研究的目的是比较 IUI 后的生育能力，特别关注印第安人。
这是一项对 2007 年 7 月至 2012 年 5 月在一家大学不孕诊所接受 IUI 的患者进行的回顾性分析。主要结局是阳性妊娠试验，次要结局是持续妊娠/分娩（OP/D）。我们使用聚类加权广义估计方程方法计算风险比（RR）和 95%置信区间（CI），使用稳健标准误差估计修正泊松回归模型，以考虑同一患者的多个 IUI 周期。
共有 663 名女性（中位年龄 32 岁）接受了 2007 年 IUI 周期的分析。总体妊娠率为每 IUI 周期 15%。总体 OP/D 率为每 IUI 周期 10%。与非西班牙裔白人相比，印第安患者的妊娠率（RR 0.34，95%CI 0.16-0.72）和 OP/D 率（RR 0.33，95%CI 0.12-0.87）明显较低，当控制患者和周期特征时。黑人、亚洲人和西班牙裔的妊娠率和 OP/D 率与非西班牙裔白人没有差异。
我们发现印第安患者的 IUI 治疗成功率较低，这是一个新发现，因为没有发表的研究检查过辅助生殖技术或其他生育治疗对这一亚组的影响。需要进一步研究可能影响生育治疗结果的种族/族裔差异的患者和临床因素。
