Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
Am J Obstet Gynecol. 2021 Apr;224(4):374.e1-374.e12. doi: 10.1016/j.ajog.2020.09.013. Epub 2020 Sep 12.
A growing literature suggests that minority races, particularly Black women, have a lower probability of live birth and higher risk of perinatal complications after autologous assisted reproductive technology. However, questions still remain as to whether these racial disparities have arisen because of associations between race and oocyte/embryo quality, the uterine environment, or a combination of the two. Oocyte donation assisted reproductive technology represents a unique approach to examine this question.
This study aimed to evaluate the associations between the race of female oocyte donors and recipients and live birth rates following vitrified donor oocyte assisted reproductive technologies.
This was a retrospective study conducted at a single, private fertility clinic that included 327 oocyte donors and 899 recipients who underwent 1601 embryo transfer cycles (2008-2015). Self-reported race of the donor and recipient were abstracted from medical records. Live birth was defined as the delivery of at least 1 live-born neonate. We used multivariable cluster weighted generalized estimating equations with binomial distribution and log link function to estimate the adjusted risk ratios of live birth, adjusting for donor age and body mass index, recipient age and body mass index, tubal and uterine factor infertility, and year of oocyte retrieval.
The racial profile of our donors and recipients were similar: 73% white, 13% Black, 4% Hispanic, 8% Asian, and 2% other. Women who received oocytes from Hispanic donors had a significantly higher probability of live birth (adjusted risk ratio, 1.20; 95% confidence interval, 1.05-1.36) than women who received oocytes from white donors. Among Hispanic recipients, however, there was no significant difference in probability of live birth compared with white recipients (adjusted risk ratio, 1.07; 95% confidence interval, 0.90-1.26). Embryo transfer cycles using oocytes from Black donors (adjusted risk ratio, 0.86; 95% confidence interval, 0.72-1.03) and Black recipients (adjusted risk ratio, 0.84; 95% confidence interval, 0.71-0.99) had a lower probability of live birth than white donors and white recipients, respectively. There were no significant differences in the probability of live birth among Hispanic, Asian, and other race recipients compared with white recipients.
Black female recipients had a lower probability of live birth following assisted reproductive technology, even when using vitrified oocytes from healthy donors. Female recipients who used vitrified oocytes from Hispanic donors had a higher probability of live birth regardless of their own race.
越来越多的文献表明，少数族裔，尤其是黑人女性，在自体辅助生殖技术后活产的可能性较低，围产期并发症的风险较高。然而，种族差异是否是由于卵子/胚胎质量、子宫环境或两者结合的关联引起的，仍存在疑问。卵母细胞捐赠辅助生殖技术为研究这一问题提供了一种独特的方法。
本研究旨在评估女性供卵者和受卵者的种族与玻璃化捐卵辅助生殖技术后活产率之间的关联。
这是一项在一家私人生育诊所进行的回顾性研究，共纳入 327 名供卵者和 899 名接受了 1601 个胚胎移植周期（2008-2015 年）的受卵者。供卵者和受卵者的自我报告种族均从病历中提取。活产定义为至少有 1 个活产新生儿的分娩。我们使用多变量聚类加权广义估计方程，采用二项分布和对数链接函数，调整供卵者年龄和体重指数、受卵者年龄和体重指数、输卵管和子宫因素不孕以及卵母细胞采集年份，估计活产的调整风险比。
我们的供卵者和受卵者的种族分布相似：73%为白人，13%为黑人，4%为西班牙裔，8%为亚洲人，2%为其他种族。接受西班牙裔供卵者卵子的女性活产的可能性显著高于接受白人供卵者卵子的女性（调整风险比，1.20；95%置信区间，1.05-1.36）。然而，在西班牙裔受卵者中，与白人受卵者相比，活产的可能性并无显著差异（调整风险比，1.07；95%置信区间，0.90-1.26）。接受黑人供卵者（调整风险比，0.86；95%置信区间，0.72-1.03）和黑人受卵者（调整风险比，0.84；95%置信区间，0.71-0.99）的胚胎移植周期活产的可能性均低于白人供卵者和白人受卵者。与白人受卵者相比，西班牙裔、亚洲裔和其他种族受卵者的活产可能性无显著差异。
即使使用来自健康供者的玻璃化卵子，黑人女性受卵者在接受辅助生殖技术后活产的可能性也较低。无论自身种族如何，使用来自西班牙裔供卵者的玻璃化卵子的受卵者活产的可能性更高。
