From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
University of Pittsburgh School of Medicine and Magee-Women's Research Institute, Pittsburgh, PA.
Sex Transm Dis. 2021 Oct 1;48(10):748-753. doi: 10.1097/OLQ.0000000000001435.
Nearly 14% of US women report any lifetime infertility which is associated with health care costs and psychosocial consequences. Tubal factor infertility (TFI) often occurs as a result of sexually transmitted diseases and subsequent pelvic inflammatory disease. We sought to evaluate for and describe potential racial disparities in TFI and in vitro fertilization (IVF) prevalence.
Records of women aged 19 to 42 years in our retrospective cohort from 2 US infertility clinics were reviewed. We calculated TFI prevalence, IVF initiation prevalence, and prevalence ratios (PRs), with 95% confidence intervals (CIs) for each estimate, overall and by race.
Among 660 infertile women, 110 (16.7%; 95% CI, 13.8-19.5%) had TFI which was higher in Black compared with White women (30.3% [33/109] vs 13.9% [68/489]; PR, 2.2 [95% CI, 1.5-3.1]). For women with TFI, IVF was offered to similar proportions of women by race (51.5% [17/33] vs 52.9% [36/68] for Black vs White women); however, fewer Black than White women with TFI started IVF (6.7% [1/15] vs 31.0% [9/29]; PR, 0.2 [95% CI, 0-1.0]), although the difference was not statistically different.
Tubal factor infertility prevalence was 2-fold higher among Black than White women seeking care for infertility. Among women with TFI, data suggested a lower likelihood of Black women starting IVF than White women. Improved sexually transmitted disease prevention and treatment might ameliorate disparities in TFI.
近 14%的美国女性报告存在终身不孕，这与医疗保健费用和心理社会后果有关。输卵管因素不孕（TFI）常因性传播疾病和随后的盆腔炎引起。我们试图评估 TFI 和体外受精（IVF）的患病率是否存在潜在的种族差异。
我们回顾了美国 2 家不孕诊所的回顾性队列中年龄在 19 至 42 岁的女性记录。我们计算了 TFI 的患病率、IVF 起始率以及每个估计值的比值比（PR）及其 95%置信区间（CI），按种族进行了总体和分层分析。
在 660 名不孕女性中，110 名（16.7%；95%CI，13.8-19.5%）患有 TFI，黑人女性的 TFI 患病率高于白人女性（30.3%[33/109] vs 13.9%[68/489]；PR，2.2[95%CI，1.5-3.1]）。对于患有 TFI 的女性，不同种族接受 IVF 的比例相似（黑人女性中，51.5%[17/33]与白人女性中，52.9%[36/68]接受 IVF；然而，黑人女性中接受 IVF 的人数少于白人女性（6.7%[1/15] vs 31.0%[9/29]；PR，0.2[95%CI，0-1.0]），尽管差异无统计学意义。
在寻求不孕治疗的黑人女性中，TFI 的患病率是白人女性的 2 倍。在患有 TFI 的女性中，黑人女性开始接受 IVF 的可能性低于白人女性，数据表明这一差异存在。改善性传播疾病的预防和治疗可能会减轻 TFI 的差异。
