Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
Fertil Steril. 2023 Nov;120(5):1023-1032. doi: 10.1016/j.fertnstert.2023.08.001. Epub 2023 Aug 5.
To determine if ovarian responsiveness to gonadotropin stimulation differs by race/ethnicity and whether this predicts live birth rates (LBRs) in non-White patients undergoing in vitro fertilization (IVF).
Retrospective cohort study.
Academic infertility center.
PATIENT(S): White, Asian, Black, and Hispanic patients undergoing ovarian stimulation for IVF.
INTERVENTION(S): Self-reported race and ethnicity.
MAIN OUTCOME MEASURE(S): The primary outcome was ovarian sensitivity index (OSI), defined as (the number of oocytes retrieved ÷ total gonadotropin dose) × 1,000 as a measure of ovarian responsiveness, adjusting for age, body mass index, infertility diagnosis, and cycle number. Secondary outcomes included live birth and clinical pregnancy after first retrievals, adjusting for age, infertility diagnosis, and history of fibroids, as well as miscarriage rate per clinical pregnancy, adjusting for age, body mass index, infertility diagnosis, duration of infertility, history of fibroids, and use of preimplantation genetic testing for aneuploidy.
RESULT(S): The primary analysis of OSI included 3,360 (70.2%) retrievals from White patients, 704 (14.7%) retrievals from Asian patients, 553 (11.6%) retrievals from Black patients, and 168 (3.5%) retrievals from Hispanic patients. Black and Hispanic patients had higher OSIs than White patients after accounting for those with multiple retrievals and adjusting for confounders (6.08 in Black and 6.27 in Hispanic, compared with 5.25 in White). There was no difference in OSI between Asian and White patients. The pregnancy outcomes analyses included 2,299 retrievals. Despite greater ovarian responsiveness, Black and Hispanic patients had lower LBRs compared with White patients, although these differences were not statistically significant after adjusting for confounders (adjusted odds ratio, 0.83; 95% confidence interval [CI], 0.63-1.09, for Black; adjusted odds ratio, 0.93; 95% CI, 0.61-1.43, for Hispanic). Ovarian sensitivity index was modestly predictive of live birth in White and Asian patients but not in Black (area under the curve, 0.51; 95% CI, 0.38-0.64) and Hispanic (area under the curve, 0.50; 95% CI, 0.37-0.63) patients.
CONCLUSION(S): Black and Hispanic patients have higher ovarian responsiveness to stimulation during IVF but do not experience a consequent increase in LBR. Factors beyond differences in responsiveness to ovarian stimulation need to be explored to address the racial/ethnic disparity established in prior literature.
确定促性腺激素刺激的卵巢反应是否因种族/民族而异，以及这种差异是否可以预测非白人患者在接受体外受精（IVF）时的活产率（LBR）。
回顾性队列研究。
学术不孕不育中心。
接受 IVF 卵巢刺激的白人、亚裔、黑人和西班牙裔患者。
自我报告的种族和民族。
主要结局指标是卵巢敏感指数（OSI），定义为（获卵数÷总促性腺激素剂量）×1000，作为卵巢反应的衡量标准，调整了年龄、体重指数、不孕诊断和周期数。次要结局指标包括首次取卵后的活产和临床妊娠，调整了年龄、不孕诊断和子宫肌瘤史，以及每例临床妊娠的流产率，调整了年龄、体重指数、不孕诊断、不孕持续时间、子宫肌瘤史和使用胚胎植入前染色体非整倍体检测。
OSI 的主要分析包括 3360 次（70.2%）白人患者的取卵、704 次（14.7%）亚裔患者的取卵、553 次（11.6%）黑人和 168 次（3.5%）西班牙裔患者的取卵。在考虑多次取卵并调整混杂因素后，黑人和西班牙裔患者的 OSI 高于白人患者（黑人 6.08，西班牙裔 6.27，白人 5.25）。亚裔和白人患者的 OSI 没有差异。妊娠结局分析包括 2299 次取卵。尽管卵巢反应性更强，但与白人患者相比，黑人和西班牙裔患者的活产率较低，尽管在调整混杂因素后这些差异没有统计学意义（调整优势比，0.83；95%置信区间[CI]，0.63-1.09，黑人；调整优势比，0.93；95%CI，0.61-1.43，西班牙裔）。OSI 在白人患者和亚裔患者中对活产有一定的预测作用，但在黑人（曲线下面积，0.51；95%CI，0.38-0.64）和西班牙裔（曲线下面积，0.50；95%CI，0.37-0.63）患者中则不然。
黑人患者和西班牙裔患者在 IVF 期间对刺激的卵巢反应性更高，但活产率并没有相应提高。需要探讨刺激卵巢反应性以外的因素，以解决先前文献中已确定的种族/民族差异。
