Systematic review of racial and ethnic disparities in reproductive endocrinology and infertility: where do we stand today?

Abstract

Objective: To conduct a comprehensive review of racial and ethnic health disparities in infertility care and treatment. Evidence Review: Systematic literature searches were performed in PubMed and Embase from inception to April 2021. Studies were eligible for inclusion if they were original research performed in humans, observational study design, focused on circumstances contributing to infertility, access to infertility care, or outcomes of infertility treatment, and provided relevant information on racial or ethnic groups. Titles and abstracts were reviewed independently by two reviewers to identify pertinent articles. In addition, references of included articles were screened. Result(s): The PubMed search yielded 2,113 articles. An additional 2,301 articles were found in the Embase search. In total, 4,414 articles were screened on the basis of title and, where necessary, abstract. Thirty-four were found to meet the inclusion criteria and included in this review. Three additional studies were found from searching references of the included articles, resulting in 37 articles for discussion: 26 retrospective cohort studies, 2 prospective cohort studies, and 9 cross-sectional studies. The overall consensus in the literature is that reproductive health disparities on the basis of race and ethnicity impact fertility, access to care, and fertility treatment outcomes. Conclusion(s): Racial and ethnic differences in access to full-spectrum reproductive care, including infertility evaluation and treatment, remain. Despite access to infertility treatment, disparate treatment outcomes persist. Intrinsic and extrinsic factors, such as the institutionalization of racism and discrimination within medicine, remain influential in the diagnosis, care, and treatment outcomes of individuals with infertility. To address these inequities, we should mitigate provider bias, fund high-quality health disparity research, improve patient reproductive health knowledge, and advocate for increased access to treatment for all. (Fertil Steril Rev Ò 2021;2:169-88. Ó2021 by American Society for Reproductive Medicine.

Primary ovarian insufficiency: a glimpse into the racial and socioeconomic disparities found within third-party reproduction

“…As technological advances continue to progress over time, epidemiological studies in the US have demonstrated persistent racial/ethnic disparities in the prevalence of infertility as well as ART utilization and outcomes ( 7 , 10 , 11 , 12 ). This was reconfirmed in 2021 by Jackson-Bey et al ( 13 ) in a systematic literature review of racial/ethnic disparities in infertility care and treatment. Lower clinical pregnancy and live birth rates have been found collectively in Asian, Hispanic, and Black women in comparison to White women based on analyses of the Society for Assisted Reproductive Technology Clinic Outcome Reporting System data, with the trend of Black women having the poorest outcomes of all minority groups ( 11 , 13 , 14 , 15 ).…”

“…This was reconfirmed in 2021 by Jackson-Bey et al ( 13 ) in a systematic literature review of racial/ethnic disparities in infertility care and treatment. Lower clinical pregnancy and live birth rates have been found collectively in Asian, Hispanic, and Black women in comparison to White women based on analyses of the Society for Assisted Reproductive Technology Clinic Outcome Reporting System data, with the trend of Black women having the poorest outcomes of all minority groups ( 11 , 13 , 14 , 15 ). Determining the precise prevalence of infertility can be difficult.…”

See one, do one, teach one: Reimagining reproductive endocrinology and infertility training programs to expand access to care

“…Furthermore, Black and Asian women have been found to present with a longer duration of infertility before seeking treatment ( 18 , 20 ). There is also evidence of poorer fertility treatment outcomes among minority women ( 21 , 22 , 23 ), and among those who seek treatment, there are higher rates of treatment discontinuation ( 24 ) ( Fig. 1 ).…”

Eliminating health inequities in reproductive medicine: ensuring care for all

“…The stark reality is that health inequities are prevalent across all medical specialties. However, some of the most dramatic disparities in outcomes occur in the field of reproductive health ( 3 , 4 ). In obstetrics, Black and Native American women are more likely to die during childbirth ( 3 ).…”

“…In obstetrics, Black and Native American women are more likely to die during childbirth ( 3 ). In the field of gynecology, Black women suffer from worse outcomes when faced with the diagnosis gynecologic cancer ( 3 ) and experience inferior outcomes while being treated for infertility ( 4 ).…”