Black-white disparities exist in fertility medicine, which are reflected in the life and death outcomes of babies, according to a large study of US births.
The study, published Wednesday in the journal Pediatrics, is the broadest look yet at racial disparities for women who use IVF, fertility drugs or other fertility treatments. The researchers found higher death rates for babies born to black women who used such treatments than for white women who did the same — a gap that was much wider than for babies born without the treatments.
Infant mortality is rare in the US, and the reasons for the poor outcomes are unclear. The researchers observed racial differences even after adjusting for age, diabetes, obesity, smoking and other maternal risk factors.
The high cost of IVF and lack of insurance means that women receiving fertility care are on average wealthier.
The findings suggest that women seeking fertility treatment are not protected from racism despite their relative wealth, said Dr. Cynthia Gyamfi-Bannerman, chief of obstetrics and gynecology at the University of California San Diego School of Medicine.
“These women are still experiencing the same racism that could cause poor outcomes in other pregnancies,” said Gyamfi-Bannerman, who was not involved in the study. “We all have to pay more attention and see how we can find a solution.”
Black women who use fertility treatments may not receive the highest quality care during pregnancy and after childbirth, said Dr. Michael A. Thomas, who next week will become the first black president of the American Society for Reproductive Medicine.
“IVF patients, they work so hard to get there that they don’t let anything get in the way of that baby having a good outcome,” said Thomas, who was not involved in the study. “But does the black patient get the same high-level, priority, concierge treatment?”
The researchers thought that women using fertility treatments might see fewer racial differences in birth outcomes.
“We were somewhat surprised that this disparity was actually greater than in the general population,” said Dr. Sarka Lisonkova from the University of British Columbia in Vancouver, who led the research.
Her team analyzed data from more than 7 million births in the US in 2016 and 2017, including more than 93,000 births as a result of fertility treatments.
They looked only at singletons, which carry a lower risk than twins or other multiple births. Household income was not analyzed because it was not available in the data.
Death within four weeks after birth was four times higher in babies born to black mothers who used IVF compared to white women who used IVF. Among babies born without fertility treatment, infant mortality was twice as high for black mothers compared to white mothers.
Similar disparities existed for Hispanic mothers and Asian mothers who had fertility treatments, but the differences were less pronounced. There were too few American Indian and Alaska Native women using fertility treatments in the study to analyze their birth outcomes.
White women were much more likely than other groups to use fertility treatments. Of the 69,778 white mothers who used fertility treatments during the two-year study, 227 infants died. Of the 4,669 black mothers who used fertility treatments, 68 infants died.
The findings should not dissuade women from starting a family, Lisonkova said.
“There are countless women who have had fantastic pregnancies that started with medically assisted reproduction,” Lisonkova said. But because pregnancies by older women and those conceived with the help of fertility treatments have worse outcomes than spontaneous pregnancies, she encouraged women who want children to consider starting a family when they are “relatively young”.
“I know there are pressures to get an education, to have a job and then to have a family, but I think both are important,” she said. “And they can be combined in a way that women don’t have to choose. “