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Racial disparities in outcomes of in vitro fertilization: a systematic review and meta-analysis

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Video Presentation

View Paige Veira's poster presentation in this video recording: 

Abstract

The aim of this systematic review and meta-analysis was to quantify the disparity between Black and White patients receiving in vitro fertilization. 

We systematically searched seven databases for studies published before August 2021 reporting pregnancy and other maternal outcomes by race after in vitro fertilization. Specifically, we investigated rates of implantation, clinical pregnancy, spontaneous abortion, and live birth. Two members of the research team independently screened and extracted data from eligible studies. The risk of bias for the included studies was assessed using the Newcastle-Ottawa Scale. We used random effects models to calculate unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) using the Mantel-Haenszel and generic inverse variance methods, respectively. 

Seven retrospective cohort studies met inclusion criteria, with a total of 560 Black and 6,198 White patients who receiving in vitro fertilization. All studies were conducted in the United States. In unadjusted meta-analyses, Black patients had a greater likelihood of spontaneous abortion compared with White patients, but no statistically significant differences in implantation, clinical pregnancy or live birth rates. After adjusting for age, body mass index and infertility diagnosis, Black patients had a lower likelihood of live birth, but no statistically significant difference in clinical pregnancy rates. 

The results of the meta-analyses suggests that Black and White patients can achieve pregnancy at similar rates after in vitro fertilization. The findings highlight that the differences in later stages of pregnancy (live birth and spontaneous abortion) may be due to systemic factors rather than individual characteristics. The analysis stage of this systematic review and meta-analysis is complete, and the manuscript is currently in the final stages of editing before submission to a journal. 

This review is the first meta-analysis to quantify the disparities between Black and White patients after in vitro fertilization. The results will hopefully be used to inform future public health policies and guidelines to foster equity in fertility care. 

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