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Racial and Ethnic Differences in Pregnancy Rates Following Intrauterine Insemination with a Focus on American Indians

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Abstract

Background

No research exists on American Indian pregnancy rates following infertility treatment. Most racial/ethnic fertility research has focused on pregnancy following in vitro fertilization, with only rare studies looking at intrauterine insemination (IUI). The objective of our study was to compare fecundability following IUI by race/ethnicity, with a special focus on American Indians.

Methods

This was a retrospective analysis of subjects undergoing IUI July 2007–May 2012 at a university-based infertility clinic. The primary outcome was positive pregnancy test, with a secondary outcome of ongoing pregnancy/delivery (OP/D). We calculated risk ratios (RR) and 95% confidence intervals (CI) using cluster-weighted generalized estimating equations method to estimate modified Poisson regression models with robust standard errors to account for multiple IUI cycles in the same patient.

Results

A total of 663 females (median age 32) undergoing 2007 IUI cycles were included in the analysis. Pregnancy rates overall were 15% per IUI cycle. OP/D rates overall were 10% per IUI cycle. The American Indian patients had significantly lower pregnancy (RR 0.34, 95% CI 0.16–0.72) and OP/D rates (RR 0.33, 95% CI 0.12–0.87) compared to non-Hispanic whites when patient and cycle characteristics were controlled. Pregnancy and OP/D rates for blacks, Asians, and Hispanics did not differ from those of non-Hispanic whites.

Conclusions

Our finding of lower IUI treatment success among American Indian patients is novel, as no published studies of assisted reproductive technology or other fertility treatments have examined this subgroup separately. Further investigation of patient and clinical factors that may mediate racial/ethnic disparities in fertility treatment outcomes is warranted.

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Acknowledgements

Thank you to Brooke Storer, MD, and Ruchika Vij, MD, for data collection and support.

Funding

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under 1 R40MC29449-01-00. Support is also provided by Oklahoma Shared Clinical and Translational Resource Institute NIGMS U54 GM104938. The information, content, and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the USA.

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Authors and Affiliations

  1. Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA

    LaTasha B. Craig, Elizabeth A. Weedin, William D. Walker & Karl R. Hansen

  2. Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, AAT 2400, Oklahoma City, OK, 73126, USA

    LaTasha B. Craig

  3. Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., Oklahoma City, OK, 73104, USA

    Amanda E. Janitz & Jennifer D. Peck

Authors
  1. LaTasha B. Craig
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  2. Elizabeth A. Weedin
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  3. William D. Walker
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  4. Amanda E. Janitz
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  5. Karl R. Hansen
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  6. Jennifer D. Peck
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Corresponding author

Correspondence to LaTasha B. Craig.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

This study was conducted in Oklahoma City, OK.

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Craig, L.B., Weedin, E.A., Walker, W.D. et al. Racial and Ethnic Differences in Pregnancy Rates Following Intrauterine Insemination with a Focus on American Indians. J. Racial and Ethnic Health Disparities 5, 1077–1083 (2018). https://doi.org/10.1007/s40615-017-0456-8

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  • DOI: https://doi.org/10.1007/s40615-017-0456-8

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