Poor Prognosis with In Vitro Fertilization in Indian Women Compared to Caucasian Women Despite Similar Embryo Quality
Open Access
- 26 October 2009
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 4 (10), e7599
- https://doi.org/10.1371/journal.pone.0007599
Abstract
Disease prevalence and response to medical therapy may differ among patients of diverse ethnicities. Poor outcomes with in vitro fertilization (IVF) treatment have been previously shown in Indian women compared to Caucasian women, and some evidence suggests that poor embryo quality may be a cause for the discrepancy. In our center, only patients with the highest quality cleavage stage embryos are considered eligible for extending embryo culture to the blastocyst stage. We compared live birth rates (LBR) between Indian and Caucasian women after blastocyst transfer to investigate whether differences in IVF outcomes between these ethnicities would persist in patients who transferred similar quality embryos. In this retrospective cohort analysis, we compared IVF outcome between 145 Caucasians and 80 Indians who had a blastocyst transfer between January 1, 2005 and June 31, 2007 in our university center. Indians were younger than Caucasians by 2.7 years (34.03 vs. 36.71, P = 0.03), were more likely to have an agonist down regulation protocol (68% vs. 43%, P<0.01), and were more likely to have polycystic ovarian syndrome (PCOS), although not significant, (24% vs. 14%, P = 0.06). Sixty eight percent of Indian patients had the highest quality embryos (4AB blastocyst or better) transferred compared to 71% of the Caucasians (P = 0.2). LBR was significantly lower in the Indians compared to the Caucasians (24% vs. 41%, P<0.01) with an odds ratio of 0.63, (95%CI 0.46–0.86). Controlling for age, stimulation protocol and PCOS showed persistently lower LBR with an adjusted odds ratio of 0.56, (95%CI 0.40–0.79) in the multivariate analysis. Despite younger age and similar embryo quality, Indians had a significantly lower LBR than Caucasians. In this preliminary study, poor prognosis after IVF for Indian ethnicity persisted despite limiting analysis to patients with high quality embryos transferred. Further investigation into explanations for ethnic differences in reproduction is needed.Keywords
This publication has 19 references indexed in Scilit:
- Defining Human Embryo Phenotypes by Cohort-Specific Prognostic FactorsPLOS ONE, 2008
- Polycystic ovary syndrome in the Indian SubcontinentSeminars in Reproductive Medicine, 2008
- South Asian women with polycystic ovary syndrome exhibit greater sensitivity to gonadotropin stimulation with reduced fertilization and ongoing pregnancy rates than their Caucasian counterpartsEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2007
- Role of Latent Genital Tuberculosis in Repeated IVF Failure in the Indian Clinical SettingGynecologic and Obstetric Investigation, 2006
- A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndromeHuman Reproduction Update, 2005
- Change in the diagnosis of patients with idiopathic hirsutism (IH) to Polycystic Ovary Syndrome (PCOS) due to the use of the 2003 Rotterdam criteriaFertility and Sterility, 2004
- Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: is there a difference?Clinical Endocrinology, 2002
- Epidemiology of endometriosis among parous womenObstetrics & Gynecology, 1995
- Endometriosis and RaceAustralian and New Zealand Journal of Obstetrics and Gynaecology, 1992
- The changing pattern of tuberculosis of the female genital tract. A thirty year surveyArchiv für Gynäkologie, 1983