P-720 Ethnic diversity in fertility treatment in 2017-2021 using national register data, United Kingdom
Authors: Machiyama K , Ng A , Evans A 
Published: July 2024

Abstract

Study question
Are there any differences in fertility treatment use and outcomes across ethnic groups in the UK?

Summary answer
There are clear ethnic disparities – Black patients had lower IVF birth rates and started treatment later than White patients.

What is known already
Previous studies in US and UK have shown disparities in IVF outcomes, differences in perceptions around fertility treatment usage and prevalence of infertility across ethnicities. The mechanism in differences recorded in IVF outcomes by ethnicity is not fully understood due to the complexity influenced by existing social and economic inequalities, pre-existing diseases and other societal factors.

Study design, size, duration
The study used data from the UK national register held by the Human Fertilisation and Embryology Authority (HFEA), where all licensed clinics in the UK are required to submit treatment data.

Participants/materials, setting, methods
All treatment cycles recorded on the HFEA Register with a focus on cycles undertaken in 2017-2021 were analysed. This includes over 232,000 patients who had treatment between 2017 and 2021 and their partners. Five aggregated ethnic categories were used in most of the analyses (Asian, Black, Mixed, White and Other).

Main results and the role of chance
IVF pregnancy and birth rates have increased in all major ethnic groups since ethnicity data started being collected in 2008. However, Black and Asian patients consistently had lower pregnancy and birth rates compared with White patients. For Black patients aged 18-37, the average IVF birth rate per embryo transferred using fresh embryo transfers was on average 23%, compared to 32% for White patients in 2020-21.
Among heterosexual couples, IVF cycles funded by the National Health Service (NHS) declined most among Black patients, decreasing from 60% in 2019 to 41% in 2021, compared to a decrease from 66% to 53% among White patients. Average age at starting treatment was higher among Black patients in heterosexual couples at 36.0 years of age, compared to the national average of 35.0 in 2021. Partner type varied by ethnicity and Black patients were more commonly single compared to other ethnic groups, with 6% of Black IVF patients and 62% of Black DI patients being single in 2017-21. Multiple birth rates have decreased across all ethnic groups, with disparities narrowing in recent years.

Limitations, reasons for caution
Due to the COVID-19 pandemic and large-scale work to upgrade the HFEA data submission system and migrate data to a new database, data on treatments and pregnancies from 2020-21 and outcomes from 2019-21 have not yet been validated. Around 13% of patients excluded due to unreported ethnicity data.

Wider implications of the findings
The HFEA and key stakeholders in UK have agreed a call to action to reduce the ethnic disparities through improving in development of clinical policy, information and awareness, NHS commissioning, and research to tackle the ethnic disparities in fertility treatment.

Trial registration number
NA