For mixed and white patients, the overall birth rates are around 30 percent per embryo transferred, but this figure decreases to only 23 percent with black patients. Suggestions for the reason behind this discrepancy include black patients starting IVF almost two years later compared to the average patient (36.4 years vs. 34.6 years), or that 31 percent of black female patients have fertility problems relating to their fallopian tubes, in comparison to 18 percent in the average population. However, despite some biological explanations, it is yet another example of racial inequality within the healthcare system.
Sally Cheshire CBE, chair of the HFEA, said ‘We want anyone who is struggling to conceive to have equal access to fertility treatment and understand their chances of being successful. What is clear from this report is that there are several disparities in fertility treatment across ethnic groups that need to be addressed… It’s crucial that more work is done, and that action is taken to level the playing field for all our patients… The HFEA will drive this work forward, working closely with stakeholders in the sector, patients and other organisations to ensure all patients receive the highest standards of care as they try for a much longed-for family.’
Black patients also had the highest multiple birth rates of any ethnic groups at 14 percent, compared to a national average of 12 percent. The combination of the higher age of black fertility patients and the higher prevalence of heart conditions in the black population means the decision for a double embryo transfer should not be taken lightly, as multiple births represent the single biggest risk to both mother and babies.
Whilst disparities in treatment are the most obvious in black women, inequalities for other ethnic groups were also highlighted. The report flagged fertility differences regarding egg donation, whereby it was found that over half of Asian couples use a white donor egg after struggling for access to Asian donor eggs. Asian patients make up approximately 14 percent of all IVF patients, but only 4 percent of egg donors are of Asian descent, making it harder for Asian patients to obtain eggs matching their ethnicity. Furthermore, Asian women commonly had lower than average live birth rates after fertility treatment – particularly South Asian women – with a success rate of only 25 percent for people aged 30-34.
The British Fertility Society responded to the publication of the HFEA Report with a statement:
‘This report highlights differences in access to, and outcomes of, licensed fertility treatment among different ethnic groups… The report also confirms what fertility professionals have long noted, the relative shortage of egg and sperm donors from minority ethnic groups… As professionals providing fertility care, we support fair and equitable NHS funding of fertility services. This report makes clear that restricting the number of NHS-funded IVF cycles disproportionately affects some ethnic groups with a lower per cycle success rate and NHS commissioners should take note of this in their funding decisions.’
Sarah Norcross, director of Progress Educational Trust, the charity which publishes BioNews, said:
‘This shocking report reveals the scale of research that needs to be done immediately to unpick why both IVF success rates and access to fertility treatment are so different for ethnic minority patients, in particular black women. We need social science research to understand why ethnic minority patients may not be coming forwards to access healthcare which can potentially prevent fertility problems and also why there are delays in starting fertility treatment. Hand in hand with this work, we need to prioritise scientific studies to investigate the reduced success rates experienced by young black women as this is a phenomenon that has been noted for over a decade.’
In support of the release of the report, the HFEA held a small event in conjunction with Fertility Network UK to discuss the matter and engage with ethnic minority patients and social media influencers.
The video of the discussion can be found here.