Influence of race and ethnicity on in vitro fertilization outcomes: systematic review

Endometriosis Surgery: Debates About Restorative Reproductive Medicine

Humphries LA, 2026 · Obstetrics and gynecology

For many patients with endometriosis, laparoscopic surgery is the most effective treatment to alleviate severe chronic pelvic pain and improve quality of life. Because endometriosis is common among individuals with infertility, surgery is often considered alongside fertility evaluation and treatment to manage symptoms, identify disease pathology, and restore pelvic anatomy. In patients who desire pregnancy, the decision of whether and when to pursue surgery should be guided by clear medical indications and shared decision making between the patient and their obstetrician-gynecologist. In recent months, however, religious and political groups have sought to reframe this medical decision as an ideologic and moral one, advocating for endometriosis surgery in nearly all patients with infertility and claiming that this can eliminate the need for assisted reproductive technologies. This framework, known as restorative reproductive medicine (RRM), aligns with efforts to promote the "personhood" of fertilized eggs, restrict access to in in vitro fertilization (IVF), and advance endometriosis surgery and lifestyle modifications as "root-cause treatment leading to natural fertility." Recent editorials and issue briefs in the obstetrics and gynecology literature have discussed the serious ethical, medical, and policy implications of RRM, yet there remains an urgent need to address specifically the unfounded claims about endometriosis surgery and its purported advantages over assisted reproductive technology. This article examines the social context of this controversy and reviews the current evidence regarding the indications, benefits, and limitations of endometriosis surgery in the management of infertility. In contrast to RRM's assertions, no evidence supports the adoption of endometriosis surgery as a replacement for IVF or as a primary treatment for infertility. Rather, the role of surgery in fertility care is highly nuanced and depends on each patient's clinical presentation, reproductive goals, and personal priorities.

The reproductive endocrinology and infertility subspecialist: definition, training, and scope of practice in the United States

Gracia C et al., 2025 · Fertility and Sterility

Child Opportunity Index at birth and asthma with recurrent exacerbations in the US ECHO program

Miller RL et al., 2025 · Journal of Allergy and Clinical Immunology · Free full text on PubMed Central

The Boston IVF Handbook of Infertility

Alper M et al., 2025

Racial and Ethnic Disparities in the Perinatal Health of Infants Conceived by ART

Lisonkova S et al., 2022 · Pediatrics

Although racial and ethnic disparities in adverse birth outcomes have been well documented, it is unknown whether such disparities diminish in women who use medically assisted reproduction (MAR). We examined differences in the association between maternal race and ethnicity and adverse birth outcomes among women who conceived spontaneously and those who used MAR, including assisted reproduction technology (ART), eg, in-vitro fertilization, and also non-ART MAR, eg, fertility drugs. We conducted a population-based retrospective cohort study using data on all singleton births (N = 7 545 805) in the United States from 2016 to 2017. The outcomes included neonatal and fetal death, preterm birth, and serious neonatal morbidity, among others. Modified Poisson regression was used to estimate adjusted rate ratios (aRR) and 95% confidence intervals (CI) and to assess the interactions between race and ethnicity and mode of conception. Overall, 93 469 (1.3%) singletons were conceived by MAR. Neonatal mortality was twofold higher among infants of non-Hispanic Black versus non-Hispanic White women in the spontaneous-conception group (aRR = 1.9, 95% CI: 1.8-1.9), whereas in the ART-conception group, neonatal mortality was more than fourfold higher in infants of non-Hispanic Black women (aRR = 4.1, 95% CI: 2.9-5.9). Racial and ethnic disparities between Hispanic versus non-Hispanic White women were also significantly larger among women who conceived using MAR with regard to preterm birth (<34 weeks) and perinatal mortality. Compared to women who conceived spontaneously, racial and ethnic disparities in adverse perinatal outcomes were larger in women who used MAR. More research is needed to identify preventive measures for reducing risks among vulnerable women who use medically assisted reproduction.

Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting

Feinberg EC et al., 2006 · Fertility and sterility

Racial disparity in assisted reproductive technology (ART) outcomes has been reported but remains controversial. Reasons for the disparity are unclear, and access to care has been suggested as a causative factor. In this study, we sought to examine minority utilization of ART in the Department of Defense (DoD) compared with minority utilization in the U.S. ART population. Outcomes from ART were compared between Caucasian (Cau) and African American (AA) patients, and etiologies of disparity were examined. Retrospective cohort study. University-based ART program. PATIENT(S): A total of 1,457 patients undergoing first-cycle fresh, nondonor ART. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate, live birth rate, implantation rate, spontaneous abortion rate. RESULT(S): Within the DoD population, AA women had a fourfold increase in utilization of ART services relative to the U.S. ART population. In this equal-access-to-care setting, AA women experienced a clinically significant decrease in live birth rate that did not reach statistical significance (29.6% vs. 35.8%, risk ratio [RR] 0.83, 95% confidence interval [CI] 0.67-1.02) and a statistically significant increase in spontaneous abortions compared with Cau women (25% vs. 15.9%, RR 1.57, 95% CI 1.05-2.36). This might be explained, in part, by a higher prevalence of uterine leiomyomas in AA women (30.8% AA vs. 10.7% Cau, RR 2.85, 95% CI 2.06-3.95). For both AA and Cau women, the presence of fibroids at baseline ultrasound was associated with reductions in clinical pregnancy rates (35% with leiomyomas vs. 43.2% without leiomyomas, RR 0.74, 95% CI 0.51-0.98), live birth rates (26.2% vs. 36.0%, RR 0.63, 95% CI 0.44-0.90), and implantation rates (25.6% vs. 31.1% RR 0.82, 95% CI 0.69-0.98). CONCLUSION(S): Utilization of ART services among AA women increased when access to care was improved. A clinically significant reduction in live birth rate and statistically significant increase in spontaneous abortion rate was observed in AA women compared with Cau women. Leiomyomas were three times more prevalent in AA women and reduced ART success, regardless of race. The persistence of racial differences in an equal-access-to-care environment might be explained, in part, by the increased prevalence of leiomyomas in AA women.

Ethnic Diversity in Fertility Treatment 2018

Human Fertilisation and Embryology Authority, 2020

# Ethnic diversity in fertility treatment 2018 UK ethnicity statistics for IVF and DI fertility treatment Published: March 2021 [**Download the underlying dataset as .xlsx (27kb)**](https://www.hfea.gov.uk/media/3348/2021-03-03-bame-report-suppl_mental-underlying-data-final.xlsx "download the underlying data as .xlsx"). ## Table of contents - [Main points](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#mainpoints) - [Introduction](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#introduction) - [Section 1. IVF birth rates lowest for patients of Black ethnicities](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#Section1) - [Section 2. Multiple birth rate higher on average for Black patients](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#Section2) - [Section 3. White egg donors most commonly used across all ethnic groups](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#Section3) - [Section 4. Fewer Asian egg and sperm donors compared to UK Asian population](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#Section4) - [Section 5. Asian patients represent a larger proportion of IVF users](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#Section5) - [Section 6. Variation in NHS-funded IVF cycles between cycles in larger in younger age groups](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/#Section6) - [Section 7. Black patients start IVF later than other ethnic groups](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversit...

Ethnic Diversity in Fertility Treatment 2021

Human Fertilisation and Embryology Authority, 2023

# Ethnic diversity in fertility treatment 2021 Preliminary UK ethnicity statistics for IVF and DI treatment, storage, and donation Published: December 2023 [Download the underlying dataset as .xlsx](https://www.hfea.gov.uk/media/5rgnpqsr/ethnic-diversity-in-fertility-treatment-2021-underlying-dataset.xlsx "Ethnic diversity in fertility treatment 2021 - underlying dataset") ## Table of contents - [Main points](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#main-points) - [Introduction](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#introduction) - [Note on preliminary and ethnicity data](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#note-on-preliminary-and-ethnicity-data) - [Section 1. IVF birth rates increased across all ethnic groups, though disparities remain](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#section-1) - [Section 2. Black patients started fertility treatment later than other ethnic groups](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#section-2) - [Section 3. DI predominantly used by White patients](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#section-3) - [Section 4. Imported donor sperm and eggs vary by ethnicity](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#section-4) - [Section 5. Multiple birth rate decreased in all ethnic groups, but remain highest for Black patients](https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2021/#section-5) - [Section 6. Use of egg storage was similar across all ethnic groups](https://www.hfea.gov.uk/about-us/publications/res...