Figures show fertility treatment less successful for ethnic minority patients

People from ethnic minority backgrounds undergoing fertility treatment are less likely to have a baby, with Black patients having the lowest chances of successful treatment, according to a new report published today. 

While overall birth rates from fertility treatment have increased and are highest in patients under 35, Black patients aged 30-34 have an average birth rate of 23%, compared to 30% for Mixed and White patients, new data from the HFEA shows.   

The new report ‘Ethnic diversity in fertility treatment’ also highlights that 31% of Black fertility patients have fertility problems related to issues with their fallopian tubes, compared to only 18% of patients overall, with Black patients also starting IVF almost two years later (36.4 years old) compared to the average patient at 34.6 years old.  

The report also shows that Black patients experienced higher than average multiple births from double embryo transfers, at around 14% from 2014-2018. The higher age of Black IVF patients and the higher prevalence of heart conditions in the Black population mean that it is particularly important that risks should be seriously considered prior to using double embryo transfers, as multiple births represent the single biggest risk to both mother and babies. 

While disparities for Black patients are the most notable, other ethnic groups also have worse outcomes when going through fertility treatment. Asian patients, who represent a larger proportion of IVF users at 14% whilst comprising 7% of the UK population, are struggling to access donor eggs if needed. The report shows that 89% of egg donors are White, followed by 4% Asian, 3% Mixed and 3% Black, resulting in the use of White eggs in 52% of IVF cycles with an Asian patient.  

Sally Cheshire, Chair of the HFEA, said: 

“This report is very timely as there has been much discussion recently of health inequalities amongst ethnic communities, with many of these being highlighted by the COVID-19 pandemic. 

“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.  

“During my time as HFEA Chair we have worked hard with the sector to reduce the risks from multiple births for women and any children born and I would like to see more work done to address this amongst Black patients. 

“Whilst we currently do not have definitive explanations for why these differences exist between patients of different ethnicities, 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.  

“We are committed to using our data, regulatory powers and feedback from patients, working with our partners to ensure all patients have fair and equal access to treatment and care throughout their fertility journey.” 

Dr Christine Ekechi, Co-Chair of the Royal College of Obstetricians and Gynaecologists’ Race Equality Taskforce, said: 

“It is disappointing but not surprising to see healthcare inequalities for Black, Asian and minority ethnic women extend to every corner of their lives including sadly, for those who desire to have a baby. 

“When tackling racial inequalities in health outcomes for women, it is important to acknowledge that for some women, these poorer outcomes affect them throughout their life course, limiting the available choices that others often take for granted.  

“We cannot underestimate the negative impact of infertility and reduced outcomes following fertility treatment, on Black, Asian and minority ethnic women. We know that infertility can have a devastating effect on people’s lives, causing distress, depression, and the breakdown of relationships. It is therefore essential that we begin to understand the factors contributing to these poorer outcomes in this particular group of women. 

“This HFEA report is vital in understanding the barriers faced by women from ethnic minority backgrounds when trying to start a family and we welcome it’s publication. What is now required is a combined effort to provide solutions to include better awareness, safeguarding of reproductive health and improving the availability of targeted options for fertility treatments.  

“We owe it to Black, Asian and minority ethnic women to give them an equal opportunity to starting a family, and to provide the solutions that will help them achieve this dream.”       

Gwenda Burns, Chief Executive for charity Fertility Network UK, said: 

“We are deeply concerned by the health inequalities for ethnic minority fertility patients highlighted in this new report from the HFEA, and it is vital that the underlying reasons for this are thoroughly investigated and addressed.  

“We believe every patient should have access to high-quality care, and we are committed to working with the HFEA, professionals and other stakeholders to ensure equity for all.  

“We know how isolating fertility problems can be, and today we are launching a new peer support group for Black women alongside our existing Asian group. We aim to provide spaces for all patients to be open about the issues they face so we can make certain every voice is heard.” 

To tackle disparities in access and outcomes of fertility treatment among ethnic minority groups, the HFEA has committed to several actions and is calling for more collaborative work across the sector, including further research, to reduce the disparities that exist. Some of the actions and recommendations include: 

  • Review feedback from clinics and patients against our Code of Practice to see if we should make any changes, for example, relating to information provision.  
  • To better enable research on the disparities across ethnic groups within the fertility sector, we will include more information on ethnicity in our regular data releases.  
  • We will work with grassroots and other organisations to further understand cultural and religious beliefs that may impact on donor recruitment and help to overcome any barriers that may exist.  
  • We will share data with GPs, highlighting for example that in some communities, access to fertility treatment is starting at a later age.  
  • We urge clinics to ensure all patients are informed of their own likely chance of success based on all factors, including ethnicity.  
  • Clinics should ensure ethnicity information is collected from patients. Currently 12% of patients have no ethnicity data recorded on our Register.     
  • Clinics should regularly update their information on donor waiting times – especially if the wait is longer for different ethnicities – to help patients who require donated sperm and eggs to plan their treatment.   
  • We encourage all those who commission fertility services to review their funding eligibility criteria to consider whether these have an adverse impact on access to treatment among particular ethnic groups.  
  • More research is needed to understand the many external factors that contribute to these disparities to inform evidence-based decision-making.  

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