Ethnic diversity data highlights disparities in treatment outcomes, UK regulator finds

The Human Fertilisation and Embryology Authority (HFEA) found fertility treatment outcomes varied widely for Black, Asian and ethnic minority patients.

HFEA data shows significant differences by ethnic group in the use and outcomes of fertility treatment. The average IVF birth rate per embryo transferred has increased across all groups, but Black and Asian patients aged 18-37 had the lowest birth rates (23% and 24% respectively) compared to White patients (32%) in 2020-21.

Multiple births are a high risk to patients and babies, and the Ethnic Diversity in Fertility Treatment 2021 report shows that Black patients continued to have the highest multiple birth rates at 9%, compared to 7% for White patients in 2017-21.

The disparities highlighted demonstrate a need for decisive and long-lasting actions to improve treatment outcomes for Black, Asian and ethnic minority patients. Today, the HFEA, the Royal College of Obstetricians and Gynaecologists, the British Fertility Society and Fertility Network UK call for action to ensure that Black, Asian and ethnic minority patients and their partners are not left behind in access to and experience of fertility treatment. Professor Geeta Nargund, member of the Human Fertilisation and Embryology Authority, said:

“There is no room for the health inequalities that exist within fertility treatment. While it is good news that multiple birth rates in all groups have dropped, this new HFEA report highlights the health inequalities that still exist within fertility treatment.

It shows that there is a need for meaningful changes so that Black, Asian and ethnic minority fertility patients and their partners are not left behind in access to and experience of fertility treatment.”

The report also highlights disparities in the age that patients start treatment. Black patients in heterosexual relationships started fertility treatment about a year later than other ethnic groups at 36, this matters as age is a key factor in success of treatment.

NHS-funded IVF cycles among patients under 40 in heterosexual relationships were found to have decreased across all ethnic groups. The report found, however, that funding decreased most among Black patients, from 60% in 2019 to 41% in 2021. Patients of Other ethnic background were more likely to receive NHS-funded treatment (63%), followed by patients of White (53%), Asian (49%) and Mixed (47%) background.

Decreases in funding among Black patients may relate to decreases the HFEA has found in our Fertility Trends 2021 report, which showed the number of NHS-funded IVF cycles reduced the most in London, from 23% in 2019 to 17% in 2021. ONS data showed 49% of the Black population in England and Wales lived in London in 2021.

The decline in NHS-funded IVF cycles from 2019-2020 that were observed across all ethnicities may also be partly attributed to difficulties in accessing treatment, tests, or surgeries prior to starting treatment as a result of the COVID-19 pandemic.

Other key findings include:

• There were some key differences in the ethnicity of IVF patients aged 18-49 in the UK.  In 2017-2021, IVF was most used by White patients (77%), with Black IVF patients accounting for 3% of IVF patients compared to 4% of the age-matched population. However, Asian patients represented a larger proportion of IVF patients than other ethnic groups, at 15% compared with 11% of the age-matched population.
• Over half of sperm used in treatment from donors of Mixed, Other and Black backgrounds in 2017-21 was imported from abroad.
• Use of egg storage cycles was similar across ethnic groups with egg storage accounting for 3% of all cycles on average in 2017-21.

The report  builds on previous data and looks at how the use and outcomes of fertility treatment differs by ethnic groups. The reasons for these variations are complex but may relate to other differences across ethnicities, ranging from reproductive and underlying general health conditions to cultural, social, economic and structural factors, including stigma experienced by ethnic minority patients. Professor Geeta Nargund added:

“We know that fertility declines with age, and we are concerned the data shows that Black, Asian and ethnic-minority patients are left behind. A shared focus of all members within the sector is equalising treatment and hearing from the impacted groups to inform robust policy making.

Increasing information awareness, addressing high-risk factors and further investigating health conditions such as endometriosis or fibroids, start the right conversations to begin to eradicate the disparities.

The HFEA is committed to working together with other key bodies and healthcare professionals to ensure patients across all groups have better access to fertility treatment.”