Objectives Infertility Treatment in Asians Asian women and - PDF document

 10/10/2017 Objectives Infertility Treatment in Asians Asian women and Fecundity Risk • Infertile Asian women and Treatment • Victor Y. Fujimoto, MD Outcomes (National Data – SART) Professor of Clinical Obstetrics, Gynecology and UCSF Data (IVF and IUI) • Reproductive Sciences UCSF Data (Access to Care issues) Reproductive Endocrinology and Infertility • Department of Obstetrics, Gynecology and UCSF Data (Egg Donation) • Reproductive Sciences UCSF School of Medicine Fecundability in Fertile Asian Women Do Asian women differ from Caucasian women in Natural Fecundity?  Wang et al, Fertil Steril 2011  1

 10/10/2017 Fecundability in Fertile Asian Women Do Asian women differ from Caucasian women in Natural Fecundity?  No evidence that Asian women get pregnant less often naturally than Caucasian women  Wang et al, Fertil Steril 2011 The Ovaries: Natural Menstrual Cycle Compared to IVF Do Asian Patients Differ from Caucasian Patients in Reproductive Outcomes?  IUI and IVF Outcomes  VS.  Natural Cycle  IVF Cycle 8  2

 10/10/2017 Embryo Development Asian Disparities in Assisted Reproductive  Day 1 embryo  Day 2 embryo  Day 3 embryo Technologies  Day 4 embryo  Day 5 embryo  Day 6 embryo Racial and Ethnic  Society of Assisted Reproductive Disparities in ART Technology (SART)  AOR  White  0.86 CI 0.80-0.93 1.0  Asian 0.90  Black SART /CDC National ART 0.62 Databases  Hispanic 0.87  Fujimoto et al, Fertil Steril 93: 382-90, 2010  3

 10/10/2017 Analysis of outcome variables: Self-reported Asian Nationalities Asian vs. Caucasian of UCSF IVF Population Asian – Chinese 39%  Asian – Indian 13%  Outcom e variables Asian – Filipino 13%    Gestational Sac Asian – Japanese 9%   Presence of sac on ultrasound Asian – Korean 7%   Clinical pregnancy Asian – Vietnamese 2%   Presence of fetal heart beat Asian – Other 17%   On-going pregnancy  Presence of viable pregnancy at 1 0 -1 2 w eeks  Unpublished data, VY Fujimoto Asians have Decreased Asian Disparities in ART Outcomes 0.5 Rate per Transfer 0.4  Gest. Sac 0.3  OR 0.69 [0.49-0.99] 0.2  Clin Pregnancy  OR 0.65 [0.45-0.93] 0.1  On-going Pregnancy 0  OR 0.61 [0.42-0.88] Sac Clinical On- going Asian Caucasian  Purcell et al, Fertil Steril 2007  4

 10/10/2017 Stimulation parameters The Ovaries: Natural Menstrual Cycle Compared to IVF Asian Caucasian p value Start dose 5 .4 + 1.2 5 .6 + 5.1 0 .3 9 (ampules) 4 7 .5 + 15.3 4 9 .1 + 16.3 0 .2 3 Total dose Follicle > 18 mm 2 .7 + 2.1 2 .9 + 2.1 0 .4 1 Follicles 13-17 7 .4 + 4.7 7 .3 + 5.0 0 .9 2  VS. Tot foll > 10 mm 1 4 .1 + 7.1 1 4 .2 + 8.6 0 .8 2 1 1 .1 + 1.6 1 1 .4 + 1.5 0 .0 5 Days stim  Natural Cycle  IVF Cycle 2 7 4 0 + 1376 2 3 8 3 + 1522 < 0 .0 1 E2 at hCG Lining 1 0 .2 + 2.1 9 .8 + 2.0 0 .0 3 17 Embryo Development Aneuploidy and Ancestry  Day 1 embryo  Day 2 embryo  Day 3 embryo  e  Day 4 embryo  Day 5 embryo  Day 6 embryo From: Embryonic aneuploidy does not differ among genetic ancestry according to continental origin as determined by ancestry informative markers Hum Reprod. 2016;31(10):2391-2395. doi:10.1093/humrep/dew195  5

 10/10/2017 UCSF 1 st Cryopreserved Embryo Asian Disparity in IUI Outcomes Transfer Outcomes  Lamb et al, RBM Online 2010  Unpublished data Oocyte Donation cycles: Asian and Endometriosis Caucasian Estrogen dependent  Cause of pelvic pain, dysmenorrhea and infertility  Asian women have 3-fold higher risk of  endometriosis diagnosis, either by laparoscopy or presence of endometriomas on pelvic ultrasound  Huddleston et al, Fertil Steril 94: 2059, 2010  Yamamoto et al, J Assist Reprod Genet, 2017  6

 10/10/2017 Asian Disparity in ART Asian Outcomes in ART Outcomes  Endometrial Defect with Ovarian • Reduced clinical pregnancy rates with fresh I VF cycles Stimulation in Asian Women • Reduced live birth rates with fresh I VF cycles  Access to care in Asian patients • Exaggerated serum estradiol levels during ovarian stimulation  Reduce IUI success in Asian women • Estradiol levels are higher with defined estradiol patch use  Altered Estrogen metabolism in Asian adjusted for BMI women • Similar embryo development to blastocyst stage • No difference in clinical outcomes with cycles involving  Higher incidence of Endometriosis in either frozen embryos or donor embryos Asian women • Fecundability not different in Asian pregnant population  7