Objectives Infertility Treatment in Asians Asian women and - - PDF document

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Objectives Infertility Treatment in Asians Asian women and - - PDF document

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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

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10/10/2017 1

Infertility Treatment in Asians

Victor Y. Fujimoto, MD Professor of Clinical Obstetrics, Gynecology and Reproductive Sciences Reproductive Endocrinology and Infertility Department of Obstetrics, Gynecology and Reproductive Sciences UCSF School of Medicine

Objectives

  • Asian women and Fecundity Risk
  • Infertile Asian women and Treatment

Outcomes (National Data – SART)

  • UCSF Data (IVF and IUI)
  • UCSF Data (Access to Care issues)
  • UCSF Data (Egg Donation)

Do Asian women differ from Caucasian women in Natural Fecundity?

Wang et al, Fertil Steril 2011

Fecundability in Fertile Asian Women

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Fecundability in Fertile Asian Women

Wang et al, Fertil Steril 2011

Do Asian women differ from Caucasian women in Natural Fecundity?

No evidence that Asian women

get pregnant less often naturally than Caucasian women

Do Asian Patients Differ from Caucasian Patients in Reproductive Outcomes?

IUI and IVF Outcomes

The Ovaries:

Natural Menstrual Cycle Compared to IVF

VS. IVF Cycle Natural Cycle

8

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Embryo Development

Day 1 embryo  Day 2 embryo  Day 3 embryo Day 4 embryo  Day 5 embryo Day 6 embryo

Asian Disparities in Assisted Reproductive Technologies SART /CDC National ART Databases

Society of Assisted Reproductive

Technology (SART)

Fujimoto et al, Fertil Steril 93: 382-90, 2010

Racial and Ethnic Disparities in ART

0.86 CI 0.80-0.93 White

1.0

Asian

0.90

Black

0.62

Hispanic

0.87

AOR

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10/10/2017 4

Self-reported Asian Nationalities

  • f UCSF IVF Population

Asian – Chinese 39%

Asian – Indian 13%

Asian – Filipino 13%

Asian – Japanese 9%

Asian – Korean 7%

Asian – Vietnamese 2%

Asian – Other 17%

Unpublished data, VY Fujimoto

Analysis of outcome variables: Asian vs. Caucasian

Outcom e variables

 Gestational Sac

 Presence of sac on ultrasound

 Clinical pregnancy

 Presence of fetal heart beat

 On-going pregnancy

 Presence of viable pregnancy at 1 0 -1 2 w eeks

Asians have Decreased Outcomes

0.1 0.2 0.3 0.4 0.5

Sac Clinical On- going Rate per Transfer

Asian Caucasian

Gest. Sac OR 0.69 [0.49-0.99] Clin Pregnancy OR 0.65 [0.45-0.93] On-going Pregnancy OR 0.61 [0.42-0.88]

Asian Disparities in ART

Purcell et al, Fertil Steril 2007

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The Ovaries:

Natural Menstrual Cycle Compared to IVF

VS. IVF Cycle Natural Cycle

17

Stimulation parameters

Asian Caucasian p value Start dose (ampules)

5 .4 + 1.2 5 .6 + 5.1 0 .3 9

Total dose

4 7 .5 + 15.3 4 9 .1 + 16.3 0 .2 3

Follicle > 18mm

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

Tot foll > 10mm

1 4 .1 + 7.1 1 4 .2 + 8.6 0 .8 2

Days stim

1 1 .1 + 1.6 1 1 .4 + 1.5 0 .0 5

E2 at hCG

2 7 4 0 + 1376 2 3 8 3 + 1522 < 0 .0 1

Lining

1 0 .2 + 2.1 9 .8 + 2.0 0 .0 3

Embryo Development

Day 1 embryo  Day 2 embryo  Day 3 embryo 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

e

Aneuploidy and Ancestry

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Asian Disparity in IUI Outcomes

Lamb et al, RBM Online 2010

UCSF 1st Cryopreserved Embryo Transfer Outcomes

Unpublished data

Oocyte Donation cycles: Asian and Caucasian

Huddleston et al, Fertil Steril 94: 2059, 2010

Endometriosis

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

Yamamoto et al, J Assist Reprod Genet, 2017

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10/10/2017 7

Asian Disparity in ART Outcomes

  • Reduced clinical pregnancy rates with fresh I VF cycles
  • Reduced live birth rates with fresh I VF cycles
  • Exaggerated serum estradiol levels during ovarian

stimulation

  • Estradiol levels are higher with defined estradiol patch use

adjusted for BMI

  • Similar embryo development to blastocyst stage
  • No difference in clinical outcomes with cycles involving

either frozen embryos or donor embryos

  • Fecundability not different in Asian pregnant population

 Endometrial Defect with Ovarian

Stimulation in Asian Women

 Access to care in Asian patients  Reduce IUI success in Asian women  Altered Estrogen metabolism in Asian

women

 Higher incidence of Endometriosis in

Asian women

Asian Outcomes in ART