Fertility treatment: groups call to tackle ethical disparities for black and Asian patients

Black, Asian and ethnic minority patients must not be “left behind” when it comes to accessing fertility treatment, a coalition of health organisations has said after research showed black and Asian patients had lower birth rates from such treatment, while black patients started treatment later and were least likely to have NHS-funded treatment.

The Human Fertilisation and Embryology Authority (HFEA), the Royal College of Obstetricians and Gynaecologists, the British Fertility Society, and Fertility Network UK said they had issued a “call to action” for change.

They said: “We 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.

“Fertility treatment can be extremely stressful and expensive, and the changes we are calling for aim to reduce disparities in access to and outcomes for black, Asian and ethnic minority patients. Our call is for improvements to be made in development of clinical policy, information and awareness, NHS commissioning, and research to tackle the ethnic disparities in fertility treatment.”

The HFEA research looked at disparities in use and outcomes of fertility treatment in the UK by ethnic groups from 2017-21.

The coalition of groups said the reasons for the disparities are “complex and not fully understood”, suggesting possible factors could include gynaecological or other health conditions, as well as cultural, social, economic and structural factors, including stigma experienced by ethnic minority patients.

The HFEA report, published on Wednesday, said IVF (in vitro fertilisation) cycles funded by the NHS declined most among black patients in heterosexual couples, down from 60% in 2019 to 41% in 2021.

This compared with a decrease from 66% to 53% among white patients.

While IVF birth rates increased across all ethnic groups during the most recent time period, black patients had lower birth rates, the research showed.

For black patients aged 18-37, the average IVF birth rate per embryo transferred using fresh embryo transfers was on average 23% while for Asian patients it was 24%, compared with 32% for white patients in 2020-21.

On average, black patients in heterosexual couples were a year older, aged 36, on starting treatment, compared with the national average of 35 in 2021. The researchers acknowledged age at which treatment is started is “a key factor in success rates”.

When it came to single patients, Asian and black people started fertility treatment aged 38 or 39 on average, compared with an average age of 36.2 years for white single patients in 2017-21, the report said.

Multiple birth rates fell in all ethnic groups, but black patients continued to have the highest rates at 9%, compared with 7% for white patients in 2017-21.

Researchers said multiple births cause increased risk of health problems for patients and their babies, such as late miscarriage, gestational diabetes, stillbirth and neonatal and maternal death.

Among their recommendations, the coalition called for publicly funded research “to explore barriers” patients experience and for a look at the relationship between gynaecological and other health conditions that can affect fertility and whether this is a contributing factor to disparities, and further improvement in collecting “high-quality ethnicity data” to help with data analysis and research.