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Hyperstimulation and Protocols
If a Black woman or couple moves forward with IVF, there are a few things they may want to keep in mind, beyond what other patients should hear.
The first major step in the IVF process is for a woman to take hormones to stimulate the growth of an abnormally large number of eggs.
Occasionally, women can become “hyperstimulated” in the process, which can be both painful, and in some cases, dangerous. As you can see from the data below, Black women are more likely to “hyperstimulate” than Caucasian women.
Hyperstimulation is often a reaction to the medication protocol strategy, or drug volumes, prescribed by the doctor. To oversimplify the subject, there are really two core protocols: the “Long Agonist” protocol and the “Antagonist” protocol.
The two have similar success rates, but with the “Antagonist” protocol, hyperstimulation is generally less of an issue. Below is an example of this taken from a study on women with polycystic ovarian syndrome (PCOS). Thus, Black women should ask their doctor specifically about whether the “Antagonist” protocol provides a better risk vs. reward.
Fresh or Frozen Embryo Transfer
Once a woman has had her eggs retrieved, those eggs will be fertilized with sperm to create embryos. Now the decision becomes when to transfer them.
The embryos could be transferred just a few days after a retrieval, in what is known as a “fresh transfer.” Or someone can wait a month or longer to have embryos transferred, in which case the embryos will stay frozen until they’re needed. This is known as a “frozen transfer.” To learn more about the distinction, you can see our lesson on the subject here.
In one study that took place at Walter Reed National Military Medical Center, Black women had higher live birth rates after a frozen transfer than after a fresh transfer.
That said, while frozen transfers were more productive than fresh transfers, in a much larger study investigators still noticed a gap between the outcomes for Caucasian and Black patients. In a study of over 7,000 IVF cycles featuring only frozen transfers of genetically-normal embryos (theoretically equally likely to work), investigators noticed Black patients recorded lower pregnancy rates and higher miscarriage rates that ultimately culminated in lower live birth rates.
Single Embryo Transfer
Another important question to consider is how many embryos will be transferred at one time. Black patients are often more nervous than Caucasian patients about having twins or triplets from their IVF cycle.
It turns out, carrying twins or triplets raises the medical risk to both mother (for example, excessive bleeding) and offspring (severe risks like infant mortality), as you can see in the data here.
If a woman has two embryos available, whether she transfers both at once, or one at a time, makes no difference to her odds of having a child. Yes, a woman may spend a few thousand dollars more to have a second transfer if the first doesn’t work, but the risk she takes on is dramatically lower.
