Will decreasing assisted reproduction technology costs improve utilization and outcomes among minority women?

Objective: To evaluate assisted reproduction technology (ART) usage and outcomes in minority women seeking care at enhanced access, military ART programs. Design: Retrospective cohort. Setting: Federal ART programs. Patient(s): Two thousand fifty women undergoing first cycle, fresh, nondonor ART from 2000 to 2005. Intervention(s): None. Main Outcome Measure(s): Rate of ART use, clinical pregnancy rate, live birth rate. Result(s): African American women had an almost fourfold increased use of ART and Hispanic women had decreased use. Clinical pregnancy rates were significantly lower for African American women compared with white women (46.1% vs. 52.6%, relative risk [RR] 0.88; 95% confidence interval [CI], 0.78-0.99) as were live birth rates (33.7%. vs. 45.7%, RR 0.74; 95% CI, 0.63-0.91). Conclusion(s): Economics appear to influence ART use by African American women but not Hispanic women. Despite increased use by African American women, outcomes in this group were worse when compared with Caucasian women. Improving access through decreased cost may increase use by some but not all minority groups. Improved access may not translate into improved outcomes in some ethnic groups.