Interpretation
The more similar distribution of infertility diagnoses seen among White
and Black American women compared to Black Haitian and Black African
women point to the potential stronger influence of environmental factors
on infertility than race alone, or “nurture over nature.” Some of the
differences may also be attributable to more limited access to
infertility care seen among women not born in the United States, as
suggested by the higher age at presentation, lower rates of commercial
insurance, and higher unemployment rates seen among Black African and
Black Haitian women. Black African and Black Haitian women also had
higher day 3 FSH levels at baseline compared to Black American and White
American women, further suggesting that immigrant women present for care
at a later age than their American counterparts.
The differences in infertility diagnosis prevalence seen between Black
ethnic groups are also likely secondary to environmental rather than
genetic influences. Differences in the rate of PCOS/anovulation between
Black American women and Black African women suggest that genetics may
not be the most important factor impacting their diagnosis. Other ethnic
group differences, such as those seen for tubal factor infertility
between Black African women compared to Black American and Black Haitian
women, may be attributable to lifestyle differences.