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.