Assisted reproductive technologies (ART) use in indigenous women with PCOS
PCOS is more common among Aboriginal and Torres Strait Islander women than other Australian women. Very little is currently known about the impact of PCOS on fertility in this group, including the extent to which these women seek fertility treatments such as assisted reproductive technologies (ART). As a first step towards understanding these issues, Dr Alice Rumbold and a group of fellow researchers examined the frequency of infertility associated with PCOS among Aboriginal women accessing ART in South Australia and the Northern Territory. Alice explains.
Data were analysed from the South Australian Birth Cohort established by Prof Michael Davies and Prof Vivienne Moore at the University of Adelaide. The cohort includes data on 57,010 cycles among 17,303 couples in South Australia and the Northern Territory for the years 1986 to 2002. In the study period, we identified 72 (0.1%) cycles among 52 couples where the female was Aboriginal, and 99 (0.2%) cycles for 59 couples whether either the male or female partner was Aboriginal. The very low proportion of Aboriginal couples in this dataset suggests that the recording of Aboriginal status of clients may be incomplete or that there are major impediments to accessing care (e.g. cost) for this group. It is likely that both factors occur.
Aboriginal women who did access ART treatment were slightly younger and less likely to be nulliparous than other female clients, indicating that Aboriginal women more often had secondary infertility.
When the cause of infertility was examined, we found that overall, PCOS status was poorly recorded, with no Aboriginal women and only 0.3% of non-Aboriginal having a documented diagnosis of PCOS. However, Aboriginal women were more likely than other clients to have PCOS symptoms recorded in their notes, including PCO detected by scan (19% vs 12%) and PCO based on hormonal profile (14% vs 5%). This suggests that the prevalence of PCOS is likely to be higher among Aboriginal clients.
Almost one third of Aboriginal women had one recorded treatment consultation only, and almost half of those who became pregnant had a multiple birth. These findings may indicate that Aboriginal women had difficulty having more than one cycle of treatment due to the costs associated with treatment.
Our findings provide the first evidence about use of infertility treatments among Aboriginal couples, and identify clear opportunities to improve the recording of Aboriginal status as well as investigations for PCOS among women seeking infertility treatment. This work is the foundation for further in-depth work with Aboriginal women examining the impact of PCOS on fertility and potential barriers to accessing fertility treatments.
Flinders Fertility and Promed, Adelaide; Perinatal Outcomes Unit, SA Dept of Health.