Ethnic differences in ovarian reserve and assisted reproductive technology outcomes

Abstract

Ethnic disparities in access to assisted reproduction and treatment outcomes are well discussed in literature (1). But data regarding ethnic variations in ovarian reserve are limited. Our study evaluates influence of ethnicity on ovarian reserve markers and assisted reproductive technology (ART) outcomes. Retrospective cohort study. We reviewed data of women who underwent IVF in our fertility clinic between 2008 and 2015. Antral Follicle Counts (AFC), Anti Mullerian Hormone (AMH) level, basal Follicle Stimulating Hormone (FSH) level, number of oocytes retrieved, clinical pregnancy rate and live birth outcome data were compared between ethnic groups (White, Black, Hispanic and Asians). Parameters of white ethnicity were taken as reference value for comparison. Statistical significance of difference tested with Chi-square and ANOVA. Adjusted odds ratio (AOR) calculated with logistic regression analysis using the Statistical Package for the Social Sciences (SPSS), version 23. Out of 2792 women, there were 12% (n=334) Asian, 7.2% (n=201) Black, 14% (n=390) Hispanic and 66.8% (n=1867) White. The mean age was higher in Hispanics (35.6 ± 5.1, p= 0.002). Black women had higher BMI (27.7 ± 4.9, p < 0.001) and high incidence of tubal factor infertility (20.4%). Asian women had lower BMI (24.2 ± 4.7) and higher E2 levels (1805 ± 1384). There was statistical significant difference in AMH, AFC and basal FSH among the groups as shown in table 1. In logistic regression analysis, ovarian reserve correlated significantly with ethnic group even after adjusting for age, smoking, BMI (AOR 1.59, 95% CI 1.29 - 1.99, P < 0.01). In comparison to white women, further adjusting for number of embryos transferred, odds of clinical pregnancy and live birth were reduced for Asians (AOR 0.40; 95% CI 0.36-0.44), Hispanics ( AOR 0.40 ; 95% CI 0.36-0.44). Black race was an independent risk factor for reduced live birth rate (AOR 0.41; 95% CI, 0.12 - 0.99). Our study showed significant difference in ovarian reserve and IVF outcomes between different ethnic groups. In multivariate regression analysis, these differences persisted even after controlling for potential confounding factors. Further research with larger representative dataset is warranted to confirm these findings.