P–723 Ovarian reserve parameters and ovarian stimulation outcome for IVF/ICSI are influenced by ethnicity
Authors: Lawrenz B , Banker M , Arefi S , Mehrafza M , Lotti B , ElGindy E , Iglesias C , Bachmann A , Soares S , Henes M , Garcia-Velasco J A , Fatemi H , Garrido N 
Published: August 2021

Abstract

Study question
Are the ovarian reserve parameters and the outcome of ovarian stimulation for IVF / ICSI influenced by ethnicity?

Summary answer
Ethnicity influences ovarian reserve parameters and the outcome of ovarian stimulation for IVF / ICSI

What is known already
Infertility affects couples worldwide and due to a lack of a standardized reporting system, the real number, especially in developing countries, might be underestimated. The etiology of infertility may differ around the world and is often subjected not only to social, cultural and religious peculiarities, but also to different genetic influences. Published data suggest that ethnicity influences the ovarian reserve as well as the outcome of Assisted-Reproductive-Techniques (ART)-treatments. Key players of a successful ART outcome are the ovarian reserve and consequently the number of oocytes retrieved. Until today, the impact of ethnical differences is not sufficiently addressed in research.

Study design, size, duration
Prospective observational study, performed in 10 infertility centers worldwide (Europe (4 centers), Middle East North Africa (MENA) region (2 centers), Iran (2 centers), South America (1 center), India (1 center)) between May 2019 and September 2020, evaluating ovarian reserve and outcome parameters of ovarian stimulation treatments for IVF/ICSI. The study was approved by the Ethical Committee of each participating center.

Participants/materials, setting, methods
Couples with primary / secondary infertility and an indication for an IVF/ICSI treatment were included into this study. Besides anamnestic data regarding the history of the infertility and self-reported ethnicity (Arab, Caucasian, Hispanic, Ohters, Persian and South Asian), data obtained during the basic fertility assessment on the ovarian reserve parameters (Antral follicle count (AFC) and Anti-Muellerian-Hormone (AMH)) as well as stimulation parameters from the ovarian stimulation treatment were collected and analyzed.

Main results and the role of chance
This study comprised 1032 couples with the following distribution of the ethnicities: Arab 21.5%, Caucasian 15.9%, Hispanic 5%, Others 1.2%, Persian 33.4%, and South Asian 23%. The unadjusted means, SD and 95%CI (Confidence Interval) of AMH (ng/ml) for the groups were 3.33±0.19 [2.95–3.71]; 2.03±0.25 [1.55–2.52]; 2.43±0.74 [0.97–3.88]; 2.76±0.96 [0.88–4.64]; 3.10±0.16 [2.79–3.41]; 3.62±0.19 [3.25–3.98], for AFC 15.52±0.53 [14.49–16.55]; 12.00±0.67 [10.69–13.31]; 12.69±1.08 [10.57–14.81]; 15.11±2.60 [10.01–20.21]; 13.58±0.42 [12.75–14.41]; 13.49±0.51 [12.49–14.48] and for the number of retrieved oocytes (rCOC) 14.08±0.61 [12.88–15.27]; 9.84±0.71 [8.44–11.24]; 7.94±1.26 [5.48–10.41]; 9.92±2.62 [4.78–15.05]; 10.83±0.49 [9.87–11.79]; 17.06±0.59 [15.90–18.21], respectively. Univariate analysis of AMH, AFC and rCOC with the ethnicities revealed highly statistically significant differences for AMH and rCOC (p &lt; 0.001, respectively) and significant differences for AFC (p = 0.0014).
As age is a major confounder for the ovarian reserve, multivariate analyses were performed. After adjusting for age, AMH was significantly different between Arab-Persian, Arab-South Asian and Arab-Caucasian (p &lt; 0.001, p &lt; 0.001, p = 0.002) and AFC statistically significant between Arab and all other ethnicities. For rCOC, besides age, also the stimulation-dosage and -duration was taken into account. Highly statistically significant differences were found for the groups Arab-Persian and Arab-Caucasian and no differences towards the other ethnical groups.

Limitations, reasons for caution
Limitations of the study are an unequal number of included patients per ethnicity and that the data for the ovarian reserve parameters and the stimulation outcome were not available for all of the included patients.
Wider implications of the findings: Counselling of couples with infertility have to take, besides all other factors, also the ethnicity of the couple into account as ethnicity influences the ovarian reserve parameters as well as the number of retrieved oocytes in ovarian stimulation cycles for IVF/ICSI.

Trial registration number
ClinicalTrials.gov Identifier: NCT03927417