P-638 Racial Disparity of Anti Mullerian Hormone (AMH) &amp; Antral Follicle Count (AFC) among the subfertile women: A Systematic Review and Meta-analysis
Authors: Vitthala S , Adiga P , Bhat C 
Published: June 2022

Abstract

Study question
Do racial disparities exist in AMH & AFC among the subfertile women ?

Summary answer
An insignificant disparity was noted in AMH&AFC among different races.Standard Mean Difference of AMH was in favour of non-whites & AFC in favour of whites.

What is known already
Evidence exposes racial disparity exists in clinical medicine. An emerging body of literature suggests that reproductive potential and function differ across different racial groups.Racial disparities permeate at every level of fertility care from access, baseline evaluation, care provision and treatment outcomes.AMH & AFC are important predictors of successful reproductive outcomes and their disparity amongst different races may be associated with poor reproductive outcomes.Evidence shows that non-white women have significantly lower live birth rates after fertility treatments when compared to white women.

Study design, size, duration
An electronic literature search of MEDLINE,EMBASE,CINAHL,Google Scholar, Scopus, Web of Science databases, Cochrane Library was done up to December 2021. The search used a combination of keywords like AMH, AFC, Ovarian reserve markers, Ethnicity, Race, Caucasian, Black, Hispanic, Asian. A total of 1178 abstracts were screened which reported on AMH & AFC in different races, 127 publications of them were reviewed and 20 were included for meta-analyses after detailed scrutiny done independently by authors.

Participants/materials, setting, methods
Studies that reported on AMH&AFC in subfertile women of different races (Whites, Blacks, Asians and Hispanics) were included in the meta-analysis. Comparison of AMH&AFC among different races was the main outcome. AMH and AFC’s were reported as means ± SD, standard mean differences (SMD) with 95% CI. p &lt; 0.005 was considered as significant. NIH risk assessment tool was used to assess bias. The statistical analysis was done in STATA and Rev Man 5.4.

Main results and the role of chance
The mean AMH (ng/dl) among Asians, Hispanics, Blacks and Whites were 3.03,2.65,2.64and2.51 respectively. The mean AFC among Hispanics, Blacks, Whites and Asians were 16.48,5.76,3.63and11.53 respectively. The Standard Mean Difference (SMD) of AMH was in favour of non-whites in comparison to whites (0.32,95%CI 0.08-0.56,p=0.008) and subgroup analysis showed Asians fared better among all the races and there was no difference between Hispanics and Whites, Blacks and Whites. The Standard Mean Difference(SMD) of AFC was in favour of whites in comparison to non-whites (0.67,95%CI-0.38-1.71,p=0.21) and subgroup analysis showed Asians fared worse among all the races and there was no difference between Whites and Blacks, Hispanics and Blacks.

Limitations, reasons for caution
All Included studies were observational without age-specific fertility outcomes. The heterogeneity of the geography and the age groups included in different studies are not a global representation of the AMH & AFC in different races. The necessity of large multi-centre randomized controlled studies is needed to validate our findings.

Wider implications of the findings
The insignificant disparity in AMH & AFC in the background of skewed accessibility and availability of fertility services may explain the significant differences in the reproductive outcomes. The fertility societies may need to make race-specific fertility guidelines to counter the disparity of available resources and services to different races.

Trial registration number
not applicable