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Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response in women undergoing fresh ICSI cycles

Abstract

Purpose

Recent studies have demonstrated that ethnicity can be an independent determinant of assisted reproductive technology (ART) outcomes. In this context, we investigate whether ART outcomes differ between Arabian Peninsula and Caucasian women.

Methods

This is a retrospective cohort study of women undergoing fresh intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) cycles for male factor infertility. The study cohort was divided into 2 groups based on ethnicity—Arabian Peninsula or Caucasian. Ovarian reserve, ovarian response, and pregnancy outcomes were compared between the groups. A sub-analysis was performed between individual Arabian Peninsula nationalities for the same outcomes. A multiple linear regression model was used to assess the independent effect of ethnicity on ovarian response.

Results

Seven hundred sixty-three patients were included—217 (28.4%) Arabian Peninsula and 546 (71.6%) Caucasian. There was no difference in the mean age of the two groups; however, the former had a higher body mass index (28.5 ± 7.5 vs. 23.3 ± 5.7; P < 0.001). Although follicle stimulating hormone (FSH) levels and antral follicle counts (AFC) were within the normal range in both groups, Arabian Peninsula women had higher FSH levels (5.7 ± 2.5 vs. 4.9 ± 2.8; P = 0.001) and lower AFC (13.9 ± 4.7 vs. 16.5 ± 4.3; P < 0.001) when compared to Caucasian women. Women from the Arabian Peninsula also had a statistically lower number of mature oocytes retrieved (15.6 ± 6.8 vs. 14.1 ± 8.4; P = 0.01), despite requiring higher gonadotropin doses. Multiple linear regression reveled that Arabian Peninsula women had 2.5 (95% CI 2.1–3.9) less mature oocytes, even after controlling for confounders. A sub-analysis within the Arab cohort demonstrated that Qatari women had a higher yield of mature oocytes when compared to Emirati, Kuwaiti, and Saudi women. There was no difference in the rates of implantation, clinical pregnancy, or live birth when comparing individual Arabian Peninsula nationalities with each other or to Caucasians.

Conclusions

Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response parameters in women undergoing their first ICSI-ET cycle.

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References

  1. Dyer S, Chambers GM, de Mouzon J, Nygren KG, Zegers-Hochschild F, Mansour R, et al. International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2008, 2009 and 2010. Hum Reprod. 2016;31(7):1588–609.

    CAS  Article  PubMed  Google Scholar 

  2. Aboulghar M. Ethnicity affects IVF outcome world-wide with no clear explanation. BJOG. 2017;124(6):911.

    CAS  Article  PubMed  Google Scholar 

  3. Fujimoto VY, Luke B, Brown MB, Jain T, Armstrong A, Grainger DA, et al. Racial and ethnic disparities in assisted reproductive technology outcomes in the United States. Fertil Steril. 2010;93(2):382–90.

    Article  PubMed  Google Scholar 

  4. Dhillon RK, Smith PP, Malhas R, Harb HM, Gallos ID, Dowell K, et al. Investigating the effect of ethnicity on IVF outcome. Reprod BioMed Online. 2015;31(3):356–63.

    Article  PubMed  Google Scholar 

  5. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mansour R, Ishihara O, Adamson GD, Dyer S, de Mouzon J, Nygren KG, et al. International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2006. Hum Reprod. 2014;29(7):1536–51.

    Article  PubMed  Google Scholar 

  7. Sullivan EA, Zegers-Hochschild F, Mansour R, Ishihara O, de Mouzon J, Nygren KG, et al. International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2004. Hum Reprod. 2013;28(5):1375–90.

    CAS  Article  PubMed  Google Scholar 

  8. Feichtinger M, Göbl C, Weghofer A, Feichtinger W. Reproductive outcome in European and Middle Eastern/North African patients. Reprod BioMed Online. 2016;33(6):684–9.

    Article  PubMed  Google Scholar 

  9. Salem WH, Abdullah A, Abuzeid O, Bendikson K, Sharara FI, Abuzeid M. Decreased live births among women of Middle Eastern/North African ethnicity compared to Caucasian women. J Assist Reprod Genet. 2017;34(5):581–6.

    CAS  Article  PubMed  Google Scholar 

  10. Rodriguez-Flores JL, Fakhro K, Agosto-Perez F, Ramstetter MD, Arbiza L, Vincent TL, et al. Indigenous Arabs are descendants of the earliest split from ancient Eurasian populations. Genome Res. 2016;26(2):151–62.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. Elias RT, Pereira N, Artusa L, Kelly AG, Pasternak M, Lekovich JP, et al. Combined GnRH-agonist and human chorionic gonadotropin trigger improves ICSI cycle outcomes in patients with history of poor fertilization. J Assist Reprod Genet. 2017;34(6):781–8.

    Article  PubMed  Google Scholar 

  12. Huang JY, Rosenwaks Z. Assisted reproductive techniques. Methods Mol Biol. 2014;1154:171–231.

    Article  PubMed  Google Scholar 

  13. Pereira N, Friedman C, Hutchinson AP, Lekovich JP, Elias RT, Rosenwaks Z. Increased odds of live birth in fresh in vitro fertilization cycles with shorter ovarian stimulation. Fertil Steril. 2017;107(1):104–109.e2.

    Article  PubMed  Google Scholar 

  14. Palermo GD, Neri QV, Schlegel PN, Rosenwaks Z. Intracytoplasmic sperm injection (ICSI) in extreme cases of male infertility. PLoS One. 2014;9(12):e113671.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Palermo GD, Kocent J, Monahan D, Neri QV, Rosenwaks Z. Treatment of male infertility. Methods Mol Biol. 2014;1154:385–405.

    CAS  Article  PubMed  Google Scholar 

  16. Gosden LV. Oocyte retrieval and quality evaluation. Methods Mol Biol. 2014;1154:343–60.

    Article  PubMed  Google Scholar 

  17. Agarwal A, Mulgund A, Hamada A, Chyatte MRA. Unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Inhorn MC, King L, Nriagu JO, Kobeissi L, Hammoud N, Awwad J, et al. Occupational and environmental exposures to heavy metals: risk factors for male infertility in Lebanon? Reprod Toxicol. 2008;25(2):203–12.

    CAS  Article  PubMed  Google Scholar 

  19. Inhorn MC, Kobeissi L, Nassar Z, Lakkis D, Fakih MH. Consanguinity and family clustering of male factor infertility in Lebanon. Fertil Steril. 2009;91(4):1104–9.

    Article  PubMed  Google Scholar 

  20. Luke B, Brown MB, Stern JE, Missmer SA, Fujimoto VY, Leach R. Racial and ethnic disparities in assisted reproductive technology pregnancy and live birth rates within body mass index categories. Fertil Steril. 2011;95(5):1661–6.

    Article  PubMed  Google Scholar 

  21. Schuh-Huerta SM, Johnson NA, Rosen MP, Sternfeld B, Cedars MI, Reijo Pera RA. Genetic variants and environmental factors associated with hormonal markers of ovarian reserve in Caucasian and African American women. Hum Reprod. 2012;27(2):594–608.

    CAS  Article  PubMed  Google Scholar 

  22. Bosdou JK, Kolibianakis EM, Tarlatzis BC, Fatemi HM. Sociocultural influences on fertility in the Middle East: the role of parental consanguinity, obesity and vitamin D deficiency. Fertil Steril. 2016;106(2):259–60.

    Article  PubMed  Google Scholar 

  23. Fouda MA, Turkestani IZ, Almusharraf S, Al-Ajlan A, Angkaya-Bagayawa FF, Sabico S, et al. Extremely high prevalence of maternal and neonatal vitamin D deficiency in the Arab population. Neonatology. 2017;112(3):225–30.

    CAS  Article  PubMed  Google Scholar 

  24. Yoshizawa T, Handa Y, Uematsu Y, Takeda S, Sekine K, Yoshihara Y, et al. Mice lacking the vitamin D receptor exhibit impaired bone formation, uterine hypoplasia and growth retardation after weaning. Nat Genet. 1997;16(4):391–6.

    CAS  Article  PubMed  Google Scholar 

  25. Merhi Z, Doswell A, Krebs K, Cipolla M, Vitamin D. Alters genes involved in follicular development and steroidogenesis in human cumulus granulosa cells. J Clin Endocrinol Metab. 2014;99(6):E1137–45.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. Parikh G, Varadinova M, Suwandhi P, Araki T, Rosenwaks Z, Poretsky L, et al. Vitamin D regulates steroidogenesis and insulin-like growth factor binding protein-1 (IGFBP-1) production in human ovarian cells. Horm Metab Res. 2010;42(10):754–7.

    CAS  Article  PubMed  Google Scholar 

  27. Tal R, Seifer DB. Potential mechanisms for racial and ethnic differences in antimüllerian hormone and ovarian reserve. Int J Endocrinol. 2013;2013:818912.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Polyzos NP, Anckaert E, Guzman L, Schiettecatte J, Van Landuyt L, Camus M, et al. Vitamin D deficiency and pregnancy rates in women undergoing single embryo, blastocyst stage, transfer (SET) for IVF/ICSI. Hum Reprod. 2014;29(9):2032–40.

    CAS  Article  PubMed  Google Scholar 

  29. Paffoni A, Ferrari S, Viganò P, Pagliardini L, Papaleo E, Candiani M, et al. Vitamin D deficiency and infertility: insights from in vitro fertilization cycles. J Clin Endocrinol Metab. 2014;99(11):E2372–6.

    CAS  Article  PubMed  Google Scholar 

  30. Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ. Tubal factor infertility and perinatal risk after assisted reproductive technology. Obstet Gynecol. 2013;121(6):1263–71.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. Kawwass JF, Crawford S, Session DR, Kissin DM, Jamieson DJ, National ART. Surveillance system group. Endometriosis and assisted reproductive technology: United States trends and outcomes 2000-2011. Fertil Steril. 2015;103(6):1537–43.

    Article  PubMed  Google Scholar 

  32. Verza S Jr, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. Int Braz J Urol. 2008;34(1):49–56.

    Article  PubMed  Google Scholar 

  33. Balaban B, Urman B, Isiklar A, Alatas C, Mercan R, Aksoy S, et al. Blastocyst transfer following intracytoplasmic injection of ejaculated, epididymal or testicular spermatozoa. Hum Reprod. 2001;16(1):125–9.

    CAS  Article  PubMed  Google Scholar 

  34. Drakopoulos P, van de Vijver A, Schutyser V, Milatovic S, Anckaert E, Schiettecatte J, et al. The effect of serum vitamin D levels on ovarian reserve markers: a prospective cross-sectional study. Hum Reprod. 2017;32(1):208–14.

    PubMed  Google Scholar 

  35. Fabris AM, Cruz M, Iglesias C, Pacheco A, Patel A, Patel J, et al. Impact of vitamin D levels on ovarian reserve and ovarian response to ovarian stimulation in oocyte donors. Reprod BioMed Online. 2017;35(2):139–44.

    CAS  Article  PubMed  Google Scholar 

  36. Neville G, Martyn F, Kilbane M, O'Riordan M, Wingfield M, McKenna M, et al. Vitamin D status and fertility outcomes during winter among couples undergoing in vitro fertilization/intracytoplasmic sperm injection. Int J Gynaecol Obstet. 2016;135(2):172–6.

    CAS  Article  PubMed  Google Scholar 

  37. Moy V, Jindal S, Lieman H, Buyuk E. Obesity adversely affects serum anti-müllerian hormone (AMH) levels in Caucasian women. J Assist Reprod Genet. 2015;32(9):1305–11.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Russo M, Ates S, Shaulov T, Dahan MH. Morbid obesity and pregnancy outcomes after single blastocyst transfer: a retrospective, North American study. J Assist Reprod Genet. 2017;34(4):451–7.

    Article  PubMed  Google Scholar 

  39. Kawwass JF, Kulkarni AD, Hipp HS, Crawford S, Kissin DM, Jamieson DJ. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States. Fertil Steril. 2016;106(7):1742–50.

    Article  PubMed  Google Scholar 

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Corresponding author

Correspondence to Nigel Pereira.

Ethics declarations

Our retrospective study was approved by the Institutional Review Board.

Conflict of interest

The authors declare that they have no conflict of interest.

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Cite this article

Tabbalat, A.M., Pereira, N., Klauck, D. et al. Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response in women undergoing fresh ICSI cycles. J Assist Reprod Genet 35, 331–337 (2018). https://doi.org/10.1007/s10815-017-1071-7

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  • DOI: https://doi.org/10.1007/s10815-017-1071-7

Keywords

  • Intracytoplasmic sperm injection
  • Assisted reproductive technologies
  • Ovarian response
  • Ethnicity
  • Disparities
  • Arabian Peninsula