Dados do Trabalho

Title

The relevance of ethnicity in social fertility preservation: should it be included as a variable while counseling our patients?

Objective

There is a growing demand on oocyte cryopreservation for non-medical reasons as a tool to mitigate age-related fertility decline. The ideal number of frozen oocytes to reach a good future prognostic is estimated around 10 to 20, depending on women’s age, in infertile patients. Still, there is a lack of knowledge on the ideal number in social preservation and how other variables, besides age, would affect the treatment planning for this population. There are growing evidence that ethnicity may be related to ovarian response in controlled ovarian hyperstimulation. The aim of this study was to assess the number of mature oocytes retrieved from donors considering their ethnicity.

Methods

Large observational cohort study from 1757 egg retrievals of 820 oocyte donors, performed between April/2013 and December/2022 in a single ART center. Oocyte donors are young women (between 18 and 35 years old) with regular menstrual cycles, no historic of genetically and sexual transmitted diseases, with antral follicle count (AFC) ≥12. Donors were treated with a conventional starting gonadotrophin dose of 150–225 IU recombinant FSH (rFSH) in a fixed GnRH antagonist protocol. They were categorized in four groups according to their ethnicity: A - Latin american (n = 587), B - Caucasian white (n = 109), C - African American (n = 88) and D - Asian (n = 36). Kruskal-Wallis with Dunn’s multiple comparisons test was applied for statistical analysis. p<0,05 was considered significant.

Results

Asian donors were slightly older (27,4±3,68 yo) than A (25,1±3,91), B (25,7±4,13) and C (24,2±3,26, p<0.001). White Caucasian showed lower body mass index (BMI) in comparison to D (23,37±3,28 vs 24,8±2,43, p=0.01). Asians received the highest recombinant FSH dosage (total rFSH) during controlled ovarian hyperstimulation (2917,01±694,03) in comparison to A (2481,08±692,30), B (2487,77±780,38) and C (2537,18±618,55, p<0.001). Asians also showed the lowest AFC in comparison to groups A, B and C (16,30±4,49 vs 20,45±9,32, 19,52±7,09, 20,35±6,40, p<0.01, respectively) and the lowest number of oocytes retrieved (21,54±7,45 vs 25,91±12,07, 24,00±10,49, 26,12±9,55, p=0.02, respectively). White Caucasians showed less mature oocytes in comparison to African Americans (17,11±8,30 vs 19,11±7,59, p=0.01). When analyzing the percentage of mature oocytes per number of oocytes retrieved, Asians showed highest %MII (76%±13.3%) in comparison to A (71.2%±15.2%) and B (68.5%±15.5%, p<0.001). White Caucasians (B) also showed lower %MII in comparison to A and C (73.9%±14.3%, p<0.001). In despite of showing the highest age, BMI and total rFSH and lowest AFC and number of oocytes retrieved, Asians showed the highest %MII in our cohort while White Caucasians the lower %MII.

Conclusion

White Caucasians showed lower %MII in comparison to other ethnicities. This may have an impact on the number of oocytes available for cryopreservation and reinforce the importance to consider other variables in the moment of patient’s counseling and treatment planning.

Keywords

Ethnicity, Oocyte donation, Fertility preservation, Counseling