Neighborhood deprivation in relation to ovarian reserve and outcomes of ovarian stimulation among oocyte donors

Objective To study the relation of neighborhood deprivation index (NDI) and markers of ovarian reserve and outcomes of controlled ovarian stimulation among young, healthy oocyte donors. Design Retrospective cohort study Subjects 547 oocyte donors who underwent 905 oocyte retrieval cycles (2008-2020) at a private fertility center in Sandy Springs, Georgia, USA. Exposure NDI was calculated using principal component analysis applied to census-level measures of poverty, employment, household composition, and public assistance, which was then standardized and linked to donor information based on donor residence. Main Outcome Measures Markers of ovarian reserve, including antral follicle count (AFC) and anti-Müllerian hormone (AMH) levels, and outcomes of controlled ovarian stimulation including number of total and mature oocytes retrieved and ovarian sensitivity index (OSI) (defined as the number of oocytes retrieved ÷ total gonadotropin dose × 1,000). Multivariable generalized estimating equations with Poisson and normal distribution were used to model the relationship between NDI and outcome measures adjusting for age, BMI, and year of retrieval. Results The mean (standard deviation) age of donors was 25.0 (2.8) years and 29% of the donors were racial/ethnic minorities. There were no associations between donor NDI and ovarian reserve markers. For every interquartile range increase in NDI, there was a reduction of -1.5% (95% CI -5.3, 2.4%) in total oocytes retrieved although the effect estimate was imprecise. Associations of NDI with number of mature oocytes retrieved and OSI were in a similar direction. We observed evidence for effect modification of the NDI and OSI association by donor race. There was a suggestive positive association between NDI and OSI in Black donors but no association in White donors. Conclusion and relevance In this cohort of young, healthy, racially diverse oocyte donors, we found little evidence of associations between NDI and markers of ovarian reserve or outcomes of ovarian stimulation.