Reduced ovarian reserve among female offspring of consanguineous marriages in the Middle East—a mini review

Background: Consanguineous marriages remain prevalent in many regions of the world, particularly within the Middle East, where reported prevalence exceeds 50% in countries such as Saudi Arabia, Oman, and the United Arab Emirates. Despite evidence that consanguineous marriages increase genetic risks through increased levels of homozygosity, which might lead to gene dysfunction, their impact on female fertility remains unclear. Although the data is limited and inconsistent, female offspring of consanguineous marriages appear to have a higher risk of reduced ovarian reserve compared to their peers from non-consanguineous marriages, with a more pronounced effect in young women.

Aim: This mini review synthesizes current evidence on the relationship between parental consanguinity and ovarian reserve in female offspring to clarify existing findings and highlight research gaps.

Methods: A systematic search of MEDLINE, Embase, and Web of Science was conducted up to March 2024 in accordance with the PRISMA guidelines. Studies evaluating ovarian reserve markers, including Anti-Müllerian Hormone (AMH) and Antral Follicle Count (AFC), in women with and without parental consanguinity were included. This review was registered with PROSPERO (Registration ID: CRD42022300162).

Results: Three studies (n = 2,903) from Kuwait, the UAE, and Oman met the inclusion criteria. Two reported significantly lower AMH and AFC levels among women aged ≤35 years with parental consanguinity, whereas one found no significant association between parental consanguinity and ovarian reserve markers.

Discussion: The current findings suggest that parental consanguinity may contribute to reduced ovarian reserve in female offspring; however, the data are not consistent. Differences in study design and degree of consanguinity may explain these inconsistencies. This review could be used to raise awareness about the potential influence of parental consanguinity on the reproductive health of their family's offspring, to encourage early counselling and proactive fertility assessment. The results present a call to action, highlighting the need for further research on this issue within the Middle East region, where consanguinity is highly prevalent.

Systemic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022300162, PROSPERO CRD42022300162.