卵裂期与囊胚期新鲜胚胎移植对子代出生性别比例影响的Meta分析

Effect of cleavage stage and blastocyst stage embryo transfer on offspring sex ratio in fresh cycle:a Metaanalysis

目的评价新鲜周期卵裂期与囊胚期胚胎移植对子代出生性别的影响。方法采用Meta分析的方法,利用计算机检索PubMed、Embase、Medline和Cochrane library、维普(VIP)、中国生物医学文献数据库(CMB)、中国知网全文数据库(CNKI)和万方数据库。检索时间自建库至2017年12月,查找关于卵裂期和囊胚期新鲜胚胎移植对新生儿出生性别比例影响的相关研究,按照纳入和排除标准对文献进行筛选。对纳入文献进行资料提取和质量评价后,利用Stata12.0软件进行统计学分析,并进一步进行亚组分析和敏感性分析,评估纳入文献的发表偏倚风险。结果共纳入16篇文献。Meta分析结果显示:囊胚期移植组的新生儿男/女比值显著高于卵裂期胚胎移植组,差异具有统计学意义(OR=1.12,95% CI=1.07~1.16,P<0.001);在亚组分析中,时间亚组结果表明,在2007年前、后2个亚组中,囊胚移植组的新生儿男/女比值均高于卵裂期胚胎移植组,差异均具有统计学意义(2007年前:OR=1.29,95% CI=1.10~1.51,P=0.002;2007年后:OR=1.10,95% CI=1.06~1.15,P<0.001);而在地区亚组分析结果显示,在美洲、亚洲和欧洲3个亚组中,囊胚移植组的新生儿男/女比值均高于卵裂期胚胎移植组,可信区间均完全位于无效线右侧,提示差异均具有显著统计学意义(美洲亚组:OR=1.20,95% CI=1.05~1.37,P=0.008;亚洲亚组:OR=1.11,95% CI=1.05~1.18,P<0.001;欧洲亚组:OR=1.10,95% CI=1.07~1.17,P=0.008)。结论在新鲜移植周期中,与卵裂期胚胎移植相比,囊胚移植可能增加子代男性比例,但该结论仍需更多的大样本、高质量、多中心的随机对照研究加以验证。

ObjectiveTo evaluate the sex ratio in fresh embryo transfer at cleavage stage and blastocyst stage.MethodsThe relevant papers were electronically searched in PubMed, Embase, Medline, Cochrane library, VIP database, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI) and Wanfang database. Literatures were screened according to the inclusion and exclusion criteria. After data extraction and quality assessment, Meta-analysis was performed using Stata 12.0 software, and subgroup analysis and sensitivity analysis were performed.ResultsSixteen studies were scrutinized for this Meta-analysis. There was a significantly higher ratio of male to female at blastocyst stage fresh embryo transfer (OR=1.12, 95% CI=1.07-1.16, P<0.001). In time subgroup analysis, the ratio of male to female at blastocyst stage was significantly higher than that of cleavage stage in both before 2007 and after 2007 subgroups (before 2007: OR=1.29, 95% CI=1.10-1.51, P=0.002;after 2007: OR=1.10, 95% CI=1.06-1.15, P<0.001). In region subgroup analysis, the ratio of male to female at blastocyst stage was significantly higher than that of cleavage stage in three subgroups (America subgroup: OR=1.20, 95% CI=1.05-1.37, P=0.008;Asia subgroup: OR=1.11, 95% CI=1.05-1.18, P<0.001;Europe subgroup: OR=1.10, 95% CI=1.07-1.17, P=0.008).ConclusionCompared with fresh embryo transfer at cleavage stage, blastocyst stage fresh embryo transfer was associated with a significantly higher ratio of male to female. However, it still needs larger sample, high quality, multi-center randomized controlled study to be verified.