ART中影响新生儿性别比的相关因素分析

Factors Affecting Offspring Sex Ratio in ART

辅助生殖技术(assisted reproductive technology,ART)在给广大不孕不育患者带来福音的同时,也带来了男女出生性别比的失衡,相关影响因素有待研究分析。通过收集并分析2013年1月至2014年12月于广州医科大学附属第三医院接受ART治疗并成功分娩4 635个新生儿的3 462个周期患者的临床资料发现,ICSI组与IVF组比较,活产男婴比例没有统计学差异(P=0.07),但PESA/TESA-ICSI组出生男婴比例较IVF组显著降低(P=0.036);同时,移植囊胚期胚胎出生的男婴比例要显著高于移植卵裂期胚胎的男婴比例(P=0.005)。进一步的分层卡方检验结果显示,除去授精方式的影响,移植胚胎期别仍然可以影响出生婴儿的性别比(P=0.021)。但多因素logistic回归分析提示,以上因素均不能构成独立预测因素。上述结果表明在体外受精-胚胎移植周期中,移植囊胚期胚胎可显著增加男婴出生比例,而PESA/TESA-ICSI授精方式则会显著降低男婴出生比例。

The assisted reproductive technology （ART） brings hope to patients with infertility. However, it also brings offspring sex ratio imbalance. Relative risk factors affecting sex ratio of live births still need to be studied. The clinical data of 3 462 cycles gaining 4 635 babies, collected from Jan. 2013 to Dec. 2014 in the Third Affiliated Hospital of Guangzhou Medical University, were analyzed. There was no significant difference in offspring sex ratio between IVF and ICSI groups （P=0.07）. Further analysis showed that PESA/TESA-ICSI was significantly correlated with a decreased percentage of male babies （P=0.036）. Meanwhile, a higher male birth rate following blastocyst transfer was found, compared with that of cleavage-stage embryo transfer （P=0.005）. Moreover, the stratified chi-square test analyses confirmed that the stage of transferred embryo was really one of the factors influencing sex ratio at birth after eliminating the disturbance of insemination （P=0.021）. But none of the above factors could be an independent predictor with the multivariate analysis. Collectively, the blastocyst transfer preferred a male baby, while PESA/TESA-ICSI correlated to a decreased proportion of male babies.