辅助生殖技术对出生性别的影响:囊胚移植增加ICSI周期出生性别比

Effect of assisted reproductive technology on birth sex:blastocyst transfer increases secondary sex ratio in ICSI cycle

目的探讨不同辅助生殖技术(ART)助孕方式对新生儿性别的影响。方法回顾性队列研究分析2015年1月至2019年12月在西北妇女儿童医院生殖中心接受体外受精(IVF)和卵胞浆内单精子注射(ICSI)助孕并进行单胚胎移植(SET)且成功分娩的患者和新生儿临床资料。比较不同助孕方式及移植囊胚形态评分对出生性别比(SSR)的影响。结果SET治疗6922对夫妇,共7062名新生儿(含单卵双胎140例),SSR为121.2。(1)IVF组SSR较ICSI组显著升高(126.4 vs.107.8,P<0.05),囊胚移植组SSR较卵裂胚移植组显著升高(125.1 vs.104.8,P<0.05)。亚组分析发现,囊胚移植只增加ICSI周期中的SSR[OR=1.44,95%CI(1.14,1.82),P=0.002],对IVF周期中SSR无显著影响[OR=1.10,95%CI(0.95,1.28),P=0.185]。(2)囊胚形态评分中,滋养层细胞(TE)评分增高与SSR增加有关[A vs.C:OR=1.76,95%CI(1.34,2.31),P<0.001;B vs.C:OR=1.28,95%CI(1.14,1.44),P<0.001],而囊胚形成时间[OR=1.10,95%CI(0.84,1.42),P=0.497]、囊胚扩张度[(3~4)vs.(1~2):OR=1.01,95%CI(0.49,2.08),P=0.986;(5~6)vs.(1~2):OR=2.04,95%CI(0.85,4.90),P=0.109]以及内细胞团(ICM)评分[A vs.C:OR=0.89,95%CI(0.69,1.14),P=0.363;B vs.C:OR=0.89,95%CI(0.77,1.04),P=0.158]对SSR均无显著影响。结论囊胚移植增加ICSI治疗后新生儿的出生性别比;囊胚形态评分中,滋养层细胞质量对出生性别的影响具有更加重要的意义。

Objective:To investigate the effect of different assisted reproductive technologies(ART)on the newborn sex.Methods:The clinical data of patients and newborn who underwent IVF-ET or ICSI-ET cycles followed by single embryo transfer(SET)and successfully delivered in Reproductive Center of Northwest Women and Children’s Hospital from January 2015 to December 2019 were retrospectively analyzed.The relationship between the sex ratio of the live births and different ART was studied.Blastocysts parameters including expansion,grade of the inner cell mass(ICM)and trophectoderm(TE)were also analyzed.The effects of different ARTs and the morphological score of transplanted blastocysts on the secondary sex ratio(SSR)were compared.Results:A total of 7062 newborns(including 140 monozygotic twins)were delivered by 6922 couples treated with SET and the SSR was 121.2.The SSR in IVF group was significantly higher than that in ICSI group(126.4 vs.107.8,P<0.05).The SSR of blastocyst group was significantly higher than that of blastocyst group(125.1 vs.104.8,P<0.05).Subgroup analysis showed that blastocyst embryo transfer only increased the SSR in ICSI cycle[OR=1.44,95%CI(1.14,1.82),P=0.002].There was no significant effect on SSR in IVF cycle[OR=1.10,95%CI(0.95,1.28),P=0.185].In blastocyst morphological score,the increase of trophoblast cell(TE)score was associated with the increase of the SSR[A vs.C:OR=1.76,95%CI(1.34,2.31),P<0.001;B vs.C:OR=1.28,95%CI(1.14,1.44),P<0.001],while the time of blastocyst formation[OR=1.10,95%CI(0.84,1.42),P=0.497],blastocyst expansion[(3-4)vs.(1-2):OR=1.01,95%CI(0.49,2.08),P=0.986;(5-6)vs.(1-2):OR=2.04,95%CI(0.85,4.90),P=0.109]and inner cell mass(ICM)score[A vs.C:OR=0.89,95%CI(0.69,1.14),P=0.363;B vs.C:OR=0.89,95%CI(0.77,1.04),P=0.158]had no significant effect on SSR.Conclusions:Blastocyst transplantation increases the secondary sex ratio in ICSI treatment.In blastocyst morphology score,the influence of trophoblast cell quality on SSR is of more significance.