IVF/ICSI-ET实验室因素对子代出生性别比的影响

Effect of IVF/ICSI-ET laboratory factors on sex ratio at birth

目的 分析体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)实验室因素对子代出生性别比(SRB)的影响。方法 回顾性分析2010年1月至2019年12月在我院行IVF/ICSI-ET治疗并成功妊娠分娩患者(共19 844个周期)的SRB情况。辅助生殖技术(ART)的主要实验室因素包括受精方式、移植胚胎类型、移植胚胎时期和移植胚胎数目等,故根据不同的受精方式分为IVF组(n=14 626)和ICSI组(n=4 908);根据不同移植胚胎时期分为卵裂胚组(n=8 778)和囊胚组(n=11 066);根据不同移植胚胎类型分为新鲜胚胎组(n=11 533)和解冻胚胎组(n=8 311);根据不同移植胚胎个数分为单胚胎组(n=3 871)和双胚胎组(n=14 483)。分别观察以上4个实验室因素对SRB的影响;采用单因素及多因素Logistic回归分析各因素与SRB的相关性;并分析2010~2019年我院总SRB的变化趋势。结果 我院2010年1月至2019年12月行IVF/ICSI-ET共出生新生儿24 661名,其中男婴13 532名(54.9%),女婴11 129名(45.1%),该时期ART的SRB(121.6∶100)高于文献报道的自然受孕SRB(106~110.2∶100)。不同实验室因素的分组中,IVF组的SRB(126.2∶100)显著高于ICSI组(107.5∶100)(P<0.05);囊胚组的SRB(129.2∶100)显著高于卵裂胚组(112.8∶100)(P<0.05);解冻胚胎组的SRB略高于新鲜胚胎组,但差异无统计学意义(P>0.05);单胚胎组的SRB(130.0∶100)显著高于双胚胎组(120.5∶100)(P<0.05)。Logistic回归分析结果显示,受精方式[OR=0.854,95%CI(0.803,0.908)]和移植胚胎时期[OR=1.192,95%CI(1.114,1.276)]是SRB的独立影响因素(P<0.001)。2010—2019年我院总SRB没有明显逐年升高或者降低的趋势;在相同年份中,卵裂胚的SRB相对于囊胚有降低趋势,ICSI的SRB相对于IVF有降低趋势。结论 ART的SRB高于自然受孕,IVF受精的SRB显著高于ICSI,囊胚移植的SRB显著高于卵裂期胚胎移植。

Objective:To analyze the effects of IVF/ICSI-ET laboratory factors on sex ratio at birth(SRB).Methods:The SRB of 19844 IVF/ICSI-ET cycles of patients with successful pregnancy and delivery in our hospital from January 2010 to December 2019 were retrospectively analyzed.The main laboratory factors of assisted reproductive technology(ART)included fertilization methods,the type of embryo transferred,stage of embryo transferred and the number of embryos transferred.According to different fertilization methods,the cycles were divided into IVF group(n=14626)and ICSI group(n=4908).According to different stages of embryos,the cycles were divided into cleavage embryo group(n=8778)and blastocyst group(n=11066).According to different types of embryos,the cycles were divided into fresh embryo group(n=11533)and frozen-thawed embryo group(n=8311).According to the number of transplanted embryos,the cycles were divided into 1 embryo group(n=3871)and 2 embryos group(n=14483).The effects of the above 4 laboratory factors on SRB were analyzed.Univariate and multivariate logistic regression analysis were used to analyze the correlation between each factor and SRB,and analyze the change trend of the total SRB of our hospital from 2010 to 2019.Results:A total of 24661 newborns were born by IVF/ICSI-ET,including 13532 boys(54.9%)and 11129 girls(45.1%).The SRB of ART(121.6∶100)was higher than that of natural conception(106-110.2∶100)during the same period.The SRB in IVF group(126.2∶100)was significantly higher than that in ICSI group(107.5∶100)(P<0.05).The SRB in blastocyst group(129.2∶100)was significantly higher than that in cleavage embryo group(112.8∶100)(P<0.05).The SRB in frozen-thawed embryo group was slightly higher than that in fresh embryo group,but the difference is not significant(P>0.05).The SRB in the 1 embryo group(130.0∶100)was significantly higher than that in the 2 embryos transferred(120.5∶100)group(P<0.05).Logistic regression analysis showed that fertilization method[OR=0.854,95%CI(0.803,0.908)]and stage of embryo transferred[OR=1.192,95%CI(1.114,1.276),P<0.001]were independent influencing factors of SRB.From 2010 to 2019,the total SRB of our hospital has no obvious trend of increasing or decreasing year by year.In the same year,SRB of cleavage embryo was lower than that of blastocyst,and SRB of ICSI was lower than that of IVF.Conclusions:The SRB of ART is higher than that of natural conception,the SRB in IVF group is significantly higher than that in ICSI group,and the SRB in blastocyst group is significantly higher than that in cleavage group.