背景:辅助生殖技术(ART)取得了显着进步,引起人们对其对次要性别比例(SSR)影响的担忧,这是后代出生时的性别比。本研究旨在探讨影响单身人士SSR的因素,来自双胞胎妊娠的单身人士,和在ART背景下双胞胎妊娠的双胞胎。
方法:对8335例新生儿的数据进行了回顾性分析,涉及6,223对接受ART的夫妇。二元逻辑回归评估了双胎妊娠的单胎和单胎中父母和胚胎因素与SSR之间的关系。利用多项逻辑回归模型来确定影响双胎妊娠双胞胎SSR的因素。
结果:继发性不孕症(OR=1.164,95%CI:1.009-1.342),高龄(OR=1.261,95%CI:1.038-1.534),和囊胚胚胎移植(OR=1.339,95%CI:1.030-1.742)与SSR增加有关,而冷冻胚胎移植(FET)与单胎SSR呈负相关(OR=0.738,95%CI:0.597-0.912)。使用促性腺激素(Gn)的持续时间较长会降低单胎(OR=0.961,95%CI:0.932-0.990)和双胎妊娠单胎(OR=0.906,95%CI:0.838-0.980)的SSR。在双胞胎妊娠的单身人士中,男性不育(OR=2.208,95%CI:1.120-4.348)和更高的Gn剂量(OR=1.250,95%CI:1.010-1.548)与SSR增加显著相关.年龄>35岁的女性和卵胞浆内单精子注射(ICSI)与较低的SSR相关(分别为OR=0.539,95%CI:0.293-0.990和OR=0.331,95%CI:0.158-0.690)。在双胞胎怀孕的双胞胎中,父亲年龄超过母亲年龄(OR=0.682,95%CI:0.492-0.945)和更高的Gn剂量(OR=0.837,95%CI:0.715-0.980)与更高的男性双胞胎比例相关。卵裂期移植(OR=1.754,95%CI:1.133-2.716)导致男孩-女孩双胞胎的百分比高于胚泡移植。
结论:这项研究证明了在确定ART中SSR时各种因素的复杂相互作用,强调考虑不孕类型的重要性,父系年龄,施肥方法,胚胎移植阶段,和Gn在评估SSR时使用持续时间。然而,有必要进行大样本量的进一步研究,以确认和扩展本研究的发现。
BACKGROUND: Assisted reproduction technology (ART) has advanced significantly, raising concerns regarding its impact on the secondary sex ratio (SSR), which is the sex ratio at birth in offspring. This study aimed to explore factors affecting SSR in singletons, singletons from twin gestation, and twins from twin gestation within the context of ART.
METHODS: A retrospective analysis was conducted on data from 8335 births involving 6,223 couples undergoing ART. Binary logistic regression assessed relationships between parental and embryonic factors and SSR in singletons and singletons from twin gestation. Multinomial logistic regression models were utilized to identify factors influencing SSR in twins from twin gestation.
RESULTS: Secondary infertility (OR = 1.164, 95% CI: 1.009-1.342), advanced paternal age (OR = 1.261, 95% CI: 1.038-1.534), and blastocyst embryo transfer (OR = 1.339, 95% CI: 1.030-1.742) were associated with an increased SSR, while frozen embryo transfer (FET) showed a negative association with SSR (OR = 0.738, 95% CI: 0.597-0.912) in singletons. A longer duration of gonadotropin (Gn) usage reduced SSR in singletons (OR = 0.961, 95% CI: 0.932-0.990) and singletons from twin gestation (OR = 0.906, 95% CI: 0.838-0.980). In singletons from twin gestation, male-induced infertility (OR = 2.208, 95% CI: 1.120-4.348) and higher Gn dosage (OR = 1.250, 95% CI: 1.010-1.548) were significantly associated with an increased SSR. Women aged > 35 years and intracytoplasmic sperm injection (ICSI) were associated with lower SSR (OR = 0.539, 95% CI: 0.293-0.990 and OR = 0.331, 95% CI: 0.158-0.690, respectively). In twins from twin gestation, paternal age exceeded maternal age (OR = 0.682, 95% CI: 0.492-0.945) and higher Gn dosage (OR = 0.837, 95% CI: 0.715-0.980) were associated with a higher proportion of male twins. Cleavage stage transfer (OR = 1.754, 95% CI: 1.133-2.716) resulted in a higher percentage of boy-girl twins compared to blastocyst transfer.
CONCLUSIONS: This study demonstrates the complex interplay of various factors in determining the SSR in ART, highlighting the importance of considering infertility type, paternal age, fertilization method, embryo transfer stage, and Gn use duration when assessing SSR. Nevertheless, further research with a large sample size is necessary to confirm and expand upon the findings of this study.