Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China.
Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China
Hum Reprod. 2015 May;30(5):1039-45. doi: 10.1093/humrep/dev049. Epub 2015 Mar 6.
Does embryo culture medium influence the percentage of males at birth?
The percentage of males delivered after ICSI cycles using G5™ medium was statistically significantly higher than after cycles where Global, G5™ PLUS, and Quinn's Advantage Media were used.
Male and female embryos have different physiologies during preimplantation development. Manipulating the energy substrate and adding growth factors have a differential impact on the development of male and female embryos.
STUDY DESIGN, SIZE AND DURATION: This was a retrospective analysis of the percentage of males at birth, and included 4411 singletons born from fresh embryo transfer cycles between January 2011 and August 2013 at the Center for Reproductive Medicine of Third Hospital Peking University.
PARTICIPANTS/MATERIALS, SETTING, AND METHODS: Only singleton gestations were included. Participants were excluded if preimplantation genetic diagnosis, donor oocytes and donor sperm were used. The database between January 2011 and August 2013 was searched with unique medical record number, all patients were present in the database with only one cycle. Demographics, cycle characteristics and the percentage of male babies in the four culture media groups were compared with analysis of variance or χ(2) tests. Multivariable logistic regression was done to determine the association between the sex at birth and culture media after adjusting for other confounding factors, including parental age, parental BMI, type of infertility, parity, number of embryos transferred, number of early gestational sacs, cycles with testicular sperm aspiration (TESA)/percutaneous epididymal sperm aspiration (PESA)/testicular sperm extraction (TESE), number of oocytes retrieved, cycles with blastocyst transfers, and gestational age within ICSI group.
Within the IVF group, the percentage of males at birth for G5™, Global, Quinn's and G5™ PLUS media were comparable (P > 0.05); however, within the ICSI group, the percentage of male babies in cycles using G5™(56.1%) was statistically significantly higher than in cycles that used Global (47.2%; P = 0.003), G5™ PLUS (47.7%; P = 0.005) or Quinn's media (45.0%; P = 0.009). There were no statistically significant differences in the percentage of males at birth between cycles that used Global, G5™ PLUS and Quinn's media (P > 0.05). Multivariable logistic regression indicated that culture media (G5™ versus Global, G5™ PLUS, and Quinn's) were significantly associated with the sex at birth (P = 0.008) after adjusting for parental age, parental BMI, type of infertility, parity, number of embryos transferred, number of early gestational sacs, cycles with TESA/PESA/TESE, number of oocytes retrieved, cycles with blastocyst transfers, and gestational age.
This study was not a randomized controlled trial and allocation of treatment cycles over the four media was not completely at random. Cigarette smoking was not included in the current study because this confounding factor was not registered in our database. Moreover, intra-variability of sperm selection between the five embryologists may directly affect the percentage of males.
Our study suggests that human embryogenesis responds differently to G5™, Global, G5™ PLUS and Quinn's Advantage Medium. This finding can be generalized to other commercial culture media.
STUDY FUNDING/COMPETING INTERESTS: National Natural Science Foundation of China for Young Scholars (81300483 and 81200466). The authors have no conflicts of interest to declare.
Not applicable.
胚胎培养液是否会影响出生男婴的比例？
使用 G5™ 培养基进行 ICSI 周期后出生的男性比例明显高于使用 Global、G5™ PLUS 和 Quinn's Advantage Media 的周期。
在植入前胚胎发育过程中，男性和女性胚胎具有不同的生理机能。操纵能量基质并添加生长因子对男性和女性胚胎的发育有不同的影响。
研究设计、规模和持续时间：这是对出生男婴比例的回顾性分析，包括 2011 年 1 月至 2013 年 8 月在北京大学第三医院生殖医学中心进行的新鲜胚胎转移周期中的 4411 例单胎妊娠。
参与者/材料、设置和方法：仅包括单胎妊娠。如果使用了植入前遗传诊断、供体卵和供体精子，则排除了参与者。2011 年 1 月至 2013 年 8 月的数据库使用唯一的病历号进行搜索，所有患者都在数据库中，只有一个周期。使用方差分析或 χ(2)检验比较了四个培养介质组的男性婴儿比例、人口统计学特征和男性婴儿比例。多变量逻辑回归用于确定在调整其他混杂因素（包括父母年龄、父母 BMI、不孕类型、产次、移植胚胎数量、早期妊娠囊数量、睾丸精子抽吸术（TESA）/经皮附睾精子抽吸术（PESA）/睾丸精子提取术（TESE）周期、卵母细胞数量、囊胚转移周期和 ICSI 组的孕龄）后，出生性别与培养液之间的关系。
在 IVF 组中，G5™、Global、Quinn's 和 G5™ PLUS 培养基的男婴比例相当（P > 0.05）；然而，在 ICSI 组中，使用 G5™ 的周期中男婴的比例（56.1%）明显高于使用 Global（47.2%；P = 0.003）、G5™ PLUS（47.7%；P = 0.005）或 Quinn's 培养基（45.0%；P = 0.009）。使用 Global、G5™ PLUS 和 Quinn's 培养基的周期中出生男婴的比例无统计学差异（P > 0.05）。多变量逻辑回归表明，在调整父母年龄、父母 BMI、不孕类型、产次、移植胚胎数量、早期妊娠囊数量、TESA/PESA/TESE 周期、卵母细胞数量、囊胚转移周期和孕龄后，培养液（G5™ 与 Global、G5™ PLUS 和 Quinn's）与出生性别显著相关（P = 0.008）。
本研究不是一项随机对照试验，四种培养基的治疗周期分配不完全随机。目前的研究没有包括吸烟，因为这个混杂因素没有在我们的数据库中登记。此外，五位胚胎学家之间的精子选择的个体内变异性可能直接影响男性比例。
我们的研究表明，人类胚胎发生对 G5™、Global、G5™ PLUS 和 Quinn's Advantage Medium 的反应不同。这一发现可以推广到其他商业培养介质。
国家自然科学基金青年科学基金（81300483 和 81200466）。作者没有利益冲突要声明。
不适用。
