Supramaniam P R, Mittal M, Ohuma E O, Lim L N, McVeigh E, Granne I, Becker C M
Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
Imperial College Healthcare NHS Trust, St Mary's and Hammersmith Hospitals, London, UK.
Hum Reprod Open. 2019 Oct 5;2019(4):hoz020. doi: 10.1093/hropen/hoz020. eCollection 2019.
Does ART impact the secondary sex ratio (SSR) when compared to natural conception?
IVF and ICSI as well as the stage of embryo transfer does impact the overall SSR.
The World Health Organization quotes SSR for natural conception to range between 103 and 110 males per 100 female births.
A total of 1 376 454 ART cycles were identified, of which 1 002 698 (72.8%) cycles involved IVF or ICSI. Of these, 863 859 (85.2%) were fresh cycles and 124 654 (12.4%) were frozen cycles. Missing data were identified in 14 185 (1.4%) cycles.
PARTICIPANTS/MATERIALS SETTING METHODS: All cycles recorded in the anonymized UK Human Fertilisation and Embryology Authority (HFEA) registry database between 1991 and 2016 were analysed. All singleton live births were included, and multiple births were excluded to avoid duplication.
The overall live birth rate per cycle for all IVF and ICSI treatments was 26.2% ( = 262 961), and the singleton live birth rate per cycle was 17.1% ( = 171 399). The overall SSR for this study was 104.0 males per 100 female births (binomial exact 95% CI: 103.1-105.0) for all IVF and ICSI cycles performed in the UK recorded through the HFEA. This was comparable to the overall SSR for England and Wales at 105.3 males per 100 female births (95% CI: 105.2-105.4) from 1991 to 2016 obtained from the Office of National Statistics database. Male predominance was seen with conventional insemination in fresh IVF treatment cycles (SSR 110.0 males per 100 female births; 95% CI: 108.6-111.5) when compared to micro-injection in fresh ICSI treatment cycles (SSR 97.8 males per 100 female births; 95% CI: 96.5-99.2; odds ratio (OR) 1.16, 95% CI 1.12-1.19, < 0.0001), as well as with blastocyst stage embryo transfers (SSR 104.8 males per 100 female births; 95% CI: 103.5-106.2) when compared to a cleavage stage embryo transfer (SSR 101.2 males per 100 female births; 95% CI: 99.3-103.1; OR 1.03, 95% CI 1.01-1.06, = 0.011) for all fertilization methods.
The quality of the data relies on the reporting system. Furthermore, success rates through ART have improved since 1991, with an increased number of blastocyst stage embryo transfers.
This is the largest study to date evaluating the impact of ART on SSR. The results demonstrate that, overall, ART does have an impact on the SSR when assessed according to the method of fertilization (ICSI increased female births while IVF increased males). However, given the ratio of IVF to ICSI cycles at present with 60% of cycles from IVF and 40% from ICSI, the overall SSR for ART closely reflects the population SSR for, largely, natural conceptions in England and Wales.
STUDY FUNDING/COMPETING INTERESTS: The study received no funding. C.M.B. is a member of the independent data monitoring group for a clinical endometriosis trial by ObsEva. He is on the scientific advisory board for Myovant and medical advisory board for Flo Health. He has received research grants from Bayer AG, MDNA Life Sciences, Volition Rx and Roche Diagnostics as well as from Wellbeing of Women, Medical Research Council UK, the NIH, the UK National Institute for Health Research and the European Union. He is the current Chair of the Endometriosis Guideline Development Group for ESHRE and was a co-opted member of the Endometriosis Guideline Group by the UK National Institute for Health and Care Excellence (NICE). I.G. has received research grants from Wellbeing of Women, the European Union and Finox.
Not applicable.
与自然受孕相比，辅助生殖技术（ART）是否会影响出生性别比（SSR）？
体外受精（IVF）、卵胞浆内单精子注射（ICSI）以及胚胎移植阶段确实会影响总体出生性别比。
世界卫生组织指出，自然受孕的出生性别比为每100例女性出生对应103至110例男性出生。
研究设计、规模、持续时间：共识别出1376454个辅助生殖技术周期，其中1002698个（72.8%）周期涉及IVF或ICSI。在这些周期中，863859个（85.2%）为新鲜周期，124654个（12.4%）为冷冻周期。在14185个（1.4%）周期中发现了缺失数据。
参与者/材料、设置、方法：对1991年至2016年期间记录在匿名的英国人类受精与胚胎学管理局（HFEA）登记数据库中的所有周期进行分析。纳入所有单胎活产，排除多胎分娩以避免重复计算。
所有IVF和ICSI治疗的每个周期总体活产率为26.2%（n = 262961），每个周期的单胎活产率为17.1%（n = 171399）。通过HFEA记录的在英国进行的所有IVF和ICSI周期的本研究总体出生性别比为每100例女性出生对应104.0例男性出生（二项式精确95%置信区间：103.1 - 105.0）。这与1991年至2016年从英国国家统计局数据库获得的英格兰和威尔士总体出生性别比每100例女性出生对应105.3例男性出生（95%置信区间：105.2 - 105.4）相当。与新鲜ICSI治疗周期中的显微注射相比（出生性别比为每100例女性出生对应97.8例男性出生；95%置信区间：96.5 - 99.2；优势比（OR）1.16，95%置信区间1.12 - 1.19，P < 0.0001），新鲜IVF治疗周期中的传统授精出现男性优势（出生性别比为每100例女性出生对应110.0例男性出生；95%置信区间：108.6 - 111.5），并且与所有受精方法的卵裂期胚胎移植相比（出生性别比为每100例女性出生对应101.2例男性出生；95%置信区间：99.3 - 103.1；OR 1.03，95%置信区间1.01 - 1.06，P = 0.011），囊胚期胚胎移植也出现男性优势（出生性别比为每100例女性出生对应104.8例男性出生；95%置信区间：103.5 - 106.2）。
局限性、谨慎的原因：数据质量依赖于报告系统。此外，自1991年以来辅助生殖技术的成功率有所提高，囊胚期胚胎移植的数量增加。
这是迄今为止评估辅助生殖技术对出生性别比影响的最大规模研究。结果表明，总体而言，根据受精方法评估时，辅助生殖技术确实会对出生性别比产生影响（ICSI增加女性出生而IVF增加男性出生）。然而，鉴于目前IVF与ICSI周期的比例，其中60%的周期为IVF，40%为ICSI，辅助生殖技术的总体出生性别比在很大程度上紧密反映了英格兰和威尔士自然受孕的人群出生性别比。
研究资金/利益冲突：该研究未获得资金。C.M.B.是ObsEva一项临床子宫内膜异位症试验的独立数据监测小组的成员。他是Myovant科学顾问委员会成员以及Flo Health医学顾问委员会成员。他从拜耳公司、MDNA生命科学公司、Volition Rx和罗氏诊断公司以及从女性健康组织、英国医学研究理事会、美国国立卫生研究院、英国国家卫生研究院和欧盟获得研究资助。他是欧洲人类生殖与胚胎学会（ESHRE）子宫内膜异位症指南制定小组的现任主席，并且是英国国家健康与临床优化研究所（NICE）子宫内膜异位症指南小组的增选成员。I.G.从女性健康组织、欧盟和Finox获得研究资助。
不适用。
