Neonate female to male ratio after assisted reproduction following antagonist and agonist protocols

Al‐Jaroudi, Dania; Salim, Gamar; Baradwan, Saeed

doi:10.1097/md.0000000000012310

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…However, the current evidence is conflicting with other studies demonstrating no association between ART and SSR, but they are limited by their small sample sizes (Altman and Bland, 1995; Luke et al , 2009; Al-Jaroudi et al , 2018). This is further reflected in studies looking at semen parameters and SSR, with even fewer patients included (Bae et al , 2017; Malo et al , 2017).…”

Section: Introductionmentioning

confidence: 60%

Secondary sex ratio in assisted reproduction: an analysis of 1 376 454 treatment cycles performed in the UK

Supramaniam

Mittal

Ohuma

et al. 2019

Human Reproduction Open

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STUDY QUESTION Does ART impact the secondary sex ratio (SSR) when compared to natural conception? SUMMARY ANSWER IVF and ICSI as well as the stage of embryo transfer does impact the overall SSR. WHAT IS KNOWN ALREADY The World Health Organization quotes SSR for natural conception to range between 103 and 110 males per 100 female births. STUDY DESIGN, SIZE, DURATION 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. MAIN RESULTS AND THE ROLE OF CHANCE The overall live birth rate per cycle for all IVF and ICSI treatments was 26.2% (n = 262 961), and the singleton live birth rate per cycle was 17.1% (n = 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, P < 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, P = 0.011) for all fertilization methods. LIMITATIONS, REASONS FOR CAUTION 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. WIDER IMPLICATIONS OF THE FINDINGS 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 INTEREST(S) 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. TRIAL REGISTRATION NUMBER Not applicable.

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Section: Introductionmentioning

confidence: 60%

Secondary sex ratio in assisted reproduction: an analysis of 1 376 454 treatment cycles performed in the UK

Supramaniam

Mittal

Ohuma

et al. 2019

Human Reproduction Open

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“…Over the past 4 decades, a rapidly growing number of babies born through ART treatment, and there is a great need to be investigated whether use of laboratory techniques or clinical OS protocols are associated with sex ratio at birth. Several previous studies reported that ART technologies lead to the imbalance of sex ration, such as insemination method [20], pre-implantation genetic testing (PGT) [21], blastocyst transfer [22], embryo culture media [23], Ovarian hyper-stimulation syndrome (OHSS) [24] and antagonist protocol [25]. However, at present, the mechanisms underlying the association are unknown and these viewpoints are con icting [11,13,26,27].…”

Section: Discussionmentioning

confidence: 99%

Effect of embryos quality on the sex ratio of neonates

Zhu,

Ni,

Wang

et al. 2024

Preprint

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Purpose To investigate the effect of embryos developmental stage and morphological grade on the sex ratio of neonates at birth. Methods This was a retrospective cohort study, and including 5339 singletons born from IVF/ICSI (fresh and frozen) embryos transfer cycles between 2011 and 2022 at the Center for Reproductive Medicine of the 901st Hospital of the Joint Logistics Support Force of PLA. Only single embryo transfer (SET) or equal grade embryos transfer and resulting in a singleton gestations and live birth were included. Donors (oocytes or sperm) and preimplantation genetic testing (PGT) treatment were excluded. Demographics, cycle characteristics and assisted reproductive technology (ART) procedures were analyzed. Logistic regression was used to evaluate the percentage of males at birth for association with embryos quality and morphological parameters. Results Transfer with good grade embryos (GGE) significantly increased percentage of male neonates in comparing with low grade embryos (LGE) (54.2% versus 46.0%, P = 0.001). After adjustment for potential confounding variables, logistic regression indicated that when compared to GGE, LGE decreased the percentage of male neonates (odd ratio (OR) 0.741, 95% CI 0.592–0.927, P = 0.009), as well as with low grade blastocysts (LGB) was significantly associated with reduced percentage of male neonates when compared to good grade blastocysts (GGB) (OR 0.740, 95% CI 0.591–0.926, P = 0.008), however, it has not shown a relationship between cleavage stage embryos (good and low grades) transfer and sex at birth. Moreover, in SET cycles, the speed of embryonic development (7–8 cells, ≥ 9 cells and ≤ 6 cells) in cleavage stage embryos was not shown to be significantly associated with the sex at birth (P = 0.467), in addition, the percentage of male neonates was found to be significantly different from the reference category (blastocyst grading AA, P < 0.0001), only for blastocyst grading BC (OR 0.309, 95% CI 0.141–0.676, P = 0.003) and CB (OR 0.501, 95% CI 0.253–0.992, P = 0.047), compared to the reference category in blastocyst stage embryo transfer cycles. Furthermore, the data were stratified by categorical variables (blastocyst quality and developmental culture days (day 5 and day 6/7)), after pairwise comparison, the result showed that day 5 LGB was significantly lower than day 5 GGB (46.7% versus 55.6%, P = 0.013), the variations were no statistically significant differences with day 6/7 LGB and day 6/7 GGB were found. Finally, there were no statistically significant differences in the percentage of males at birth between low grade cleavage stage embryos (LGC) and good grade cleavage stage embryos (GGC) (47.5% versus 52.9%, respectively). Conclusion The morphological scores of cleavage stage embryos were not associated with sex ratio bias. The transfer of GGB has a higher probability of being male than LGB, particularly for day 5 GGB.

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