The relationship between blastocyst morphology and the sex ratio of singleton births in single blastocyst transfer cycles: A retrospective cohort study

Abstract

Background: To study the relationship between blastocyst morphology and the sex ratio of singleton births in single blastocyst transfer cylces. Methods: This retrospective cohort study included women who underwent in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) from January 2017 to December 2019 and obtained a single live baby following a single blastocyst transfer. The sex ratio which influenced by many possible factors were studied. Age-stratified analysis was performed for the maternal and paternal groups younger and older than 35 years. The 3108 cycles included here were grouped by sex at birth (male: 1777 cycles and female: 1331 cycles). Blastocysts were conceived via 2834 IVF and 274 ICSI treatments, and were used for 1054 fresh ET cycles and 2054 frozen-thawed embryo transfer (FET) cycles. Results: Sex ratio among singleton of poor blastocyst decreased significantly compared to those of good blastocyst (51.5% vs 60%, P<0.001). The results of multivariate logistic analysis showed that high-quality blastocysts had a 151% higher probability of being male singleton than poor-quality blastocysts (P<0.001). Further stratified analysis shows that in both group younger than 35 the sex ratio increased significantly in grades A and/or B trophectoderm (P<0.001) and good-quality blastocysts (P<0.001). While grade A inner cell mass (ICM) degree was significantly associated with a lower sex ratio than grade B (P<0.05). Conclusions: A single high-quality blastocyst transfer was significantly associated with a higher neonatal sex ratio. Grade A trophectoderm and grade B ICM contributed to improving the implantation potential of male blastocysts, especially in infertile men or women ≤ 35 years old.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

NO

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was carried out after the protocol was approved by the Institutional Review Board of The Third Affiliated Hospital of Zhengzhou University. Informed consent was waived due to retrospective design of the study based on our local ethics committee protocols.

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Yes

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Data Availability

within the manuscript and/or Supporting Information files

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