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Sex ratio of offspring is not statistically altered following pre-implantation genetic testing under a specific sex selection policy

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine whether the use of pre-implantation genetic testing (PGT) under a specific sex selection policy is associated with alterations in offspring sex ratio.

Methods

This was a single-center retrospective cohort study of singleton live births from January 2018-December 2020 achieved via single blastocyst non-PGT or PGT frozen embryo transfer (FET). Per institutional policy, sex may be disclosed following PGT. If both sexes are available and morphologic grade is similar, patients may select the sex of the embryo to be transferred. Demographics and cycle characteristics were compared between non-PGT vs. PGT cycles with Mann–Whitney U or χ2. Poisson regression with robust variance estimates was used to model the probability of female vs. male offspring among non-PGT vs. PGT cycles, reported as risk ratio (RR) and 95% confidence interval (CI).

Results(s)

Among 541 live births, 350 (64.7%) were achieved with PGT and 191 (35.3%) without PGT. In both groups, female sex was more common, representing 59.4% of PGT-offspring and 55.0% of non-PGT offspring. After adjusting for potential confounders, the use of PGT was not significantly associated with an increased likelihood of female offspring (RR 1.04, 95% CI 0.98–1.11, p = 0.22).

Conclusion(s)

Singletons born following FET had a higher rate of female sex than male. Allowing sex selection per institutional policy did not increase this ratio. These results contrast with those of prior publications and should motivate individual centers to monitor their own sex ratios. As utilization of PGT increases, local, regional, and national monitoring will become increasingly important.

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References

  1. Poston DL, Bouvier LF (2011) Age and Sex Composition: 2010. United States Census Bur 1–16. https://doi.org/10.1017/cbo9780511781001.010

  2. Hentemann MA, Briskemyr S, Bertheussen K (2009) Blastocyst transfer and gender: IVF versus ICSI. J Assist Reprod Genet 26:433–436. https://doi.org/10.1007/s10815-009-9337-3

    Article  PubMed  PubMed Central  Google Scholar 

  3. Luna M, Duke M, Copperman A et al (2007) Blastocyst embryo transfer is associated with a sex-ratio imbalance in favor of male offspring. Fertil Steril 87:519–523. https://doi.org/10.1016/j.fertnstert.2006.06.058

    Article  PubMed  Google Scholar 

  4. Chang HJ, Lee JR, Jee BC et al (2009) Impact of blastocyst transfer on offspring sex ratio and the monozygotic twinning rate: a systematic review and meta-analysis. Fertil Steril 91:2381–2390. https://doi.org/10.1016/j.fertnstert.2008.03.066

    Article  PubMed  Google Scholar 

  5. Narvaez JL, Chang J, Boulet SL et al (2019) Trends and correlates of the sex distribution among U.S. assisted reproductive technology births. Fertil Steril 112:305–314. https://doi.org/10.1016/j.fertnstert.2019.03.034

    Article  PubMed  Google Scholar 

  6. Ray PF, Conaghan J, Winston RML, Handyside AH (1995) Increased number of cells and metabolic activity in male human preimplantation embryos following in vitro fertilization. J Reprod Fertil 104:165–171. https://doi.org/10.1530/jrf.0.1040165

    Article  CAS  PubMed  Google Scholar 

  7. Ethics Committee of the American Society for Reproductive Medicine (2018) Disclosure of sex when incidentally revealed as part of preimplantation genetic testing (PGT): an Ethics Committee opinion. Fertil Steril 110:625–627. https://doi.org/10.1016/j.fertnstert.2018.06.019

    Article  Google Scholar 

  8. Ethics Committee of the American Society for Reproductive Medicine (2015) Use of reproductive technology for sex selection for nonmedical reasons. Fertil Steril 103:1418–1422. https://doi.org/10.1016/j.fertnstert.2015.03.035

    Article  Google Scholar 

  9. Capelouto SM, Archer SR, Morris JR et al (2018) Sex selection for non-medical indications: a survey of current pre-implantation genetic screening practices among U.S. ART clinics J Assist Reprod Genet 35:409–416. https://doi.org/10.1007/s10815-017-1076-2

    Article  PubMed  Google Scholar 

  10. Shaia K, Truong T, Pieper C, Steiner A (2020) Pre-implantation genetic testing alters the sex ratio: an analysis of 91,805 embryo transfer cycles. J Assist Reprod Genet 37:1117–1122. https://doi.org/10.1007/s10815-020-01746-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kimelman D, Confino R, Okeigwe I et al (2019) Assessing the impact of delayed blastulation using time lapse morphokinetics and preimplantation genetic testing in an IVF patient population. J Assist Reprod Genet 36:1561–1569. https://doi.org/10.1007/s10815-019-01501-1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pavone M, Innes J, Hirshfeld-Cytron J et al (2011) Comparing thaw survival, implantation and live birth rates from cryopreserved zygotes, embryos and blastocysts. J Hum Reprod Sci 4:23–28. https://doi.org/10.4103/0974-1208.82356

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bakkensen J, Holder K, Mormol J, et al. (2022) Natural cycle frozen embryo transfer: Evaluating optimal protocols for preparation and timing. Abstr Present Pacific Coast Reprod Soc Annu Meet March 23–27

  14. Jain T, Missmer SA, Gupta RS, Hornstein MD (2005) Preimplantation sex selection demand and preferences in an infertility population. Fertil Steril 83:649–658. https://doi.org/10.1016/j.fertnstert.2004.11.023

    Article  PubMed  Google Scholar 

  15. Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702–706. https://doi.org/10.1093/aje/kwh090

    Article  PubMed  Google Scholar 

  16. Luke B, Brown MB, Stern JE et al (2011) Female obesity adversely affects assisted reproductive technology (ART) pregnancy and live birth rates. Hum Reprod 26:245–252. https://doi.org/10.1093/humrep/deq306

    Article  PubMed  Google Scholar 

  17. Weston G, Osianlis T, Catt J, Vollenhoven B (2009) Blastocyst transfer does not cause a sex-ratio imbalance. Fertil Steril 92:1302–1305. https://doi.org/10.1016/j.fertnstert.2008.07.1784

    Article  PubMed  Google Scholar 

  18. Alfarawati S, Fragouli E, Colls P et al (2011) The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril 95:520–524. https://doi.org/10.1016/j.fertnstert.2010.04.003

    Article  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA

    Jennifer B. Bakkensen & Christina Boots

  2. Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sedona Speedy

  3. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Margaret Mumm

Authors
  1. Jennifer B. Bakkensen
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  2. Sedona Speedy
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  3. Margaret Mumm
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  4. Christina Boots
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by JB, SS, and MM. Data analysis was performed by JB. The first draft of the manuscript was written JB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jennifer B. Bakkensen.

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Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was approved by the Northwestern University Institutional Review Board.

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Bakkensen, J.B., Speedy, S., Mumm, M. et al. Sex ratio of offspring is not statistically altered following pre-implantation genetic testing under a specific sex selection policy. Arch Gynecol Obstet 308, 1605–1610 (2023). https://doi.org/10.1007/s00404-023-07190-7

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  • DOI: https://doi.org/10.1007/s00404-023-07190-7

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