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Morphology-based selection from available euploid blastocysts induces male-skewed sex proportion in the offspring

  • Assisted Reproduction Technologies
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Abstract

Purpose

To determine whether blastocyst morphology has an impact on sex proportion at pre-implantation and birth in PGT-A and non-PGT-A cycles.

Methods

A total of 1254 biopsied blastocysts from 466 PGT-A cycles were analyzed for sex proportion, day of biopsy, degree of expansion, inner cell mass (ICM), and trophectoderm (TE) morphology. From these, 197 frozen single embryo transfers (SET) were assessed for clinical outcomes and sex proportion of ongoing pregnancies and deliveries. In addition, we evaluated the day of vitrification/embryo transfer, degree of expansion, and TE morphology in a group of 229 births (217 cycles) from frozen or fresh transfers of non-biopsied blastocysts.

Results

Sex proportion was impacted by day of biopsy and TE morphology, but not by ICM morphology, in PGT-A cycles. Therefore, biopsy on day 5 and TE “A” shifted the sex proportion towards males. Interestingly, we noted that our morphology-based embryo selection for SET of euploid blastocysts has favored the choice for XY embryos, generating a 54.3% XY proportion at transfer and 56.1% XY proportion at ongoing pregnancy/delivery. Our models indicate a weaker association between blastocyst morphology parameters and sex proportion of babies in non-PGT-A cycles.

Conclusion

Blastocyst features associated with a skewed sex proportion towards XY embryos, such as biopsy on day 5 and top quality TE, are also parameters used for selecting euploid embryos for SET. Therefore, our data suggest that morphology-based embryo selection represents a strong factor responsible for a skewed male sex proportion at birth in PGT-A cycles.

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Authors and Affiliations

  1. Nilo Frantz Reproductive Medicine, Porto Alegre, Brazil

    Marcos Iuri Roos Kulmann, Carolina Lumertz Martello, Luiza Mezzomo Donatti & Nilo Frantz

  2. Basic Health Sciences Institute, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Adriana Bos-Mikich

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  1. Marcos Iuri Roos Kulmann
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  2. Carolina Lumertz Martello
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  3. Luiza Mezzomo Donatti
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  4. Adriana Bos-Mikich
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  5. Nilo Frantz
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Correspondence to Marcos Iuri Roos Kulmann.

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Roos Kulmann, M.I., Lumertz Martello, C., Mezzomo Donatti, L. et al. Morphology-based selection from available euploid blastocysts induces male-skewed sex proportion in the offspring. J Assist Reprod Genet 38, 2165–2172 (2021). https://doi.org/10.1007/s10815-021-02235-9

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  • DOI: https://doi.org/10.1007/s10815-021-02235-9

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