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Ovarian Hyperstimulation Syndrome Is Associated with a High Secondary Sex Ratio in Fresh IVF Cycles with Cleavage-Stage Embryo Transfer: Results for a Cohort Study

  • Reproductive Biology: Original Article
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Abstract

The sex ratio at birth is defined as the secondary sex ratio (SSR). Ovarian hyperstimulation syndrome (OHSS) is a serious and iatrogenic complication associated with controlled ovarian stimulation (COS) during assisted reproductive technology (ART) treatments. It has been hypothesized that the human SSR is partially controlled by parental hormone levels around the time of conception. Given the aberrant hormonal profiles observed in patients with OHSS, this retrospective study was designed to evaluate the impact of OHSS on the SSR. In this study, all included patients were divided into 3 groups: non-OHSS (n=2777), mild OHSS (n=644), and moderate OHSS (n=334). Our results showed that the overall SSR for the study population was 1.033. The SSR was significantly increased in patients with moderate OHSS (1.336) compared to non-OHSS patients (1.002) (p=0.048). Subgroup analyses showed that increases in the SSR in patients with moderate OHSS were observed in the IVF group (1.323 vs 1.052; p=0.043), but not in the ICSI groups (1.021 vs 0.866; p=0.732). In addition, the elevated serum estradiol (E2) and progesterone (P4) levels in OHSS patients were not associated with SSR. In this study, for the first time, we report that a high SSR is associated with OHSS in patients who received fresh IVF treatments. The increases in SSR in OHSS patients are not attributed to the high serum E2 and P4 levels. Our findings may make both ART clinicians and patients more aware of the influences of ART treatments on the SSR and allow clinicians to counsel patients more appropriately.

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Acknowledgements

The authors also thank the staff in the Center for Reproductive Medicine at the First Affiliated Hospital of Zhengzhou University for their assistance.

Funding

This work was supported by the operating grant from the National Natural Science Foundation of China (32070848), the Key R&D Program of Henan Province (202102310062), Henan Province Medical Science and Technique R&D Program (SBGJ202002052), and Special Fund for Young Teachers from the Zhengzhou University (JC202054006) to Lanlan Fang as well as by the Research Fund for International Young Scientists from the National Natural Science Foundation of China (32050410302) and Henan Province Medical Science and Technique R&D Program (SBGJ202002046) to Jung-Chien Cheng. This work was also supported by the National Natural Science Foundation of China for the International (Regional) Cooperation and Exchange Projects (81820108016) and the National Key R&D Program of China (2019YFA 0110900) to Ying-Pu Sun.

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  1. Qiongqiong Jia and Lanlan Fang contributed equally to this work.

Authors and Affiliations

  1. Center for Reproductive Medicine, Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 40, Daxue Road, Zhengzhou, 450052, Henan, China

    Qiongqiong Jia, Lanlan Fang, Zhen Wang, Ze Wu, Yang Yan, Boqun Liu, Jung-Chien Cheng & Ying-Pu Sun

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  1. Qiongqiong Jia
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  2. Lanlan Fang
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Contributions

LF and YPS contributed to the study design, analysis, and interpretation of data. LF, JCC, and YPS contributed to manuscript drafting and critical discussion. QJ, ZW, ZW, YY, and BL collected data, analyzed data, and prepared the figures.

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Correspondence to Lanlan Fang.

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Jia, Q., Fang, L., Wang, Z. et al. Ovarian Hyperstimulation Syndrome Is Associated with a High Secondary Sex Ratio in Fresh IVF Cycles with Cleavage-Stage Embryo Transfer: Results for a Cohort Study. Reprod. Sci. 28, 3341–3351 (2021). https://doi.org/10.1007/s43032-021-00637-9

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