台灣試管嬰兒相關因子影響胎兒性別之研究

Factors associated with gender of in-vitro fertilization offspring in Taiwan

黃萱軒(Hsuan-Hsuan Huang)

指導教授 ： 黃雅莉

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00228

摘要

研究背景：
過去數十年來，台灣經由人工協助生殖科技出生活產胎兒性別比，大約介於
108-119之間，而試管嬰兒相關施術因子是否會影響胎兒性別則需要來評估探
究。
研究目的：
探討台灣試管嬰兒施術相關因子是否會影響單胎活產胎兒性別。
研究方法：
本研究是屬於以人口為基礎的研究，使用台灣行政院衛生署國民健康局人工
生殖資料庫，民國87年至93年週期療程資料，此資料庫為一國家級資料庫，共
包含46846筆週期。研究對象的選取，為經由試管嬰兒懷孕並成功產下單胞胎活
產胎兒的週期，總共納入41479筆週期。使用卡方檢定來檢驗胎兒性別比例分佈
是否有差異，將以胚囊數、取卵數、胚胎受精卵植入數與出生週數分層，分析受
術夫妻基本社會人口學特徵、試管嬰兒施術相關方式與受術夫妻不孕相關因子對
胎兒性別之影響。最後邏輯斯迴歸調整潛在的相關干擾因子後估計女胎勝算比。
結果：
父親年齡、母親年齡、雙親年齡差距、減胎數、顯微操作方式、卵巢過度刺
激症候群和不孕原因確實對胎兒性別會有影響。調整了相關可能的干擾因子後發
現，在胚囊數分層之下，胚囊數大於等於兩個足月產的活產胎兒週期，母親年齡
大於等於35歲相較於小於30歲有顯著較多女胎出生(OR=1.54,95%CI(1.02-2.33))。
在取卵數分層之下，取卵數大於等於13個早產的活產胎兒週期，有進行大於等
於1個減胎相較於沒有減胎有顯著較多男胎出生(OR=0.37,95%CI(0.16-0.85))；胚
胎受精卵植入數大於等於3個早產的活產胎兒週期，顯微操作方式為ICSI+協助
孵化相較於沒有顯微操作，有顯著較多女胎出生(OR=1.93,95%CI(1.12-3.33))。
結論：
在研究中，經由上述結果發現受術夫妻基本社會人口學特徵(父親年齡、母
親年齡、雙親年齡差距)、試管嬰兒相關施術方式(減胎數、顯微操作方式)和受術
夫妻不孕相關因子(卵巢過度刺激症候群、不孕原因)會影響胎兒性別，但目前少
有研究探討這個影響的相關機制，需要未來的研究進一步做探究。

關鍵字

試管嬰兒、胎兒性別、減胎、卵巢過度刺激症候群、單一精子卵質內顯微注射

並列摘要

Background: The secondary gender ratio (male/female) in Taiwan of assisted reproductive technology-conceived live births during the past decade was around 1.08 to 1.19. Whether the increased risk is due to the factors related in-vitro fertilization (IVF) procedures or not needs to be evaluated.
Objective: This study evaluates association between in-vitro fertilization (IVF) related factors and gender of IVF-conceived singletons in Taiwan.
Method: In order to elucidate the role of IVF related procedures ,a register study was conducted. The population included 46,846 ART cycles performed during 1998 to 2004 and reported to the registry. The study population was limited to 41,479 cycles of in vitro fertilization-conceived singleton and live births in the registry of assisted
reproductive technology , released by the Bureau of the Health Promotion, Taiwan. χ2 test for proportions was employed to compare the gender distribution on parental
demographic characteristics, infertility related factors and procedure-related factors under stratifications of numbers of gestational sacs, oocytes retrievals and embryo
implantation combined with gestational weeks. Odds ratios (ORs) for female live birth adjusted for potential confounding factors were estimated using logistic
regression.
Results: Significant differences between gender distribution was observed in bivariate analysis for stratus of paternal age,maternal age, parents' age gap, number(s) of embryo
reduction, types of micromanipulations, gradings of ovary hyperstimulation syndrome and cause of infertility. Maternal age greater than or equal to 35 year-old was associated with 60% higher risk of more female singletons compared with those maternal age less than 30 year-old [odds ratio (OR) = 1.54, 95% confidence interval (CI), 1.02-2.33 ], in the stratum of term live births with gestational sacs greater than and equal to 2. Embryo reduction number greater
than or equal to 1 was associated with less risk of female singletons compared with none embryo reduction [OR =0. 37, 95% CI, 0.16-0.85], in the stratum of preterm live births with number of oocytes retrieval greater than and equal to 13. Types of micromanipulations is ICSI and assisted hatching was associated with high risk of female singletons compared with no micromanipulations[OR =1.93, 95% CI, 1.12-3.33], in the stratum of preterm live births with embryo implantation combined with gestational weeks greater than and equal to 3.
Conclusion: Our findings suggest that parental characteristics of social demographic (Paternal age, maternal age, parental age gap), in vitro fertilization procedure-related factors (number of embryo reduction and types of micromanipulation ), and parental infertility factor (OHSS and cause of infertility) will be associated with gender of IVF singleton live births. Further studies to investigate relevant mechanisms are required.

並列關鍵字

in vitro fertilization, sex ratio, fetal reduction, ovarian hyperstimulation syndrome, intra cytoplasmic sperm injection.

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