title: Impact of blastocyst transfer on offspring sex ratio and the monozygotic twinning rate: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the sex ratio and risk of monozygotic twinning (MZT) after blastocyst transfer compared with cleavage-stage embryo transfer (ET) in fresh IVF cycles.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  University hospital center for reproductive medicine and IVF.
  
  
  METHODS
  Results of all reports from January 1995 to November 2007 with women undergoing nondonor fresh IVF. The sex ratio of 2,587 offspring and MZT rate in 40,917 cycles were included.
  
  
  METHODS
  Cleavage or blastocyst stage for embryo transfer.
  
  
  METHODS
  Sex ratio and rate of MZT.
  
  
  RESULTS
  A meta-analysis was performed using four studies for sex ratio and nine studies for MZT. The results of the meta-analysis using a fixed effect model demonstrated a higher male-female ratio after blastocyst transfer compared with cleavage-stage ET (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.10-1.51), and this difference was statistically significant. The risk of MZT after blastocyst transfer was significantly higher compared with cleavage-stage ET (OR 3.04, 95% CI 1.54-6.01).
  
  
  CONCLUSIONS
  The combined data presented in this meta-analysis suggest that blastocyst transfer appears to be associated with a sex ratio skewed in favor of males and an increased risk of MZT. The clinicians should provide this information to their infertility patients awaiting blastocyst transfer.
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors: Hye Jin
authors: HJ
authors: Chang
authors: Jung Ryeol
authors: JR
authors: Lee
authors: Byung Chul
authors: BC
authors: Jee
authors: Chang Suk
authors: CS
authors: Suh
authors: Seok Hyun
authors: SH
authors: Kim
mesh_terms: D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012189:Retrospective Studies; D012744:Sex Ratio; D014430:Twins, Monozygotic