Effect of embryo culture media on percentage of males at birth.
OBJECTIVE
Does embryo culture medium influence the percentage of males at birth?


CONCLUSIONS
The percentage of males delivered after ICSI cycles using G5™ medium was statistically significantly higher than after cycles where Global, G5™ PLUS, and Quinn's Advantage Media were used.


BACKGROUND
Male and female embryos have different physiologies during preimplantation development. Manipulating the energy substrate and adding growth factors have a differential impact on the development of male and female embryos.


METHODS
This was a retrospective analysis of the percentage of males at birth, and included 4411 singletons born from fresh embryo transfer cycles between January 2011 and August 2013 at the Center for Reproductive Medicine of Third Hospital Peking University.


METHODS
Only singleton gestations were included. Participants were excluded if preimplantation genetic diagnosis, donor oocytes and donor sperm were used. The database between January 2011 and August 2013 was searched with unique medical record number, all patients were present in the database with only one cycle. Demographics, cycle characteristics and the percentage of male babies in the four culture media groups were compared with analysis of variance or χ(2) tests. Multivariable logistic regression was done to determine the association between the sex at birth and culture media after adjusting for other confounding factors, including parental age, parental BMI, type of infertility, parity, number of embryos transferred, number of early gestational sacs, cycles with testicular sperm aspiration (TESA)/percutaneous epididymal sperm aspiration (PESA)/testicular sperm extraction (TESE), number of oocytes retrieved, cycles with blastocyst transfers, and gestational age within ICSI group.


RESULTS
Within the IVF group, the percentage of males at birth for G5™, Global, Quinn's and G5™ PLUS media were comparable (P > 0.05); however, within the ICSI group, the percentage of male babies in cycles using G5™(56.1%) was statistically significantly higher than in cycles that used Global (47.2%; P = 0.003), G5™ PLUS (47.7%; P = 0.005) or Quinn's media (45.0%; P = 0.009). There were no statistically significant differences in the percentage of males at birth between cycles that used Global, G5™ PLUS and Quinn's media (P > 0.05). Multivariable logistic regression indicated that culture media (G5™ versus Global, G5™ PLUS, and Quinn's) were significantly associated with the sex at birth (P = 0.008) after adjusting for parental age, parental BMI, type of infertility, parity, number of embryos transferred, number of early gestational sacs, cycles with TESA/PESA/TESE, number of oocytes retrieved, cycles with blastocyst transfers, and gestational age.


CONCLUSIONS
This study was not a randomized controlled trial and allocation of treatment cycles over the four media was not completely at random. Cigarette smoking was not included in the current study because this confounding factor was not registered in our database. Moreover, intra-variability of sperm selection between the five embryologists may directly affect the percentage of males.


CONCLUSIONS
Our study suggests that human embryogenesis responds differently to G5™, Global, G5™ PLUS and Quinn's Advantage Medium. This finding can be generalized to other commercial culture media.


BACKGROUND
National Natural Science Foundation of China for Young Scholars (81300483 and 81200466). The authors have no conflicts of interest to declare.


BACKGROUND
Not applicable.
Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China.
Jinliang
J
Zhu
Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China.
Xinjie
X
Zhuang
Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China.
Lixue
L
Chen
Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China bysylp@sina.com jie.qiao@263.net.
Ping
P
Liu
Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction, Beijing, China bysylp@sina.com jie.qiao@263.net.
Jie
J
Qiao
D001755:Blastocyst / Q000502:physiology*; D003470:Culture Media / Q000737:chemistry; D046149:Embryo Culture Techniques; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009865:Oocytes / Q000166:cytology; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D012744:Sex Ratio; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D053625:Sperm Retrieval; D013094:Spermatozoa / Q000473:pathology; D013737:Testis / Q000473:pathology
D003470:Culture Media
ICSI; IVF; culture medium; sex at birth; singleton gestation