研究背景：隨著全球不孕症盛行率上升，人工生殖技術（Assisted Reproductive Technology, ART）已成為協助不孕夫妻生育的重要方法之一。大量研究已探討ART的潛在影響和危害，但多集中於生理和心理健康層面，關於子代青春期發展的影響文獻仍較少。研究顯示，青春期提前或延遲可能導致子代生殖健康方面的問題，而一些研究則表明，ART 可能影響這些子代的青春期時間。此外，現有針對長期影響的研究相對不足，並且國內相關研究較少用全國性資料庫進行風險分析。因此，本研究利用台灣出生世代研究（Taiwan Birth Cohort Study, TBCS）樣本，調查ART對子代青春期發展的影響。

研究目的：本研究旨在分析TBCS資料，探討不同人工生殖方式對子代青春期發展時間之影響，並進一步分層分析性別和青春期各面向所受影響之異同。

方法：本研究採用世代研究設計，資料來自TBCS，最終納入20,226名樣本，其中ART組458人（IUI：165人；IVF：293人）。青春期發展狀況依據問卷資料中子代青春期特徵相關問題，並使用青春期發展量表（Pubertal Development Scale, PDS）進行青春期進程判斷。統計方法包括描述性統計、序列邏輯斯迴歸分析（Ordinal Logistic Regression, OLR）、多變項邏輯斯迴歸分析，並進行性別與人工生殖類型之分層分析，以評估ART使用與青春期發展時間之相關性。

研究結果：在納入的所有樣本中，ART組父母在多項社會人口學特徵上與自然受孕（Spontaneous Conception, SC）組有顯著差異。首先，ART組的母親平均年齡較高（p <.0001），且父母雙方接受教育程度普遍較高（p <.0001）。在家庭平均收入的分佈比例，可知ART組也有較佳的經濟條件。這可能說明較高齡夫妻更容易需要ART協助，並且高社經地位的夫妻更能負擔得起人工生殖治療的經濟支出。另一方面，針對自填問卷的青春期發展階段進行描述性分析，可以發現12歲時，女性的發育較早於男性，並且多數都已開始發育。此外，本研究針對不同人工生殖方式和性別進行分層分析。針對女性子代的個別青春期發展面向進行分析，IVF組在調整母親年齡與社會人口學因素後，青春痘生長顯著較高提前風險（OR=1.48，95%CI：1.03-2.12，p=0.03），說明IVF可能與特定青春期變化具潛在關聯性。整體來看，使用多變項邏輯斯回歸分析，發現IUI組男性子代在粗模型中顯示青春期提前趨勢（OR=1.64，95%CI：1.04-2.59），但經變項調整後，在調整後之模型中未達顯著，女性則皆未顯著。

結論：整體樣本中未發現顯著影響，但分層結果顯示性別與ART類型可能影響青春期發展之趨勢。未來研究應擴大樣本並提前追蹤至青少年早期，整合生心理與生物指標，深入探索ART對青春期發展與長期健康風險之潛在機制，提供臨床與政策制定更完整的實證基礎。

This study explores the association between assisted reproductive technology (ART) and offspring pubertal development using data from the nationally representative Taiwan Birth Cohort Study (TBCS). The final sample included 20,226 participants, among whom 458 were conceived via ART , including 165 through intrauterine insemination (IUI) and 293 through in vitro fertilization (IVF). Pubertal development was assessed using the Pubertal Development Scale (PDS), and analyses included stratified and multivariable models. Compared to the spontaneous conception (SC) group, ART parents were older and had higher education and income levels. Most girls entered puberty by age 12 and developed earlier than boys. Stratified analyses showed that female offspring conceived via IVF had a significantly higher risk of early acne development (OR = 1.59, 95% CI: 1.03–2.12), even after adjusting for maternal age and socioeconomic status. A non-significant trend toward earlier puberty was found in males conceived via intrauterine insemination (IUI). No significant associations were detected in the overall sample. These findings highlight possible sex- and method-specific differences in pubertal timing among ART offspring, warranting further research incorporating biological, psychosocial, and environmental mechanisms to clarify long-term health impacts.

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