Coexistence of Endometriosis and Thyroid Autoimmunity in Infertile Women: Impact on in vitro Fertilization and Reproductive Outcomes.

IF 2 4区 医学 Q2 OBSTETRICS & GYNECOLOGY
Gynecologic and Obstetric Investigation Pub Date : 2024-01-01 Epub Date: 2024-05-08 DOI:10.1159/000539265
Sara Korošec, Gaetano Riemma, Vesna Šalamun, Anita Franko Rutar, Antonio Simone Laganà, Vito Chiantera, Pasquale De Franciscis, Helena Ban Frangež
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引用次数: 0

Abstract

Objectives: The objective of the study was to evaluate the prevalence and impact of impaired thyroid-stimulating hormone (TSH) levels on the reproductive outcomes of in vitro fertilization patients diagnosed with endometriosis and compared to controls without endometriosis.

Design: This is a retrospective cohort study on prospectively collected data.

Setting: The study was conducted at tertiary care university hospital.

Participants: Participants were infertile women with histopathological diagnosis of endometriosis.

Methods: For 12 months (January 2018 to January 2019), women were deemed suitable and subsequently divided according to serum TSH levels above or below 2.5 mIU/L and compared to patients without endometriosis. Needed sample size was at least 41 patients for each cohort of women. Co-primary outcomes were the live birth rate (LBR), clinical pregnancy rate (CPR), and pregnancy loss rate (PLR).

Results: Overall, 226 women (45 with endometriosis and 181 controls without endometriosis) were included. Diagnoses of Hashimoto thyroiditis were significantly more frequent in women with rather than without endometriosis (14/45 [31.1%] vs. 27/181 [14.9%]; p = 0.012). Similarly, in women with endometriosis, Hashimoto diagnosis rates were higher with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (9/15 [60%] vs.5/30 [16.6%]; p = 0.001) so were the Hashimoto diagnosis rates in control group (women without endometriosis) with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (17/48 [35.4%] vs. 10/133 [7.5%], respectively; p = 0.001). Effect size analysis confirmed an increased risk of Hashimoto thyroiditis in women with endometriosis and TSH ≥2.5 mIU/L compared to women with endometriosis and TSH <2.5 mIU/L (risk ratio [RR] 3.60 [95% CI 1.46-8.86]) and in women with endometriosis and TSH ≥2.5 mIU/L compared to non-endometriotic euthyroid patients (RR 7.98 [95% CI 3.86-16.48]). Dysmenorrhea risk was higher in endometriotic euthyroid women compared to euthyroid patients with no endometriosis (RR 1.87 [95% CI 1.21-2.87]). The risk was still increased in euthyroid women with endometriosis relative to dysthyroid women with no endometriosis (RR 1.97 [95% CI 1.11-3.50]). There were no significant differences between the four groups for CPR, LBR, PLR and retrieved oocytes, immature oocytes, degenerated and unfertilized oocytes, cultured blastocysts, embryos and transferred embryos.

Limitations: Limitations of the study were retrospective design, limited sample size, and use of different ovarian stimulation protocol.

Conclusions: Thyroid autoimmunity seems more common in women with endometriosis and TSH over 2.5 mIU/L. However, there was no significant impact on in vitro fertilization and reproductive outcomes related to the coexistence of endometriosis, Hashimoto disease, and higher TSH levels. Due to limitations of the study, additional evidence is required to validate the abovementioned findings.

不孕妇女同时患有子宫内膜异位症和甲状腺自身免疫:对体外受精和生殖结果的影响。
目的评估被诊断患有子宫内膜异位症的体外受精患者与未患有子宫内膜异位症的对照组相比,促甲状腺激素(TSH)水平受损的发生率及其对生殖结果的影响:设计:对前瞻性收集的数据进行回顾性队列研究:地点:大学附属三级医院组织病理学诊断为子宫内膜异位症的不孕妇女.方法:在12个月内(2018年1月至2019年1月),认为妇女适合,随后根据血清促甲状腺激素水平高于或低于2.5 mIU/L进行划分,并与无子宫内膜异位症的患者进行比较。每组妇女至少需要41名患者。共同主要结果为活产率(LBR)、临床妊娠率(CPR)和妊娠损失率(PLR)。在患有子宫内膜异位症的妇女中,桥本甲状腺炎的诊断率明显高于未患子宫内膜异位症的妇女(14/45 (31.1%) vs 27/181 (14.9%);P=0.012)。同样,在患有子宫内膜异位症的妇女中,TSH ≥2.5 mIU/L 的桥本氏病诊断率高于 TSH <2.5 mIU/L 的诊断率(9/15(60%) vs 5/30(16.6%);P=0.001),对照组(无子宫内膜异位症的妇女)TSH ≥2.5 mIU/L 与 TSH <2.5 mIU/L 相比的桥本氏诊断率也是如此(分别为 17/48 (35.4%) vs 10/133 (7.5%); p=0.001)。效应大小分析证实,与患有子宫内膜异位症且TSH <2.5 mIU/L的妇女相比,患有子宫内膜异位症且TSH ≥2.5 mIU/L的妇女患桥本氏甲状腺炎的风险增加(风险比 (RR) 3.60 (95% CI 1.46 to 8.86));与非子宫内膜异位症甲状腺功能正常的患者相比,患有子宫内膜异位症且TSH ≥2.5 mIU/L的妇女患桥本氏甲状腺炎的风险增加(RR 7.98 (95% CI 3.86 to 16.48))。与无子宫内膜异位症的甲状腺功能亢进患者相比,子宫内膜异位症甲状腺功能亢进妇女的痛经风险更高(RR 1.87 (95% CI 1.21 to 2.87))。有子宫内膜异位症的甲状腺功能亢进妇女与无子宫内膜异位症的甲状腺功能减退妇女相比,风险仍然增加(RR 1.97 (95% CI 1.11 to 3.50))。四组之间在CPR、LBR、PLR以及取回的卵母细胞、未成熟卵母细胞、退化和未受精卵母细胞、培养的囊胚、胚胎和移植的胚胎方面没有明显差异:局限性:回顾性设计,样本量有限,使用了不同的卵巢刺激方案:结论:甲状腺自身免疫似乎在患有子宫内膜异位症且促甲状腺激素超过2.5 mIU/L的妇女中更为常见。然而,子宫内膜异位症、桥本氏病和较高的促甲状腺激素水平同时存在,对体外受精和生殖结果并无明显影响。由于研究的局限性,还需要更多的证据来验证上述发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.20
自引率
4.80%
发文量
44
审稿时长
6-12 weeks
期刊介绍: This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
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