Thyroid function and IVF outcome for different indications of subfertility.

Reproduction & Fertility Pub Date : 2021-10-15 eCollection Date: 2021-12-01 DOI:10.1530/RAF-20-0065
C C Repelaer van Driel-Delprat, E W C M van Dam, P M van de Ven, K Aissa, M K Ter Haar, Y Feenstra, A de Roos, G Beelen, R Schats, C B Lambalk
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引用次数: 4

Abstract

Abstract: Studies evaluating pregnancy outcomes after assisted reproductive treatment (ART) in women with high-normal (2.5-4.5 mIU/L) thyroid-stimulating hormone (TSH) levels are conflicting, possibly due to different patient charactistics and subfertility indications. The aim of this study was to examine the hypothesis that high-normal compared to low-normal TSH levels are associated with adverse implications for pregnancy outcomes in conventional in vitro fertilization (IVF)-treated women. Therefore, we analyzed retrospectively the characteristics and pregnancy outcomes of 949 subfertile women with TSH 0.3-4.5 mIU/L, treated with conventional IVF between January 2008 and March 2012. Demographic and baseline characteristics were compared between groups of patients based on TSH quartiles, using one-way Anova, Kruskal-Wallis ANOVA and chi-square test. Women with high-normal quartile TSH were significantly more likely to be primary subfertile (P = 0.01), with a higher prevalence of unexplained subfertility and with 15% fewer live births after IVF compared to lower TSH quartiles (P = 0.02). In secondary subfertile women with high-normal TSH, male factor subfertility prevailed (P = 0.01), with more live births (P = 0.01). When analyzing primary and secondary subfertile women as one group, these differences failed to be observed, showing no differences in cumulative pregnancy outcomes of IVF between TSH quartiles (I: 0.3-1.21 mIU/L; II: 1.22-1.68 mIU/L; III: 1.69-2.31 mIU/L; IV: 2.32-4.5 mIU/L). In conclusion, primary subfertile women predominate in the high-normal TSH quartile, associated with significantly fewer live births in a subgroup of primary unexplained subfertile women (9%; n  = 87/949), while in secondary subfertile women, dominated by male factor subfertility, high-normal TSH is associated with more live births.

Lay summary: Thyroid hormones are required for all cell processes in the body. An underactive thyroid gland, in which insufficient thyroid hormones are produced and thyroid-stimulating hormone (TSH) rises, is associated with a lower chance of pregnancy. It is not yet clear above which TSH level, 4.5 or also 2.5 mIU/L, this lower probability occurs. Therefore, in 949 couples treated with conventional IVF, we examined whether high-normal TSH levels (TSH: 2.5-4.5 mIU/L) compared to low normal TSH levels (0.3-2.5 mIU/L) affect the live birth rate. We found that women who were trying to become pregnant for the first time, especially without any other cause, that is unexplained subfertility, were more likely to have higher TSH levels. These women had a much lower chance of having a baby compared to women with low-normal TSH levels.

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甲状腺功能和体外受精不同适应症的结果。
摘要:评估高正常(2.5-4.5 mIU/L)促甲状腺激素(TSH)水平妇女辅助生殖治疗(ART)后妊娠结局的研究存在矛盾,可能是由于患者特征和亚生育指征不同。本研究的目的是检验高正常TSH水平与低正常TSH水平相比与传统体外受精(IVF)治疗妇女妊娠结局的不良影响相关的假设。因此,我们回顾性分析了2008年1月至2012年3月间949例TSH为0.3-4.5 mIU/L、接受常规体外受精治疗的低生育能力妇女的特点和妊娠结局。采用单因素方差分析、Kruskal-Wallis方差分析和卡方检验,比较两组患者TSH四分位数的人口学特征和基线特征。正常四分位数TSH高的妇女原发性不孕的可能性更大(P = 0.01),与TSH低四分位数的妇女相比,不明原因不孕的发生率更高,体外受精后的活产率减少15% (P = 0.02)。在高正常TSH的继发性低生育能力妇女中,男性因素低生育能力普遍存在(P = 0.01),活产率更高(P = 0.01)。当将原发性和继发性不孕妇女作为一个组进行分析时,这些差异没有被观察到,显示TSH四分位数之间的IVF累积妊娠结局没有差异(I: 0.3-1.21 mIU/L;II: 1.22-1.68 mIU/L;III: 1.69-2.31 mIU/L;IV: 2.32-4.5 mIU/L)。总之,原发性低生育能力妇女在高正常TSH四分位数中占主导地位,与原发性不明原因低生育能力妇女亚组的活产显著减少相关(9%;n = 87/949),而在继发性低生育能力妇女中,以男性因素低生育能力为主,高正常TSH与更多活产有关。概要:甲状腺激素是人体所有细胞活动所必需的。甲状腺功能低下,即甲状腺激素分泌不足,促甲状腺激素(TSH)升高,与较低的怀孕几率有关。目前尚不清楚高于何种TSH水平(4.5 mIU/L还是2.5 mIU/L),这种低概率会发生。因此,在949对接受常规试管婴儿治疗的夫妇中,我们检查了高正常TSH水平(TSH: 2.5-4.5 mIU/L)与低正常TSH水平(0.3-2.5 mIU/L)是否影响活产率。我们发现,第一次尝试怀孕的女性,尤其是没有任何其他原因,即无法解释的生育能力低下的女性,更有可能有更高的TSH水平。与TSH水平较低的女性相比,这些女性生育孩子的几率要低得多。
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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