Impacts of thyroid stimulating hormone and thyroid peroxidase antibody on pregnancy outcomes of in vitro fertilization-embryo transfer
WAN Zhonggui, HONG Mingyun, TANG Zhixia, YU Li
Maternal and Child Medical Center of Anhui Medical University/Fifth Clinical College of Anhui Medical University/Hefei Maternal and Child Health Hospital, Hefei, Anhui 230001, China
Abstract：Objective To investigate the effects of thyroid stimulating hormone (TSH) and thyroid peroxidase antibody(TPOAb) on pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET). Methods The patients who underwent IVF-ET at the Reproductive Medicine Center of Hefei Maternal and Child Health Care Hospital from December 2019 to November 2023, and had normal free thyroxine and 0.3-<10 mIU/L TSH levels were selected as subjects. The patients were divided into three groups based on TSH levels: 0.3-<2.5 mIU/L, 2.5-4 mIU/L, and >4-<10 mIU/L, and the patients with normal free thyroxine and TSH levels were further divided into TPOAb-positive and TPOAb-negative groups. The biochemical pregnancy rate, clinical pregnancy rate and miscarriage rate were compared among patients with different TSH and TPOAb groups. Results A total of 3 876 patients were recruited, including 830 patients with fresh embryo transfer cycles and 3 046 patients with frozen-thawed embryo transfer cycles. In the patients with fresh embryo transfer cycles, the biochemical pregnancy rate, clinical pregnancy rate and miscarriage rate were 59.16%, 52.77% and 19.41%, respectively. In the patients with frozen-thawed embryo transfer cycles, these rates were 55.52%, 46.98% and 20.27%, respectively. For both groups, there were no statistically significant differences in biochemical pregnancy rate, clinical pregnancy rate and miscarriage rate between TPOAb-positive and TPOAb-negative patients or among the patients with different TSH groups (all P>0.05). Additionally, a follow-up study of 150 patients who had successfully delivered after IVF-ET from 2020 to 2022 with TSH levels of >4-<10 mIU/L showed that no intellectual developmental issues or tendencies toward intellectual developmental disorders were found in their offsprings. Conclusion In the context of normal free thyroxine levels, this study did not find any impacts of mildly elevated TSH levels or isolated TPOAb positivity on the pregnancy outcomes of IVF-ET.
[1] DONG A C,STAGNARO-GREEN A.Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy:a systematic review and meta-analysis[J].Thyroid,2019,29(2):278-289. [2] 张玥,殷玉华,张卫华,等.妊娠早期合并甲状腺功能减退早期治疗效果分析[J].预防医学,2018,30(1):100-101. ZHANG Y,YIN Y H,ZHANG W H,et al.Effect of early treatment of hypothyroidism in the first trimester of pregnancy[J].China Prev Med J,2018,30(1):100-101.(in Chinese) [3] RAO M,ZENG Z Y,ZHANG Q L,et al.Thyroid autoimmunity is not associated with embryo quality or pregnancy outcomes in euthyroid women undergoing assisted reproductive technology in China[J].Thyroid,2023,33(3):380-388. [4] PEARCE E N.Thyroid disorders during pregnancy and postpartum[J].Best Pract Res Clin Obstet Gynaecol,2015,29(5):700-706. [5] 戴志俊,邹林兵,汪凌云,等.非优质卵裂胚胎继续培养至囊胚的临床应用研究[J].中国优生与遗传杂志,2015,23(5):118-119. DAI Z J,ZOU L B,WANG L Y,et al.Development of clinical application of continually cultured to blastocyst from low quality cleaved embryos[J].Chin J Birth Health & Hered,2015,23(5):118-119.(in Chinese) [6] POPPE K,BISSCHOP P,FUGAZZOLA L,et al.2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction[J].Eur Thyroid J,2021,9(6):281-295. [7] 唐志霞,马双影,张影,等.补体C3水平对冻融胚胎移植妊娠结局的早期预测价值[J].实用医学杂志,2024,40(7):924-929. TANG Z X,MA S Y,ZHANG Y,et al.Role of complement C3 in early predicting pregnancy outcomes of frozen-thawed embryo transfer[J].J Pract Med,2024,40(7):924-929.(in Chinese) [8] ALEXANDER E K,PEARCE E N,BRENT G A,et al.2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid,2017,27(3):315-389. [9] NAZARPOUR S,RAMEZANI TEHRANI F,AMIRI M,et al.Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism:a systematic review and meta-analysis[J].Arch Gynecol Obstet,2019,300(4):805-819. [10] YANG X Y,QIU S M,JIANG W W,et al.Impact of thyroid autoimmunity on pregnancy outcomes in euthyroid women following fresh/frozen-thawed embryo transfer[J].Clin Endocrinol(Oxf),2023,99(1):113-121. [11] MARAKA S,MWANGI R,MCCOY R G,et al.Thyroid hormone treatment among pregnant women with subclinical hypothyroidism:US national assessment[J].BMJ,2017,356:1-12. [12] HUANG N,CHEN L X,LIAN Y,et al.Impact of thyroid autoimmunity on in vitro fertilization/intracytoplasmic sperm injection outcomes and fetal weight[J].Front Endocrinol(Lausanne),2021,12:1-9. [13] BUSNELLI A,BELTRATTI C,CIRILLO F,et al.Impact of thyroid autoimmunity on assisted reproductive technology outcomes and ovarian reserve markers:an updated systematic review and meta-analysis[J].Thyroid,2022,32(9):1010-1028. [14] ORSOLINI F,GIANETTI E,TERRENZIO C,et al.Thyroid function rather than thyroid antibodies affects pregnancy and perinatal outcomes:results of a prospective study[J].J Clin Endocrinol Metab,2022,107(11):4302-4310. [15] MEDENICA S,GARALEJIĆE,ABAZOVIĆD,et al.Pregnancy outcomes and newborn characteristics in women with follicular fluid thyroid autoantibodies undergoing assisted reproduction[J].J Med Biochem,2023,42(1):27-33.
