Thyroid Disorders and In Vitro Outcomes of Assisted Reproductive Technology: An Unfortunate Combination?

Thyroid. 2020 Aug;30(8):1177-1185. doi: 10.1089/thy.2019.0567. Epub 2020 Feb 18.

Abstract

Background: The impact of thyroid disorders on in vitro outcomes of assisted reproductive technology (ART) remains controversial. Therefore, the aim of our study was to investigate whether thyroid peroxidase antibodies (TPO-Abs)/thyroid autoimmunity (TAI) or thyroid function (serum thyrotropin [TSH])/subclinical hypothyroidism are associated with an altered number of oocyte retrieval (NOR), fertilization rate (FR), and embryo quality (EQ). Methods: Cross-sectional study in 279 women in a single center, comprising 297 cycles and 1168 embryos. In vitro data (NOR, FR, and EQ) were documented in two groups; one according to thyroid function in women without TAI (TSH ≤2.5 and >2.5 mIU/L) and one according to the presence/absence of TAI (determined by TPO-Abs). EQ was evaluated according to international criteria and classified as excellent/good and poor. Women treated with levothyroxine (LT4) were excluded. Furthermore, the impact of thyroid parameters on outcomes, normal NOR (>6 or 8) and high FR (>60%), was verified in a multivariable logistic regression model. Results: In women without TAI, 27% had TSH levels >2.5 mIU/L, the prevalence of TAI was 8%, and overall, 6% of women had TSH levels >4.2 mIU/L. NOR, FR, and EQ were comparable between study groups. In the regression analysis, women aged ≥30 years and receiving a high ovarian stimulation dosage (>2300 IU/cycle) had lower rates of normal NOR (odds ratio [OR] 0.18 [95% confidence interval, CI 0.04-0.72]; p = 0.016 and OR 0.17 [CI 0.06-0.48]; p < 0.001, respectively). Conclusions: Our results do not suggest an impact of thyroid antibodies/autoimmunity and (dys)function on ART in vitro outcomes.

Keywords: assisted reproductive technology; embryo quality; fertilization rate; in vitro fertilization; infertility; intracytoplasmic sperm injection; ovarian retrieval; thyroid autoimmunity; thyroid function.

MeSH terms

  • Adult
  • Autoimmunity
  • Cross-Sectional Studies
  • Female
  • Humans
  • In Vitro Techniques
  • Infertility, Female / blood
  • Infertility, Female / complications*
  • Iodide Peroxidase / blood
  • Male
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Prevalence
  • Prospective Studies
  • Regression Analysis
  • Reproductive Techniques, Assisted*
  • Thyroid Diseases / blood
  • Thyroid Diseases / complications*
  • Thyroid Function Tests
  • Thyroid Gland / immunology
  • Thyrotropin / blood
  • Thyroxine / blood
  • Treatment Outcome

Substances

  • Thyrotropin
  • Iodide Peroxidase
  • Thyroxine