Abstract

PurposeTo study the effects of mildly elevated thyroid‐stimulating hormone (TSH) levels and thyroid antibodies on pregnancy rates among infertile women and their potential contribution to prolonged infertility treatment.MethodsThis case‐control study included 1479 women who underwent infertility treatment between March 2015 and August 2017. Cumulative pregnancy and miscarriage rates after assisted reproductive technology (ART) or non‐ART treatments were compared between women with TSH <2.5 mIU/L and those with TSH 2.5‐3.5 mIU/L and between women with and without thyroid antibody positivity.ResultsThe cumulative pregnancy rate of women with TSH 2.5‐3.5 mIU/L was similar to that of women with TSH <2.5 mIU/L in the non‐ART (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.56‐1.23) and ART (HR, 1.17; 95% CI, 0.93‐1.47) groups. Thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) had no correlation with cumulative pregnancy rates. In the non‐ART and ART groups, HRs for TgAb were 0.87 (95% CI, 0.55‐1.32) and 1.09 (95% CI, 0.84‐1.39) and HRs for TPOAb were 0.88 (95% CI, 0.52‐1.39) and 1.29 (95% CI, 0.97‐1.68), respectively.ConclusionsCumulative pregnancy rates and miscarriage rates were similar between women with TSH <2.5 mIU/L and those with TSH 2.5‐3.5 mIU/L and were independent of thyroid antibody positivity.

Highlights

  • Subclinical hypothyroidism (SCH) is reported to be associated with infertil‐ ity.[3-6]

  • We previously reported that the use of water‐soluble contrast medium (WSCM) implicated a lower risk for SCH than oil‐soluble contrast medium (OSCM).[17]

  • Log‐ rank test and multivariate analysis were adjusted for age, body mass index (BMI), causes of infertility, thyroid‐stimulating hormone (TSH), free T4 (FT4), and prevalence of thyroid antibodies to compare the TSH

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Summary

| INTRODUCTION

Thyroid function and reproductive function are closely related.[1]. For example, hyper‐ and hypothyroidism are associated with amenor‐ rhea.[1]. Subclinical hypothyroidism (SCH) is defined as high levels of serum thyroid‐stimulating hormone (TSH) associated with normal free thyroxine (FT4). Studies have used different cutoff points of TSH to define SCH. In most studies, the pregnancy rate used to as‐ sess the reproductive performance of infertile women with SCH has been reported in terms of pregnancy per cycle. The pregnancy rate per cycle does not account for the fact that the period for becoming pregnant could be shortened if the cutoff value of TSH is 2.5 mIU/L. In this study, we examined whether moderately increased TSH and the presence of thyroid antibodies affected the cumulative pregnancy rate of women seeking to become pregnant. The cumulative pregnancy rate used to assess reproductive performance provides a better estimate of the history of multiple infertility treatments

| MATERIALS AND METHODS
| DISCUSSION
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