Follicular fluid thyroid autoantibodies, thyrotropin, free thyroxine levels and assisted reproductive technology outcome.

Dragana Bojovic Jovic,Milos Zarkovic,Sanja Medenica,Rade Vukovic,Dzihan Abazovic,Dragana Nikitovic,Biljana Medjo,Biljana Arsic,Eliana Garalejic

doi:10.1371/journal.pone.0206652

Abstract

ObjectiveAlthough there are substantial data linking thyroid autoimmunity (TAI) and infertility, data regarding assisted reproductive technology (ART) outcomes and TAI markers in follicular fluid (FF) of women undergoing ART are scarce. Objective of the study was to assess the association of the levels of thyroid autoantibodies in FF and ART outcome expressed as the achieved pregnancies.MethodsThis study enrolled 52 women undergoing ART (26 TAI positive subjects and 26 age and body mass index matched TAI negative controls). Blood samples were drawn before the initiation of protocol for controlled ovarian stimulation, and thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroid peroxidase antibodies (TPOAbs) and thyroglobulin antibodies (TgAbs) levels were measured. TSH, fT4, TPOAbs, TgAbs and progesterone levels were also measured in FF.ResultsThere were no significant differences between the groups regarding mean levels of FF TSH and FF fT4. Statistically significant correlation was discovered regarding the levels of serum and FF TPOAbs (0,961, p<0.001 in TAI positive, 0,438, p = 0.025 in TAI negative group) and TgAbs (0,945, p<0.001 in TAI positive, 0,554, p = 0.003 in TAI negative group). Pregnancies rates per initiated cycle and per embryotransfer cycle were significantly different between TAI positive and TAI negative group, (30.8% vs 61.5%), p = 0.026 and (34.8% vs 66.7%), p = 0.029, respectively. Multivariate analysis showed that TAI positive women had less chance to achieve pregnancy (p = 0.004, OR = 0.036, 95% CI 0.004–0.347).ConclusionsHigher levels of thyroid autoantibodies in FF of TAI positive women are strongly correlated with serum levels and may have effect on the post-implantation embryo development.

Highlights

Thyroid autoimmunity (TAI) is the most prevalent autoimmune disease in women of reproductive age, affecting 5%-20% of female population [1]
Significant correlation was discovered regarding the levels of serum and follicular fluid (FF) thyroid peroxidase antibodies (TPOAbs) (0,961, p
Pregnancies rates per initiated cycle and per embryotransfer cycle were significantly different between TAI positive and TAI negative group, (30.8% vs 61.5%), p = 0.026 and (34.8% vs 66.7%), p = 0.029, respectively

Summary

Introduction

Thyroid autoimmunity (TAI) is the most prevalent autoimmune disease in women of reproductive age, affecting 5%-20% of female population [1]. Numerous studies have focused on association of TAI, infertility and obstetrical complications[6,7,8,9]. The hypotheses have been suggested to explain possible connection between TAI and obstetrical complications. TAI is associated with an increased risk of unexplained subfertility [12]. The risk for miscarriage may be higher in euthyroid, subfertile women with TAI undergoing ART [10], with lower pregnancy rate [14] compared with subfertile women without TAI. Controlled ovarian stimulation, as a part of ART procedure, seems to have a long-term impact on TSH levels [15], leading to a significant increase of serum TSH in the very first period of pregnancy and alter thyroid function in euthyroid TAI positive patients [16]

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Results

Conclusion