Abstract
BackgroundWomen with hyper-and hypothyroidism are at increased risk for infertility and adverse pregnancy outcomes. Whether in women considered euthyroid thyroid function (TSH values) and thyroid autoimmunity (thyroid antibodies) influence in vitro fertilization (IVF) cycle outcome has, however, remained controversial. Any such effect should be easily visible in women with low functional ovarian reserve (LFOR) and thus small oocyte and embryo numbers.MethodsWe evaluated the relationship between TSH levels and embryo quality in euthyroid women with LFOR undergoing IVF. Mean age for the study population was 39.9 ± 4.6 years. Embryo quality was assessed in 431 embryos from 98 first IVF cycles according to TSH levels (with cut-off 2.5μIU/mL), and to presence versus absence of thyroid autoantibodies.ResultsMean Anti Mullerian hormone (AMH) was 0.8 ± 0.8 ng/mL and mean TSH was 1.8 ± 0.9 μIU/mL. Comparable embryo quality was observed in women with TSH ≤ and >2.5μIU/mL. TPO antibodies significantly affected embryo quality in women with low-normal TSH levels (P = 0.045). In women with high-normal TSH levels, increasing TSH had a negative impact on embryo quality (P = 0.027). A trend towards impaired embryo quality with TPO antibodies was also observed in these patients (p = 0.057).ConclusionsTPO antibodies affect embryo quality in euthyroid women with low-normal TSH ≤2.5 μIU/mL. In women with high-normal TSH levels, increasing TSH levels, and possibly TPO antibodies, appear to impair embryo quality. These results suggest that the negative impact of thyroid autoimmunity becomes apparent, once thyroid hormone function is optimized.
Highlights
Women with hyper-and hypothyroidism are at increased risk for infertility and adverse pregnancy outcomes
Patients This study investigated 431 embryos in 98 infertility patients, who all underwent their first in vitro fertilization (IVF) cycles between January 2011 and February 2013 at the Center for Human Reproduction (CHR) in New York City
Routine pre-IVF evaluation at the center includes ovarian function determinations by baseline follicle stimulating hormone (FSH) on cycle days 2/3 and random anti-Müllerian hormone (AMH), thyroid-stimulating hormone (TSH) and thyroid autoantibody assessments for thyroid peroxidase (TPO), antithyroglobulin (TG) and thyroid receptor antibodies (TR), and prolactin levels
Summary
Women with hyper-and hypothyroidism are at increased risk for infertility and adverse pregnancy outcomes. Whether in women considered euthyroid thyroid function (TSH values) and thyroid autoimmunity (thyroid antibodies) influence in vitro fertilization (IVF) cycle outcome has, remained controversial. Any such effect should be visible in women with low functional ovarian reserve (LFOR) and small oocyte and embryo numbers. Thyroid function and female reproduction are closely related. This relationship appears especially pronounced during pregnancy and in women who undergo fertility treatment: Once estrogen serum concentrations rise above physiological thresholds, thyroid-binding globulin levels increase. Thyroid-stimulating hormone (TSH) rises to ensure sufficient thyroid hormone supply [7, 8]
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