Abstract
BackgroundThyroid autoimmunity (TAI) – the presence of anti-thyroid peroxidase and/or anti-thyroglobulin antibodies – affects 8–14% of reproductively-aged women. It is hotly debated whether TAI adversely affects IVF/ICSI outcomes. This systematic review and meta-analysis evaluated the relationship between thyroid autoimmunity (TAI) and IVF/ICSI outcomes, both overall and amongst euthyroid women of known age using strict criteria for grouping pregnancy outcomes.MethodsThe review was registered with PROSPERO: CRD42019120947. Searches were undertaken in MEDLINE, EMBASE, Web of Science and Cochrane Database from Inception-March 2020. Primary outcomes were clinical pregnancy rate, clinical miscarriage rate, biochemical pregnancy loss, livebirth rate per-cycle and live birth rate per clinical pregnancy (CP).Results14 studies were included in the meta-analysis. Compared with women who tested negative for thyroid autoantibodies (TAI-), there was no significant difference in clinical pregnancy rate overall (OR 0.86; 95%CI [0.70, 1.05]; P = 0.14; 11 studies; I2 = 29.0%), or in euthyroid women (OR 0.88; 95%CI [0.69, 1.12]; P = 0.29; 10 studies; I2 = 32.0%). There was also no significant difference in clinical miscarriage rate overall (OR 1.04; 95%CI [0.52, 2.07]; P = 0.908; 8 studies; I2 = 53%), or in euthyroid women (OR 1.18; 95%CI [0.52, 2.64]; P = 0.69; 7 studies; I2 = 54%). There was no significant difference in biochemical pregnancy loss (OR 1.14; 95%CI [0.48, 2.72]; P = 0.769; 4 studies; I2 = 0.0%), live birth rate per cycle (OR 0.84; 95%CI [0.67, 1.06]; P = 0.145; I2 = 1.7%), live birth rate per clinical pregnancy (OR 0.67; 95%CI [0.28, 1.60]; P = 0.369; I2 = 69.2%), both overall and in euthyroid women as all studies included consisted of euthyroid women only. There was also no significant difference in number of embryos transferred, number of oocytes retrieved, mean maternal age or TSH levels overall or in euthyroid women.ConclusionThe findings of the present study suggest that thyroid autoimmunity has no effect on pregnancy outcomes in euthyroid women alone, or in euthyroid women and women with subclinical hypothyroidism.
Highlights
Thyroid autoimmunity (TAI) – the presence of anti-thyroid peroxidase and/or anti-thyroglobulin antibodies – affects 8–14% of reproductively-aged women
TAI+ women were found to have a greater risk of spontaneous miscarriage in addition to lower live birth rates (LBR) with no reductions in either clinical pregnancy rates (CPR) or implantation rates (IR) [6]
An additional 45 articles were excluded (Fig. 1) on the following basis: 5 articles did not report maternal age, 7 articles did not include either a TAI+ group or a TAIcontrol group, 3 studies included patients on levothyroxine, 3 were review articles, 3 did not report patient outcomes, 19 were conference abstracts, 1 did not use IVF/ ICSI, 2 were excluded due to patient overlap and 2 studies were excluded during data analysis due to discrepancies in results
Summary
Thyroid autoimmunity (TAI) – the presence of anti-thyroid peroxidase and/or anti-thyroglobulin antibodies – affects 8–14% of reproductively-aged women. It is hotly debated whether TAI adversely affects IVF/ICSI outcomes. TAI+ women were found to have a greater risk of spontaneous miscarriage in addition to lower live birth rates (LBR) with no reductions in either CPR or implantation rates (IR) [6]. On the contrary, He et al (2016) [10] found no association between TAI positivity and clinical pregnancy, miscarriage rate or delivery rate. Leiva et al (2017) [11] found no association between TAI and increased risk of pregnancy loss
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