Correlation of thyroid stimulating hormone (TSH) level with pregnancy outcome in women undergoing in vitro fertilization

Baker, Valerie L.; Rone, Heather M.; Pasta, David J.; Nelson, H.; Gvakharia, M.; Adamson, G. David

doi:10.1016/j.ajog.2006.03.040

Cited by 50 publications

(22 citation statements)

References 20 publications

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“…Stuckey et al reported the development of overt hypothyroidism during IVF treatment in two patients taking levothyroxine (38). Preconception TSH levels of > 2.5 lU/mL have been associated with lower gestational age at delivery and lower birth weight in women undergoing IVF (39). Indeed, a maximum TSH level of 2.5 lU/mL before pregnancy in HYPO-Rx women has been recommended recently by the Endocrine Society in a Clinical Practice Guideline (40).…”

Section: Discussionmentioning

confidence: 99%

In VitroFertilization Pregnancy Rates in Levothyroxine-Treated Women With Hypothyroidism Compared to Women Without Thyroid Dysfunction Disorders

Scoccia

Demir

Kang

et al. 2012

Thyroid

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Background: Untreated hypothyroidism can lead to ovulatory dysfunction resulting in oligo-amenorrhea. Treatment with levothyroxine can reverse such dysfunction and thus should improve fertility. The purpose of this retrospective study was to assess whether in vitro fertilization (IVF) pregnancy rates differ in levothyroxinetreated women with hypothyroidism compared to women without thyroid dysfunction/disorders. Methods: Treated hypothyroid and euthyroid women undergoing IVF at an academic IVF center were studied after Institutional Review Board approval. Women with hypothyroidism were treated with levothyroxine 0.025-0.15 mg/day for at least 3 months to maintain baseline thyrotropin (TSH) levels of 0.35-4.0 lU/mL prior to commencing IVF treatment (HYPO-Rx group). Causes of infertility were similar in both groups with the exception of male factor, which was more common in the HYPO-Rx group. The main outcomes studied were implantation rate, clinical pregnancy rate, clinical miscarriage rate, and live birth rate. Results: We reviewed the first IVF retrieval cycle performed on 240 women aged 37 years or less during the period January 2003 to December 2007. Women with treated hypothyroidism (n = 21) had significantly less implantation, clinical pregnancy, and live birth rates than euthyroid women (n = 219). Conclusions: We conclude that, despite levothyroxine treatment, women with hypothyroidism have a significantly decreased chance of achieving a pregnancy following IVF compared to euthyroid patients. A larger prospective study is necessary to assess confounding variables, confirm these findings, and determine the optimal level of TSH prior to and during controlled ovarian hyperstimulation for IVF.

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Section: Discussionmentioning

confidence: 99%

In VitroFertilization Pregnancy Rates in Levothyroxine-Treated Women With Hypothyroidism Compared to Women Without Thyroid Dysfunction Disorders

Scoccia

Demir

Kang

et al. 2012

Thyroid

View full text Add to dashboard Cite

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“…Hypothyroidism, both overt and subclinical, affects 3-5 % of reproductive-aged women [6,16]. The effects of overt hypothyroidism on fertility include impaired ovulation [13], lower clinical pregnancy rates after assisted reproductive technology (ART) [17], higher miscarriage rates [5] and poor obstetrical outcomes [1,4]. In early pregnancy, high human chorionic gonadotropin (HCG) levels stimulate thyroid function through their receptor homology.…”

Section: Introductionmentioning

confidence: 99%

Thyroid stimulating hormone levels rise after assisted reproductive technology

Reinblatt

Herrero

Correa

et al. 2013

J Assist Reprod Genet

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Purpose The goal of this study was to determine whether high E2 levels after controlled ovarian hyperstimulation affect TSH. Methods Patients completing ART cycles between AprilOctober 2010 were eligible for this cohort study. 180 patients were recruited however those with known thyroid disease were excluded. The final analysis included 154 subjects. Blood was collected at each visit during the ART cycle as well as at the pregnancy test. Samples were frozen at −20°C and analyzed together for E2 and TSH using the same assay kit once all patients had completed their cycles. All participants were treated at the McGill University Health Center. A paired t-test was used to study the difference in TSH levels recorded at maximal and minimal Estradiol levels during ovarian stimulation. Multiple regression analysis was then used to determine if factors such as anti-thyroid antibodies and ovarian reserve measures affect this change in TSH. We used multiple imputation methods to account for missing data. Results As E2 levels rose from low to supra-physiologic levels during treatment, TSH levels also rose significantly. This increase was clinically significant by the time of pregnancy test. The factors that potentially affected the change in TSH were: male factor/tubal factor infertility, type of protocol used as well as the presence of thyroid antibodies. Conclusions Although TSH increases during ART, this change only becomes clinically significant on the day of pregnancy test. Future studies should examine TSH changes specifically in certain "at-risk" sub-groups such as those with antibodies and known thyroid disease.Capsule As estradiol levels rise during ART, TSH also rises. This rise may be affected by: cause of infertility, type of protocol used as well as the presence of anti-thyroid antibodies.

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“…28 The changing body-mass index in pregnancy and particularly interaction of hCG with TSH receptors in the first trimester may lead to a pseudo reduction in thyroid hormones and this may delay the diagnosis of hypothyroidism. 24,9 Thus fluctuations in pregnancy should be monitored and treated appropriately. In some studies it was shown that in patients with hypothyroidism necessity of LT4 increases 30% in the first 5 weeks of pregnancy and this became stabilized in the 16 th -20 th week of pregnancy.…”

Section: Hypothyroidismmentioning

confidence: 99%

“…However, even though there's a tendency towards an increase in abortus the difference wasn't significant. 24 Thyroid surveillance must be performed in patients presenting with infertility and replacement therapy should be done even in subclinical cases. 25 Even though scientific endocrine societies recommend surveillance in high risk patients, 26 routine surveillance before ART and surveillance of patients having history of abortus was recommended by many authors.…”

Section: Hypothyroidismmentioning

confidence: 99%