Effect of thyroid function on assisted reproduction outcomes in euthyroid infertile women: A single center retrospective data analysis and a systematic review and meta-analysis

d’Assunção, Viviane Rosado Negreiros; Montagna, Erik; d’Assunção, Luis Eduardo Negreiros; Caldas, Maria Madalena Pessoa; Christofolini, Denise Maria; Barbosa, Caio Parente; Negreiros, Ricardo Andre Medeiros; Laganà, Antonio Simone; Oliveira, Renato de; Bianco, Bianca

doi:10.3389/fendo.2022.1023635

Cited by 10 publications

(4 citation statements)

References 51 publications

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“…Hypo- and hyperthyroidism have adverse effects on female reproduction and are associated with a wide range of reproductive disorders, including abnormal sexual development, disturbances in menstruation and ovulation, and infertility ( 108 ). Furthermore, AIT presence in euthyroid women was associated with unexplained infertility, miscarriage, recurrent miscarriage, low fertilization rates, poor embryo quality in assisted reproductive technologies (ARTs), preterm delivery, and maternal post-partum thyroiditis ( 109 – 111 ). Anti-thyroid antibodies were detected in the ovarian follicular fluid of women with hypothyroidism at levels correlating with serum antibody levels, and their presence was associated with lower fertilization rates ( 96 ).…”

Section: Resultsmentioning

confidence: 99%

“…Anti-thyroid antibodies were detected in the ovarian follicular fluid of women with hypothyroidism at levels correlating with serum antibody levels, and their presence was associated with lower fertilization rates ( 96 ). PCOS was included among autoimmune-mediated disorders, such as endometriosis and premature ovarian failure ( 111 – 113 ). AIT presence was associated with unexplained infertility and implantation failure, irrespective of PCOS ( 114 ).…”

Section: Resultsmentioning

confidence: 99%

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Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature

Palomba,

Colombo,

Busnelli

et al. 2023

Front. Endocrinol.

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BackgroundPublished data on the relationship between polycystic ovary syndrome (PCOS) and thyroid dysfunction are sparse and confusing.ObjectiveTo comprehensively review data available in the literature regarding the relationship between PCOS and the thyroid function, and its abnormalities.MethodsNine main areas of interest were identified and analyzed according to the available evidence: 1) Evaluation of thyroid function for PCOS diagnosis; 2) Epidemiology data on thyroid function/disorders in patients with PCOS, and vice versa; 3) Experimental data supporting the relationship between thyroid function/disorders and PCOS; 4) Effects of thyroid function/disorders on PCOS features, and vice versa; 5) Effect of thyroid alterations on the cardiometabolic risk in women with PCOS; 6) Effect of thyroid abnormalities on reproductive outcomes in women with PCOS; 7) Relationship between thyroid function/abnormalities in patients with PCOS who are undergoing fertility treatment; 8) Effect of treatments for thyroid diseases on PCOS; and 9) Effect of treatments for PCOS on thyroid function. An extensive literature search for specific keywords was performed for articles published from 1970 to March 2023 using PubMed and Web of Science. Data were reported in a narrative fashion.ResultsPCOS is a diagnosis of exclusion for which diagnosis is possible only after excluding disorders that mimic the PCOS phenotype, including thyroid dysfunctions. However, the tests and the cutoff values used for this are not specified. Many experimental and clinical data suggest a relationship between perturbations of the thyroid function and PCOS. Direct and unequivocal evidence on the effects of thyroid function/disorders on PCOS features are lacking. High thyroid-stimulating hormone levels and subclinical hypothyroidism may be associated with significant worsening of several intermediate endpoints of cardiometabolic risk in women with PCOS. Thyroid abnormalities may worsen reproductive outcomes, especially in patients undergoing fertility treatment. To date, there are no data demonstrating the efficacy of thyroid medications on fertility and cardiometabolic risk in women with PCOS. Lifestyle modification changes, metformin, and vitamin D seem to improve thyroid function in the general population.ConclusionPCOS and thyroid disorders are closely related, and their coexistence may identify patients with a higher reproductive and metabolic risk. Regular screening for thyroid function and thyroid-specific autoantibodies in women with PCOS, particularly before and during pregnancy, is highly recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature

Palomba,

Colombo,

Busnelli

et al. 2023

Front. Endocrinol.

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“…According to the European Thyroid Association’s most recent recommendation for thyroid hormone suppression in TAI-positive patients is that TSH levels should remain below 2.5 µIU/mL, before IVF treatment is initiated. In contrast, variation in TSH levels within the normal range is not associated with pregnancy and delivery rates in women without autoimmune thyroid disease who underwent IVF treatment [22]. Thyroid hormone treatment of TAI-negative euthyreoid infertile women is not recommended before IVF treatment [13].…”

Section: Discussionmentioning

confidence: 99%

Hashimoto’s Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study

Herman,

Török,

Laganà

et al. 2024

Gynecol Obstet Invest

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Objective: To analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of ICSI cycles as compared to TAI negative ICSI cycles. Design: In this single IVF center retrospective study 86 infertile women with elevated TPOAb or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR) and live birth rate (LBR) were analyzed. Materials, Setting, Methods: All subjects with various infertility factors were treated with ICSI in university based IVF center. Patients in the study group received thryroxine replacement and were euthyreoid at IVF treatment. Before the IVF cycles endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (AMH, FSH, LH, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0-60-120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age adjusted analyses of FR, CPR, MR and LBR were performed. Results: TAI positive women were older (mean age 35.31±4.95 vs. 32.15±4.87 years; p=0.002), had higher FSH (8.4±3.4 vs. 7.4±2.32 U/L; p=0.024), higher E2 (53.94±47.61 vs. 42.93±18.92 pg/ml; p=0.025) levels, while AMH (2.88±2.62 vs. 3.61±1.69 ng/ml; p=0.0002) was lower. There were no differences in TSH levels (1.64±0.96 vs. 1.66±0.65 uIU/ml; p=0.652) between the two groups. FT3 (2.63±0.58 vs. 2.98±0.55 pg/ml; p=0.002) was lower and FT4 (1.3±0.29 vs. 1.13±0.21 ng/dl; p=0.0002) was higher in the TAI positive group, reflecting clinically irrevelant differences. Egg cell counts (6±3.8 vs. 7.5±3.95; p=0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9 % vs. 69.1 %, p=0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04 % vs. 69.56 %; p<0.001), LBR (23.25 % vs. 60.86 %; p<0.001) were lower, the MR (35.48 % vs. 12.5 %; p=0.024) was higher in the TAI group and these differences remained after age adjustment. Limitations: Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. Conclusion: Despite optimal thyroid supplementation in clinical or subclinical hypothyreoidism, the presence of TAI negatively influences clinical pregnancy rate and is connected to a higher miscarriage rate, thus resulting in a lower live birth rate after ICSI. Decreased fertilization rate with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.

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“…In the same way, a more recent study of women without infertility found a negative association between TPOAbs levels and natural conception rates [ 158 ]. Investigating the impact of TSH levels versus those of autoimmunity, d’Assunção et al identified no differences in pregnancy rates among infertile women with AITD undergoing IVF when comparing ‘low’ vs. ‘high’ TSH (<2.5 vs. >2.5 mU/L) [ 159 ], suggesting that autoimmune destruction rather than reduced serum TSH links thyroid and reproductive pathologies.…”

Section: Thyroid Hormones and Reproductive Physiologymentioning

confidence: 99%

The Thyroid Hormone Axis and Female Reproduction

Brown

Obeng-Gyasi

Hall

et al. 2023

IJMS

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Thyroid function affects multiple sites of the female hypothalamic-pituitary gonadal (HPG) axis. Disruption of thyroid function has been linked to reproductive dysfunction in women and is associated with menstrual irregularity, infertility, poor pregnancy outcomes, and gynecological conditions such as premature ovarian insufficiency and polycystic ovarian syndrome. Thus, the complex molecular interplay between hormones involved in thyroid and reproductive functions is further compounded by the association of certain common autoimmune states with disorders of the thyroid and the HPG axes. Furthermore, in prepartum and intrapartum states, even relatively minor disruptions have been shown to adversely impact maternal and fetal outcomes, with some differences of opinion in the management of these conditions. In this review, we provide readers with a foundational understanding of the physiology and pathophysiology of thyroid hormone interactions with the female HPG axis. We also share clinical insights into the management of thyroid dysfunction in reproductive-aged women.

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Effect of thyroid function on assisted reproduction outcomes in euthyroid infertile women: A single center retrospective data analysis and a systematic review and meta-analysis

Cited by 10 publications

References 51 publications

Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature

Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature

Hashimoto’s Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study

The Thyroid Hormone Axis and Female Reproduction

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