Elevated serum thyroid-stimulating hormone is associated with decreased anti-Müllerian hormone in infertile women of reproductive age

Abstract

Purpose Thyroid dysfunction and autoimmune thyroiditis are associated with fertility in women of reproductive age. AntiMüllerian hormone (AMH), a known biomarker of ovarian function, may be affected by impaired thyroid function; however, the relationship between AMH and thyroid hormone has not been elucidated. Methods In this case-control study, to identify the impact of thyroid hormone on ovarian reserve, we recruited 67 consecutive Japanese infertile patients and 27 normal fertile women aged 30-39 years without impact factors on thyroid and ovarian functions between 2012 and 2013. We assessed patient age, BMI and AMH, prolactin, TSH and FT4 levels of all study participations as independent variables. To evaluate the relationship between AMH and thyroid hormone, we matched patients by age and body mass index as confounding factors using 1:1 matching for statistical analysis of healthy fertile women and infertile patients and obtained 23 pairs. Then, independent variables were subjected to multiple regression analysis.Results Multiple regression analysis showed that both thyroid-stimulating hormone (TSH) levels and patient age were negatively correlated with AMH levels in infertile patients (patient age and TSH: standardized partial regression coefficient (β), −0.534 and −0.361; p=0.003 and 0.036, respectively), but not in normal fertile women. Conclusions AMH levels were inversely correlated with TSH levels in infertile women of reproductive age.

Levothyroxine supplementation improves serum anti‐Müllerian hormone levels in infertile patients with Hashimoto’s thyroiditis

“…We enrolled 174 infertile patients with high TSH levels, excluding women with factors impacting thyroid and ovarian function. According to previous reports, an increased serum TSH level is associated with diminished ovarian reserve in infertile women . We speculated that LT4 replacement adequately suppresses excess TSH secretion, leading to an improvement in impaired ovarian function and AMH level in patients with subclinical hypothyroidism.…”

“…In particular, an aberrant increased serum TSH level is associated with a high prevalence of diminished ovarian reserve in infertile women . In infertile women, the TSH level is inversely correlated with anti‐Müllerian hormone (AMH), which is produced by granulosa cells of primary developing follicles and is a known biomarker of ovarian function, excluding those with factors impacting on thyroid and ovarian function . In in vivo research, hypothyroidism has an adverse effect on folliculogenesis, granulosa cell differentiation and steroidogenesis .…”

Comparisons and correlations of anti mullerian hormone and thyroid stimulating hormones in fertile and subfertile women

“…This study findings are well in line with the previous studies on relation between AMH and primordial follicle count. 6,9 These studies revealed an inverse correlation between TSH and AMH levels in infertile women with decreased ovarian function without other factors affecting thyroid and ovarian function. 6,9 Cramer et al showed that TSH acts as predictor of fertilization failure in women undergoing IVF.…”

“…Cases were chosen from patients who visited the fertility outpatient clinic at the department of Obstetrics and Gynaecology of S.V.S Medical and Hospital and were diagnosed as infertile according to the previously established criteria were recruited into this study. 6 We also consecutively recruited 30 age matched normal fertile women aged 21 -35 years. They had no history of treatment for infertility or thyroid disorders.…”

“…Therefore, TSH may be a factor influencing ovarian reserve in infertile patients. 6 The reproductive aging process is thought to be dominated by a gradual decrease in both the quantity and the quality of the oocytes in the ovarian cortex. It is clear that monthly fecundity gradually decreases from the mean age of 30 year onward.…”