Impact of thyroid autoimmunity in euthyroid women on live birth rate after IUI

Unuane, David; Velkeniers, Brigitte; Bravenboer, Bert; Drakopoulos, Panagiotis; Tournaye, Herman; Parra, Javier; Brucker, Michael De

doi:10.1093/humrep/dex033

Cited by 45 publications

(61 citation statements)

References 20 publications

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“…Since IUI theoretically exposes fertilized eggs to underlying autoimmune conditions in order to achieve gestation, we speculate that IUI is more likely to be affected by TAI than by ART. Only one previous report has evaluated the association between IUI and TAI [45]. It showed no relation between TPOAb positivity and pregnancy outcomes in women undergoing IUI, but TPOAb titers were not evaluated.…”

Section: Discussionmentioning

confidence: 98%

The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study

et al. 2020

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Thyroid dysfunction and thyroid autoimmunity (TAI) have been reported to be linked to infertility, pregnancy loss and preterm birth. Infertile women undergoing assisted reproductive technology are recommended to maintain thyroid stimulating hormone (TSH) levels below 2.5 μIU/mL. It is unclear, however, whether levothyroxine (L-T4) treatment decreases the effects of TAI on fertility and pregnancy outcome in infertile women. We therefore aimed to clarify the influence of TAI on pregnancy undergoing L-T4 treatment for hypothyroidism. Prospectively recruited to this study were the 595 infertile women who visited the Utsunomiya Ladies Clinic between January 2013 and December 2015. Five patients with Graves' disease were excluded. Clinical profiles of 590 women were as follows: proportion of SCH = 19.6%, thyroid peroxidase antibody (TPOAb) positivity = 10.4%, and thyroglobulin antibody (TgAb) positivity = 15.1%. Fertility was not affected by any thyroid-associated factors. Regarding pregnancy outcomes, TPOAb titers were significantly higher in women who had miscarriage than in those progressed to delivery (46.4 ± 114.1 vs. 18.9 ± 54.6 IU/mL, p = 0.039), notably in those undergoing intrauterine insemination (p = 0.046) and in vitro fertilization (p = 0.023). Multivariate logistic regression analysis revealed that higher age (odds ratio 26.4, p < 0.001) and higher TPOAb titer (odds ratio 11.8, p = 0.043) were risk factors for miscarriage. Higher TPOAb titer should be considered as one of the risk factors for miscarriage in infertile women, even if they have been treated with L-T4 for hypothyroidism.

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Section: Discussionmentioning

confidence: 98%

The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study

et al. 2020

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“…Thyroid autoimmunity is more common in women with infertility and recurrent pregnancy loss, and about a fifth of untreated antibody‐positive women develop an elevated TSH during the course of pregnancy indicating a degree of thyroid hormone deficiency. Observational studies have shown an increased risk of miscarriages, preterm birth and child neuro‐intellectual deficits in pregnant women with thyroid antibodies (TPOAb) although this association was not confirmed in some studies . However, the results of meta‐analyses support an overall increased risk of pregnancy loss in association with maternal thyroid autoimmunity in spontaneous as well as assisted pregnancies .…”

Section: Euthyroid Thyroid Autoimmunitymentioning

confidence: 98%

Preconception management of thyroid dysfunction

Okosieme

Khan

Taylor

2018

Clinical Endocrinology

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Uncorrected thyroid dysfunction in pregnancy has well-recognized deleterious effects on foetal and maternal health. The early gestation period is one of the critical foetal vulnerability during which maternal thyroid dysfunction may have lasting repercussions. Accordingly, a pragmatic preconception strategy is key for ensuring optimal thyroid disease outcomes in pregnancy. Preconception planning in women with hypothyroidism should pre-empt and mirror the adaptive changes in the thyroid gland by careful levothyroxine dose adjustments to ensure adequate foetal thyroid hormone delivery in pregnancy. In hyperthyroidism, the goal of preconception therapy is to control hyperthyroidism while curtailing the unwanted side effects of foetal and maternal exposure to antithyroid drugs. Thus, pregnancy should be deferred until a stable euthyroid state is achieved, and definitive therapy with radioiodine or surgery should be considered in women with Graves' disease planning future pregnancy. Women with active disease who are imminently trying to conceive should be switched to propylthiouracil either preconception or at conception in order to minimize the risk of birth defects from carbimazole or methimazole exposure. Optimal strategies for women with borderline states of thyroid dysfunction namely subclinical hypothyroidism, isolated hypothyroxinaemia and thyroid autoimmunity remain uncertain due to the dearth of controlled interventional trials. Future trial designs should aspire to recruit and initiate therapy before conception or as early as possible in pregnancy.

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“…In a retrospective cohort study of 300 However, three studies reported no difference in ART outcomes between women with and without thyroid autoimmunity (46,47). In a retrospective cohort study of 3,143 euthyroid patients undergoing intrauterine insemination (IUI), among the 376 women who went on to conceive, Unuane et al reported no difference in live birth rates between TPOAb positive and TPOAb negative women, 86% (19/22) vs. 82% (201/354), respectively, OR 1.05, CI 0.76-1.47 (46). In a retrospective cohort study of 123 infertile, euthyroid women undergoing IVF or IVF with ICSI, 29 with thyroid autoimmunity and 94 without, Andrisani et al also reported no difference in implantation rates, 15 vs. 19%, P > 0.05 (exact cycle numbers not available), pregnancy rates, 29 vs. 34%, P > 0.05 (exact cycle numbers not available) or ongoing pregnancy rates, 26 vs. 31%, P > 0.05 (exact cycle numbers not available), although they did report significantly fewer grade 1 embryos collected in patients with antibody positivity, 22% (26/119) vs. 45% (176/394), P < 0.001 (47).…”

Section: C) Autoimmunity and Preterm Delivery (Question 19)mentioning

confidence: 98%

“…Based on the studies published since the 2017 ATA Guidelines, no alteration of the Guidelines are indicated, but further investigation is warranted. Five studies examined the association between thyroid autoimmunity and outcomes of ART (46)(47)(48)(49)(50). Two studies reported a negative association between thyroid autoimmunity and outcomes after ART (48)(49)(50).…”

Section: C) Autoimmunity and Preterm Delivery (Question 19)mentioning

confidence: 99%

“…Two studies reported a negative association between thyroid autoimmunity and outcomes after ART (48)(49)(50). In a retrospective cohort study of 300 However, three studies reported no difference in ART outcomes between women with and without thyroid autoimmunity (46,47). In a retrospective cohort study of 3,143 euthyroid patients undergoing intrauterine insemination (IUI), among the 376 women who went on to conceive, Unuane et al reported no difference in live birth rates between TPOAb positive and TPOAb negative women, 86% (19/22) vs. 82% (201/354), respectively, OR 1.05, CI 0.76-1.47 (46).…”

Section: C) Autoimmunity and Preterm Delivery (Question 19)mentioning

confidence: 99%

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The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum

2020

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Background: The American Thyroid Association Guidelines on Thyroid Disease During Pregnancy and the Postpartum (ATA Guidelines) were published in 2017, with an update not expected for another 5 years. Since release of the 2017 ATA Guidelines, greater than 500 articles have been published in the field. Furthermore, there are presently 14 prospective, interventional trials in progress registered at Clinicaltrials.gov Static guidelines updated every 5-7 years fail to provide timely evidence-based guidance to practicing clinicians. Consequently, guideline development should move toward the creation of dynamic documents. The present article reviews the literature published since the 2017 ATA Guidelines, both to benefit clinicians in practice and to make the case for Dynamic ATA Guidelines. Methods: Using the search terms "thyroid" and "pregnancy," a systematic review of literature published in Pubmed from 3/1/2017 to 12/31/2018 was conducted. The titles and/or abstracts of all articles were reviewed. All articles were classified by subject headings used in the 2017 ATA Guidelines. English-text articles classified under "hypothyroidism" or "thyroid autoimmunity" were examined in full-text. Using the questions and recommendations put forth by the previous ATA Guidelines, relevant articles were selected for discussion in this review. Results: At the time of the search, 659 unique articles on "thyroid and pregnancy" were identified, including 66 original studies on hypothyroidism and 26 on thyroid autoimmunity. Of these, 26 studies on hypothyroidism and 18 studies on thyroid autoimmunity were selected for inclusion in this review based on specific questions in the 2017 ATA Guidelines. Based on these 44 articles, we propose two specific changes to the 2017 ATA Guidelines. Conclusion: Based on new research, we recommend the 2017 ATA Guidelines be updated to recommend against treating thyroid antibody-negative women diagnosed Dong et al. Thyroid in Pregnancy Since 2017 with subclinical hypothyroidism in the second trimester or later; to reflect new, moderate-quality evidence supporting the treatment of thyroid peroxidase antibody-negative women with elevated thyroid stimulating hormone levels in the first trimester or earlier; and to recommend against treatment of euthyroid, thyroid peroxidase antibody-positive women undergoing assisted reproductive technology. Transitioning to a Dynamic ATA Guidelines would allow for these and future recommendations to be implemented in real time.

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Impact of thyroid autoimmunity in euthyroid women on live birth rate after IUI

Abstract: No external funding was used for this study. No conflicts of interest are declared.

Cited by 45 publications

References 20 publications

The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study

The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study

Preconception management of thyroid dysfunction

The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum

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