IVF/ICSI outcomes of euthyroid infertile women with thyroid autoimmunity: does treatment with aspirin plus prednisone matter?

Abstract

Background Thyroid autoimmunity (TAI) has been demonstrated to be associated with adverse pregnancy including recurrent miscarriage, unexplained infertility, and implantation failure. To settle with the fertility problem, prescribing aspirin combined with prednisone (P + A) to women positive for anti-thyroid antibodies is frequent in clinical practice, but the underlying effect remains controversial. Methods A multicenter, retrospective study was conducted in three reproductive centers from 2017 to 2020. A total of 494 euthyroid infertile women were recruited who were positive for anti-thyroperoxidase and/or thyroglobulin antibodies (TPOAb and TgAb, respectively) with thyroid-stimulating hormone (TSH) levels ranging 0.35-4.0mIU/L and underwent their first in vitro fertilization and embryo transfer (IVF-ET) cycle. Ultimately, 346 women were included of which 150 women were treated with prednisone (10 mg/d) and aspirin (100 mg/d). The remaining 196 women were untreated (control group). Treatment started on the day of embryo transfer and continued until clinical pregnancy was determined. Results The clinical pregnancy rate was 57.5% vs. 63.5% in the control and treated groups (P = 0.414) for first fresh embryo transfer cycles and 57.8% vs. 61.8% for frozen-thawed embryo transfer cycles (P = 0.606). In addition, the live birth rate for the fresh embryo transfer was 49.6% vs. 47.3% in the control and treated groups (P = 0.762). Logistic regression revealed that aspirin plus prednisone did not improve the clinical pregnancy rate or miscarriage rate. Furthermore, it was observed that low free triiodothyronine (FT3) was associated with high miscarriage rates. Conclusions Utilizing an adjuvant treatment of P + A after the embryo transfer may not be necessary in euthyroid women with thyroid autoimmunity undergoing their first IVF-ET, regardless of the embryo type (fresh or frozen).

The impact of thyroid autoimmunity on pregnancy outcomes in women with unexplained infertility undergoing intrauterine insemination: a retrospective single-center cohort study and meta-analysis

“…Furthermore, combination therapy with prednisolone enhances clinical pregnancy rates and reduces miscarriage rates in women with TAI undergoing IVF ( 50 ). However, a study involving women with TAI who underwent IVF/ICSI indicated that adjunctive therapy with aspirin and prednisone after embryo transfer may not be necessary for fresh or frozen embryos ( 51 ). This finding demonstrates that targeted pharmacological interventions may prove advantageous in improving reproductive outcomes among patients with TAI.…”

The impact of gut microbiota on autoimmune thyroiditis and relationship with pregnancy outcomes: a review

“…also confirmed that LT 4 treatment did not reduce miscarriage rates or increase live birth rates in women undergoing in vitro fertilization embryo transfer (IVF-ET) with intact thyroid function and positive TPOAb ( Wang et al., 2017 ). The use of glucocorticoids and aspirin as adjunctive therapies in euthyroid women with AITD undergoing IVF-ET may not improve pregnancy or live birth rates either ( Zhou et al., 2022 ).…”

The effect of levothyroxine and prednisolone treatment on pregnancy in in vitro fertilization patients with positive thyroid autoantibodies

“…2,6 Treatment of fertilization problems caused by thyroid disorders and thyroid autoimmune diseases that reduce thyroid reserve and lead to in vitro fertilization (IVF) cycle failures have been the focus of many studies on this topic. [7][8][9][10] Immunological factors are essential in fertilization, implantation, and placental development, and infertility has been associated with thyroid autoimmunity. 6,[11][12][13] In infertile women, hypothyroidism is observed in 2% to 4% of cases compared to other populations, and up to twofold more thyroid autoantibodies were found in the infertile group than in the control patients (14% vs. 8%).…”

“…Treatment of fertilization problems caused by thyroid disorders and thyroid autoimmune diseases that reduce thyroid reserve and lead to in vitro fertilization (IVF) cycle failures have been the focus of many studies on this topic 7–10 . Immunological factors are essential in fertilization, implantation, and placental development, and infertility has been associated with thyroid autoimmunity 6,11–13 .…”