Thyroid autoantibodies per se do not impair intracytoplasmic sperm injection outcome in euthyroid healthy women

Abstract

Objective: Autoimmune thyroid disease (AITD) has been associated with adverse pregnancy outcomes in subfertile women with spontaneous and assisted reproductive technology-induced pregnancies. The underlying pathophysiology is still elusive and an association with thyroid dysfunction or other infertility causes is discussed. However, whether thyroid autoimmunity (TAI) per se has a negative impact on female fertility has not yet been clarified. In this study, we investigated whether TAI in healthy women undergoing intracytoplasmic sperm injection (ICSI) for male infertility may affect pregnancy outcome. Design: A retrospective, single-centre study. Methods: The ICSI outcome data obtained from 835 euthyroid women (age: 31.4G4.3 years, BMI: 23.7G4.2 kg/m 2 ) were correlated with pre-ICSI TAI status. The known causes of female subfertility were excluded. Outcome parameters included rates of pregnancy, birth, miscarriage and preterm delivery. Blood analysis was carried out retrospectively using blood samples drawn before ICSI. TAI was defined by elevation of anti-thyroperoxidase-or anti-thyroglobulin-antibodies O100 U/l. Results: TAI-positive and -negative groups did not differ in age, BMI or TSH levels. TAI status did not influence any ICSI outcome parameters. In contrast, increasing maternal age was significantly correlated with lower pregnancy rate (odds ratio (OR): 0.94 (95% CI: 0.91-0.97); PZ0.0003) and birth rate (OR: 0.93 (95% CI: 0.09-0.97); P!0.0001). Conclusions: Our study suggests that TAI per se does not influence ICSI outcome. A strict definition of AITD and TAI and consideration of TAI-associated and -independent confounders are important to further elucidate the interplay between TAI and reproduction.

The impact of thyroid autoantibodies on the cycle outcome and embryo quality in women undergoing intracytoplasmic sperm injection

“…However, a recent metaanalysis by Poppe et al failed to demonstrate this effect (OR = 0.95, p = 0.31) [25]. The total events and studies [19,27].…”

“…We also did not find any significant differences between ATA-positive and ATAnegative patients regarding the ongoing pregnancy rate. Some studies assessed the live birth rate, and most of them did not establish any significant difference in ATA-positive patients in comparison with ATA-negative patients [23,25,27]. Conversely, a meta-analysis reported a lower live birth rate with an OR = 0.65 (p = 0.004) in thyroid autoimmunity [24].…”

“…We have included more than one indication for ART cycles. Tan et al restricted their population with male factor infertility, and they stated that it might avoid the selection bias [27]. However, we know that ICSI procedure is particularly successful in male factor infertility, so it may be considered another selection bias for this situation.…”

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

“…They presented a plea for further research that would look at the process of fertilization aiming at discovering other factors related to it. Tan et al [45] have looked at the outcome of ICSI in relation to thyroid antibodies and found that serology results did not affect the process of ICSI. This study included a series of 835 women.…”

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

“…A randomized controlled trial by Negro et al (2010) first reported that levothyroxine (L-T4) intervention that fertilization, pregnancy rate and live birth rate are lower in TPOAb-positive infertile women undergoing ART, but others do not [15][16][17][18]. TAI is associated with hypothyroidism, so it is unclear whether TAI itself or the subsequent thyroid dysfunction adversely affects pregnancy.…”