Department of Reproductive Medicine and Child Development, Division of Obstetrics and Gynecology, University of Pisa, Via L. Settembrini 21, Pisa, Italy.
Am J Reprod Immunol. 2011 Aug;66(2):108-14. doi: 10.1111/j.1600-0897.2010.00961.x. Epub 2011 Jan 18.
The aim of this study was to verify whether anti-thyroid antibodies are present in the follicular milieu of euthyroid infertile women with thyroid autoimmunity undergoing in vitro fertilization (IVF) and whether IVF outcome is different in affected women with respect to negative controls. A secondary endpoint was to check whether there are changes in thyroid hormone levels during the IVF cycle.
Anti-thyroglobulin and anti-thyroperoxidase levels were measured in both follicular fluid and serum on the day of oocyte retrieval in women with thyroid autoimmunity. Serum TSH, FT3, and FT4 levels were measured in all patients before treatment initiation, on the day of oocyte retrieval and of pregnancy test. IVF outcome parameters were recorded in all women.
Oocyte fertilization, grade A embryos, and pregnancy rates were lower in women with thyroid autoimmunity than in negative controls, while early miscarriage rate was higher. Anti-thyroid antibodies were measurable in follicular fluid in all affected women and were strongly correlated with serum levels. No significant changes in thyroid hormone levels were recorded in any women.
The presence of anti-thyroid antibodies in ovarian follicles, as demonstrated for the first time in this study, may play a critical role in female infertility related to thyroid autoimmunity.
本研究旨在验证甲状腺自身免疫的甲状腺功能正常不孕女性在接受体外受精（IVF）时，滤泡微环境中是否存在抗甲状腺抗体，以及受影响的女性与阴性对照相比，IVF 结局是否存在差异。次要终点是检查甲状腺激素水平在 IVF 周期中是否发生变化。
在甲状腺自身免疫的女性取卵日，同时测量滤泡液和血清中的抗甲状腺球蛋白和抗甲状腺过氧化物酶水平。所有患者在治疗前、取卵日和妊娠试验日测量血清 TSH、FT3 和 FT4 水平。所有女性均记录 IVF 结局参数。
与阴性对照组相比，甲状腺自身免疫的女性卵子受精率、A级胚胎率和妊娠率较低，而早期流产率较高。在所有受影响的女性中，均可在滤泡液中检测到抗甲状腺抗体，且与血清水平呈强相关。在任何女性中均未记录到甲状腺激素水平的显著变化。
本研究首次证明，卵巢滤泡中存在抗甲状腺抗体可能在与甲状腺自身免疫相关的女性不孕中发挥关键作用。
