Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Illinois College of Medicine, 820 South Wood St., Chicago, IL 60612-7313, USA.
Thyroid. 2012 Jun;22(6):631-6. doi: 10.1089/thy.2011.0343. Epub 2012 Apr 27.
Untreated hypothyroidism can lead to ovulatory dysfunction resulting in oligo-amenorrhea. Treatment with levothyroxine can reverse such dysfunction and thus should improve fertility. The purpose of this retrospective study was to assess whether in vitro fertilization (IVF) pregnancy rates differ in levothyroxine-treated women with hypothyroidism compared to women without thyroid dysfunction/disorders.
Treated hypothyroid and euthyroid women undergoing IVF at an academic IVF center were studied after Institutional Review Board approval. Women with hypothyroidism were treated with levothyroxine 0.025-0.15 mg/day for at least 3 months to maintain baseline thyrotropin (TSH) levels of 0.35-4.0 μU/mL prior to commencing IVF treatment (HYPO-Rx group). Causes of infertility were similar in both groups with the exception of male factor, which was more common in the HYPO-Rx group. The main outcomes studied were implantation rate, clinical pregnancy rate, clinical miscarriage rate, and live birth rate.
We reviewed the first IVF retrieval cycle performed on 240 women aged 37 years or less during the period January 2003 to December 2007. Women with treated hypothyroidism (n=21) had significantly less implantation, clinical pregnancy, and live birth rates than euthyroid women (n=219).
We conclude that, despite levothyroxine treatment, women with hypothyroidism have a significantly decreased chance of achieving a pregnancy following IVF compared to euthyroid patients. A larger prospective study is necessary to assess confounding variables, confirm these findings, and determine the optimal level of TSH prior to and during controlled ovarian hyperstimulation for IVF.
未经治疗的甲状腺功能减退症可导致排卵功能障碍，导致寡排卵和闭经。甲状腺素替代治疗可逆转这种功能障碍，从而改善生育能力。本回顾性研究的目的是评估甲状腺功能减退症患者接受甲状腺素治疗与无甲状腺功能障碍/疾病的患者相比，体外受精（IVF）的妊娠率是否不同。
在机构审查委员会批准后，对在学术性 IVF 中心接受 IVF 的治疗性甲状腺功能减退症和甲状腺功能正常的女性进行研究。甲状腺功能减退症患者接受甲状腺素替代治疗，每日 0.025-0.15mg，至少 3 个月，以使基线促甲状腺激素（TSH）水平在开始 IVF 治疗前维持在 0.35-4.0μU/ml（HYPO-Rx 组）。两组不孕的原因相似，除了男性因素，HYPO-Rx 组更为常见。主要研究结果是种植率、临床妊娠率、临床流产率和活产率。
我们回顾了 2003 年 1 月至 2007 年 12 月期间年龄在 37 岁以下的 240 名女性进行的第一次 IVF 取卵周期。接受治疗的甲状腺功能减退症患者（n=21）的种植率、临床妊娠率和活产率明显低于甲状腺功能正常的女性（n=219）。
尽管进行了甲状腺素治疗，但与甲状腺功能正常的患者相比，甲状腺功能减退症患者在接受 IVF 后妊娠的机会明显降低。需要进行更大的前瞻性研究，以评估混杂因素，证实这些发现，并确定在接受控制性卵巢刺激进行 IVF 之前和期间 TSH 的最佳水平。
