Coelho Neto Marcela de Alencar, Martins Wellington de Paula, Melo Anderson Sanches de, Ferriani Rui Alberto, Navarro Paula Andrea
Department of Obstetrics and Gynecology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (DGO-FRMP-USP), Ribeirão Preto, SP, Brazil.
Rev Bras Ginecol Obstet. 2016 Nov;38(11):552-558. doi: 10.1055/s-0036-1593986. Epub 2016 Nov 16.
Whether preconception elevated concentrations of thyroid-stimulating hormone (TSH) compromises reproductive outcomes in patients undergoing assisted reproduction techniques (ARTs) remains unclear. This study therefore compared the reproductive outcomes in patients with TSH concentrations of < 2.5 mIU/L, 2.5-4.0 mIU/L, and 4.0-10.0 mIU/L undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). This retrospective cohort study evaluated the medical records of all women with measured TSH concentrations who underwent IVF/ICSI between January 2011 and December 2012. The patients were divided into three groups: TSH < 2.5 mIU/L (group 1); THS ≥2.5 and < 4.0 mIU/L (group 2); and THS ≥4 mIU/L and < 10.0 mIU/L (group 3). Patients who were administered levothyroxine for treating hypothyroidism were excluded from the analysis. The primary endpoints were clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. During the study period, 787 women underwent IVF/ICSI. Sixty were excluded because their TSH concentrations were unavailable, and 77 were excluded due to their use of levothyroxine. The prevalence of patients presenting elevated concentrations of TSH was of 5.07% (using a TSH threshold of 4.0 mIU/L) and of 29.99% (using a TSH threshold of 2.5 mIU/L). Patient characteristics, type of COS, and response to COS did not differ among the three groups, and there were no differences in clinical pregnancy (24.4% versus 25.9% versus 24.2%, = 0.93); miscarriage (17.1% versus 14.3% versus 12.5%, = 0.93); live birth (20.2% versus 22.2% versus 21.2%, = 0.86); and multiple pregnancy rates (27.0% versus 21.4% versus 25.0%, = 0.90) respectively. Response to COS, live birth, and miscarriage rates were not altered in women with elevated concentrations of TSH undergoing IVF/ICSI, regardless of using a TSH threshold of 2.5 mIU/L or 4.0 mIU/L. These findings reinforce the uncertainties related to the impact of subclinical hypothyroidism on reproductive outcomes in women undergoing COS for ARTs.
孕前促甲状腺激素（TSH）浓度升高是否会影响接受辅助生殖技术（ART）患者的生殖结局仍不清楚。因此，本研究比较了促甲状腺激素浓度<2.5 mIU/L、2.5 - 4.0 mIU/L和4.0 - 10.0 mIU/L的患者在接受体外受精（IVF）/卵胞浆内单精子注射（ICSI）的控制性卵巢刺激（COS）时的生殖结局。 这项回顾性队列研究评估了2011年1月至2012年12月期间所有接受IVF/ICSI且测量了TSH浓度的女性的医疗记录。患者被分为三组：TSH<2.5 mIU/L（第1组）；TSH≥2.5且<4.0 mIU/L（第2组）；TSH≥4 mIU/L且<10.0 mIU/L（第3组）。接受左甲状腺素治疗甲状腺功能减退症的患者被排除在分析之外。主要终点是临床妊娠、流产、活产和多胎妊娠率。 在研究期间，787名女性接受了IVF/ICSI。60名女性因无法获得TSH浓度而被排除，77名女性因使用左甲状腺素而被排除。TSH浓度升高患者的患病率分别为5.07%（使用TSH阈值4.0 mIU/L）和29.99%（使用TSH阈值2.5 mIU/L）。三组患者的特征、COS类型和对COS的反应无差异，临床妊娠率（24.4%对25.9%对24.2%，P = 0.93）、流产率（17.1%对14.3%对12.5%，P = 0.93）、活产率（20.2%对22.2%对21.2%，P = 0.86）和多胎妊娠率（27.0%对21.4%对25.0%，P = 0.90）也无差异。 接受IVF/ICSI且TSH浓度升高的女性，无论使用TSH阈值2.5 mIU/L还是4.0 mIU/L，其对COS的反应、活产率和流产率均未改变。这些发现进一步证明了亚临床甲状腺功能减退症对接受ARTs的COS女性生殖结局影响的不确定性。
