Zhang Yuchao, Peng Jia, Liu Yanli, Wu Wenbin, Wang Xingling, Jia Liting, Guan Yichun
Department of Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, No. 7 Kangfuqian Street, Erqi, Zhengzhou, 45005, Henan, China.
Antenatal Diagnostic Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Reprod Sci. 2022 Sep;29(9):2440-2451. doi: 10.1007/s43032-021-00594-3. Epub 2021 May 10.
The role of high-normal thyroid-stimulating hormone levels has been of great concern recently. However, the conclusions of different studies are inconsistent. To assess whether high-normal conditions have an impact on reproductive and obstetric outcomes in euthyroid women undergoing ART treatment, a systematic review and meta-analysis was performed. Eligible studies published up to December 30, 2020, were searched from the PubMed, EMBASE, COCHRANE, and CNKI databases. Quality assessment of the included studies, data extraction, and synthesis were performed separately. RevMan 5.2 was used to carry out the meta-analysis. A total of 23 studies that included 25,143 patients were included. We observed similar clinical pregnancy rates (RR = 1.01, 95% CI: 0.99-1.05), miscarriage rates (RR = 0.95, 95% CI: 0.84-1.08), live birth rates (RR = 1.04, 95% CI: 0.99-1.09), birth weights (SMD = 0.07, 95% CI: -0.02 to 0.16), and gestational ages (SMD = 0.07, 95% CI: -0.02 to 0.16) between the high-normal TSH group and low TSH group. Subgroup analysis showed similar results. High-normal TSH levels were associated with similar clinical pregnancy rates, live birth rates, and miscarriage rates to those of women with low TSH levels. The results suggested that preconceptional TSH levels, regardless of potentially being affected by the controlled ovarian stimulation process, had little impact on reproductive and obstetric outcomes and should not be of great concern.
近期，促甲状腺激素（TSH）水平处于略高于正常范围的情况备受关注。然而，不同研究得出的结论并不一致。为评估TSH水平略高于正常范围的情况对接受辅助生殖技术（ART）治疗的甲状腺功能正常女性的生殖及产科结局是否有影响，我们进行了一项系统综述和荟萃分析。从PubMed、EMBASE、COCHRANE和中国知网数据库中检索截至2020年12月30日发表的符合条件的研究。对纳入研究分别进行质量评估、数据提取和合成。使用RevMan 5.2进行荟萃分析。共纳入23项研究，涉及25143例患者。我们观察到，TSH水平略高于正常范围组与低TSH水平组之间的临床妊娠率（风险比[RR]=1.01，95%置信区间[CI]：0.99 - 1.05）、流产率（RR = 0.95，95% CI：0.84 - 1.08）、活产率（RR = 1.04，95% CI：0.99 - 1.09）、出生体重（标准化均数差[SMD]=0.07，95% CI： - 0.02至0.16）以及孕周（SMD = 0.07，95% CI： - 0.02至0.16）相似。亚组分析显示了类似结果。TSH水平略高于正常范围与低TSH水平女性的临床妊娠率、活产率和流产率相似。结果表明，孕前TSH水平，无论是否可能受到控制性卵巢刺激过程的影响，对生殖及产科结局影响不大，不应过度关注。
