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甲状腺自身免疫对受精/卵胞浆内单精子注射结局和胎儿体重的影响。

Impact of Thyroid Autoimmunity on Fertilization/Intracytoplasmic Sperm Injection Outcomes and Fetal Weight.

机构信息

Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.

Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China.

出版信息

Front Endocrinol (Lausanne). 2021 Jul 8;12:698579. doi: 10.3389/fendo.2021.698579. eCollection 2021.

Abstract

Several studies have reported the association between thyroid autoimmunity (TAI) and fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes. However, the findings remain controversial. We performed a large-scale retrospective cohort study to verify the effect of the presence of thyroid antibodies on IVF/ICSI outcomes and fetal growth and to evaluate the association between the types and titers of thyroid antibodies and adverse IVF/ICSI outcomes. A total of 16481 patients with infertility were referred to the Reproductive Center of Peking University Third Hospital for their first IVF/ICSI treatment between January 2018 and June 2019.Patients who sought IVF/ICSI treatment due to tubal or male factors infertility and who achieved fresh embryo transfer were included in our study. Finally, 778 patients with thyroid antibody positivity were selected as the TAI group, and 778 age-matched patients were included in the control group. The number of oocytes retrieved and high-graded embryos and the rates of clinical pregnancy, miscarriage, live birth, and preterm delivery were compared between the TAI and control groups. In addition, subgroup analysis was performed to demonstrate whether different types and titers of thyroid antibodies had different effects on IVF/ICSI outcomes. After adjusting for thyroid function, anti-Müllerian hormone levels, basal follicle stimulating hormone levels, basal estradiol levels and antral follicle count, the number of oocytes retrieved in the TAI group was significantly lower than that in the control group. No significant differences were observed between the two groups in the rates of clinical pregnancy, miscarriage, preterm delivery, live birth, and birth weight in singletons; however, the birth weight in twin pregnancy was significantly lower in the TAI group than in the control group. Subgroup analysis showed no association between the types or titers of thyroid antibodies and adverse IVF/ICSI outcomes. In conclusion, the presence of TAI in patients with infertility did not impair embryo quality or affect pregnancy outcomes, including clinical pregnancy, miscarriage, preterm delivery, and live birth. However, it decreased the number of oocytes retrieved and birth weight in twin pregnancy.

摘要

一些研究报告了甲状腺自身免疫 (TAI) 与受精 (IVF)/卵胞浆内单精子注射 (ICSI) 结局之间的关系。然而,这些发现仍然存在争议。我们进行了一项大规模的回顾性队列研究,以验证甲状腺抗体的存在对 IVF/ICSI 结局和胎儿生长的影响,并评估甲状腺抗体的类型和滴度与不良 IVF/ICSI 结局之间的关系。

共有 16481 名不孕症患者于 2018 年 1 月至 2019 年 6 月在北京大学第三医院生殖中心接受首次 IVF/ICSI 治疗。本研究纳入了因输卵管或男性因素不孕而寻求 IVF/ICSI 治疗且实现新鲜胚胎移植的患者。最后,选择 778 例甲状腺抗体阳性患者作为 TAI 组,选择 778 例年龄匹配的患者作为对照组。比较 TAI 组和对照组的获卵数、优质胚胎数及临床妊娠率、流产率、活产率和早产率。此外,还进行了亚组分析,以表明不同类型和滴度的甲状腺抗体对 IVF/ICSI 结局是否有不同的影响。

调整甲状腺功能、抗苗勒管激素水平、基础卵泡刺激素水平、基础雌二醇水平和窦卵泡计数后,TAI 组的获卵数明显低于对照组。两组间临床妊娠率、流产率、早产率、活产率及单胎出生体重无显著差异;但 TAI 组双胎妊娠的出生体重明显低于对照组。亚组分析显示,甲状腺抗体的类型或滴度与 IVF/ICSI 不良结局之间无关联。

综上所述,不孕患者 TAI 的存在并不影响胚胎质量,也不影响妊娠结局,包括临床妊娠、流产、早产和活产。但会降低获卵数和双胎妊娠的出生体重。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c75/8296807/94ebebb7b214/fendo-12-698579-g001.jpg

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