促甲状腺激素对甲状腺功能正常的多囊卵巢综合征患者体外受精中卵母细胞成熟的影响。
Effect of TSH on oocyte maturation of PCOS patients with normal thyroid function in IVF.
机构信息
Department of Human Reproductive Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
Hubei Clinical Research Center for Reproductive Medicine, Shiyan, Hubei, China.
出版信息
Reprod Biol Endocrinol. 2022 Sep 2;20(1):133. doi: 10.1186/s12958-022-01005-1.
BACKGROUND
The serum TSH level of PCOS patients was higher than that of the general female population. For patients with thyroid dysfunction, the abnormal TSH level is negatively related to the outcomes of assisted reproductive technology, but for PCOS patients with normal thyroid function, the effect of TSH level on outcomes of in vitro fertilization has not been reported. In this study, PCOS patients with normal thyroid function were included in this study to evaluate the effect of TSH on the outcomes of IVF-ET.
METHODS
A retrospective cohort study was conducted to analyze the clinical data of 3190 patients who underwent IVF-ET in the Department of Human Reproductive Center of Renmin Hospital Hubei University of Medicine from January 2017 to July 2021, including 594 PCOS patients and 2595 non PCOS patients. The IVF-ET outcomes between the two groups were compared; Multi-factor linear regression analysis was used to analyze the correlation between the related variables and the oocyte maturation of PCOS patients; The ROC curve of the effect of TSH on oocyte maturation in PCOS patients was drawn. The PCOS patients were divided into TSH < 2.98 group (n = 454) and TSH ≥ 2.98 group (n = 141) according to ROC threshold TSH 2.98, and the outcomes were compared.
RESULTS
TSH level in PCOS group was significantly higher than that in non-PCOS group (2.42 ± 0.86 vs 2.00 ± 0.89 UU / ml, P < 0.01), and the oocyte maturation rate and 2PN fertilization rate in PCOS group were lower than those in non-PCOS group (90.9% vs 92.4%, P = 0.02) (84.57% vs 86.77%, P = 0.02). There was no significant difference in cleavage rate and high-quality embryo rate between the two groups (P > 0.05); There was no difference in clinical pregnancy rate, abortion rate, ectopic pregnancy rate and live birth rate between the two groups (P > 0.05). Multi-factor linear regression analysis showed that TSH was negatively correlated with oocyte maturation in PCOS patients [β = -0.124, P = 0.013,95%CI (-0.027 ~ -0.003)]; The oocyte maturation rate in TSH < 2.98 group was significantly higher than that in TSH ≥ 2.98 group (91.7% vs 88.2%, P = 0.001).
CONCLUSION
The TSH level of PCOS patients with normal thyroid function is higher than that of normal people, and it is negatively correlated with the oocyte maturation in in-vitro fertilization. The ROC curve showed that when TSH > 2.98uIU/ml, the possibility of immature oocytes was higher (specificity 28.9%, sensitivity 83.0%).
背景
多囊卵巢综合征（PCOS）患者的血清促甲状腺激素（TSH）水平高于一般女性人群。对于甲状腺功能异常的患者，异常的 TSH 水平与辅助生殖技术的结局呈负相关，但对于甲状腺功能正常的 PCOS 患者，TSH 水平对体外受精（IVF）结局的影响尚未报道。本研究纳入甲状腺功能正常的 PCOS 患者，评估 TSH 对 IVF-ET 结局的影响。
方法
回顾性队列研究分析了 2017 年 1 月至 2021 年 7 月在湖北医药学院人民医院生殖中心接受 IVF-ET 的 3190 例患者的临床资料，包括 594 例 PCOS 患者和 2595 例非 PCOS 患者。比较两组患者的 IVF-ET 结局；采用多因素线性回归分析 PCOS 患者相关变量与卵母细胞成熟的相关性；绘制 TSH 对 PCOS 患者卵母细胞成熟影响的 ROC 曲线。根据 ROC 曲线 TSH 2.98 的阈值，将 PCOS 患者分为 TSH<2.98 组（n=454）和 TSH≥2.98 组（n=141），比较两组患者的结局。
结果
PCOS 组 TSH 水平明显高于非 PCOS 组（2.42±0.86 vs 2.00±0.89 UU/ml，P<0.01），PCOS 组卵母细胞成熟率和 2PN 受精率低于非 PCOS 组（90.9% vs 92.4%，P=0.02）（84.57% vs 86.77%，P=0.02）。两组患者的卵裂率和优质胚胎率无差异（P>0.05）；两组患者的临床妊娠率、流产率、异位妊娠率和活产率无差异（P>0.05）。多因素线性回归分析显示，TSH 与 PCOS 患者的卵母细胞成熟呈负相关[β=-0.124，P=0.013，95%CI（-0.027~-0.003）]；TSH<2.98 组患者的卵母细胞成熟率明显高于 TSH≥2.98 组（91.7% vs 88.2%，P=0.001）。
结论
甲状腺功能正常的 PCOS 患者的 TSH 水平高于正常人，与体外受精中的卵母细胞成熟呈负相关。ROC 曲线显示，当 TSH>2.98uIU/ml 时，不成熟卵母细胞的可能性更高（特异性 28.9%，敏感性 83.0%）。
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