Zhou Danni, Deng Huali, Xia Min, Li Ruoqing, Ye Hong
Center for Reproductive Medicine, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Gynaecology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
Transl Pediatr. 2022 Aug;11(8):1301-1310. doi: 10.21037/tp-22-79.
Thyroid dysfunction is linked with adverse pregnancy outcomes, an upper limit of a normal thyroid-stimulating hormone (TSH) threshold of 4.12-4.5 mIU/L should be considered for subclinical hypothyroidism in the infertile female population. Whereas, it's controversial whether or not the infertility thresholds for upper limit of TSH threshold of 2.5 mIU/L. In our study examines the correlation of optimal TSH levels and clinical pregnancy outcomes after fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) embryo transfer cycles.
Patients who underwent fresh IVF/ICSI embryo transfer cycles for the first time who presented between January 1, 2015 and December 31, 2017 at the Chongqing Institute of Reproductive and Genetic, Chongqing Health Center for Women and Children were enrolled. We excluded patients with ≥40 years, body mass index (BMI) ≤18 or ≥28 kg/m, the man with severe oligoasthenospermia, women with poor ovarian reserve, and presence of endocrine disorders, uterine anomaly, sactosalpinx, abnormal thyroid function, preimplantation genetic diagnosis, and chromosomal abnormality or polymorphism. Baseline characteristics and clinical pregnancy outcomes were observed in our study. We detected between TSH levels and clinical pregnancy outcomes in patients undergoing IVF/ICSI by Receiver operating characteristic (ROC) curves and logical regression.
A total of 6,088 patients who undergo IVF/ICSI were included. We first detected that the live birth rate had a statistically significant difference when the TSH level was 3 mIU/L. With the TSH ≤3 mIU/L group having a higher live birth rate than the TSH >3 mIU/L group (51.79% 47.89%, P=0.024), meanwhile no significant difference were revealed between the early miscarriage rate (12.54% 14.97%, P=0.091) and early clinical pregnancy rate (59.21% 56.32%, P=0.114). There were no differences in pregnancy outcomes when the TSH threshold was at 3.5 or 4 mIU/L and no association was detected between TSH levels and clinical pregnancy outcomes in patients undergoing IVF/ICSI by ROC curves and logical regression.
Patients undergoing IVF/ICSI with a serum TSH level ≤3 mIU/L may have a higher live birth rate rather than ≤2.5 or ≤4 mIU/L.
甲状腺功能障碍与不良妊娠结局相关，对于不孕女性人群的亚临床甲状腺功能减退，应考虑将促甲状腺激素（TSH）正常阈值的上限设定为4.12 - 4.5 mIU/L。然而，TSH阈值上限为2.5 mIU/L是否为不孕的阈值存在争议。在我们的研究中，探讨了新鲜体外受精/卵胞浆内单精子注射（IVF/ICSI）胚胎移植周期后最佳TSH水平与临床妊娠结局的相关性。
纳入2015年1月1日至2017年12月31日期间在重庆市妇幼保健院生殖与遗传研究所首次接受新鲜IVF/ICSI胚胎移植周期的患者。我们排除了年龄≥40岁、体重指数（BMI）≤18或≥28 kg/m²、严重少弱精子症的男性、卵巢储备功能差的女性，以及存在内分泌疾病、子宫异常、输卵管积水、甲状腺功能异常、植入前基因诊断、染色体异常或多态性的患者。在我们的研究中观察了基线特征和临床妊娠结局。我们通过受试者工作特征（ROC）曲线和逻辑回归检测了接受IVF/ICSI患者的TSH水平与临床妊娠结局之间的关系。
共纳入6088例接受IVF/ICSI的患者。我们首先检测到当TSH水平为3 mIU/L时，活产率有统计学显著差异。TSH≤3 mIU/L组的活产率高于TSH>3 mIU/L组（51.79%对47.89%，P = 0.024），同时早期流产率（12.54%对14.97%，P = 0.091）和早期临床妊娠率（59.21%对56.32%，P = 0.114）之间无显著差异。当TSH阈值为3.5或4 mIU/L时，妊娠结局无差异，并且通过ROC曲线和逻辑回归未检测到接受IVF/ICSI患者的TSH水平与临床妊娠结局之间存在关联。
接受IVF/ICSI且血清TSH水平≤3 mIU/L的患者可能比TSH≤2.5或≤4 mIU/L的患者有更高的活产率。
