Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2023 Aug 29;14:1159991. doi: 10.3389/fendo.2023.1159991. eCollection 2023.
Maternal hypothyroidism before and during pregnancy is associated with an increased risk of adverse pregnancy outcomes; many studies have evidenced that controlled ovarian hyperstimulation (COH) triggers a significant increase in the levels of TSH; however, no large-scale prospective studies have evaluated the impact of TSH levels after COH on assisted reproductive technology outcomes. The aim of this prospective study was to investigate whether fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes are affected by TSH levels after COH in women with fresh embryo transfer (ET).
A total of 664 patients who underwent IVF/ICSI treatment and received fresh ET at the Peking University Third Hospital were included in this study. The rates of clinical pregnancy, miscarriage, live birth, and preterm delivery were analyzed.
The patients were categorized into two groups based on serum TSH levels after COH (0.55 mIU/L < TSH < 2.5 mIU/L: n= 449, 2.5 mIU/L ≤ TSH ≤ 4.78 mIU/L: n= 215). There were no significant differences in the rates of clinical pregnancy, miscarriage, and live birth between the two groups, even after adjusting for age, body mass index (BMI), thyroid antibody positivity, and COH protocols. However, the preterm delivery rate was significantly higher in women with TSH < 2.5 mIU/L than in those with TSH ≥ 2.5 mIU/L, even after adjusting for relevant confounding factors. There was no significant difference in live birth weight between the two groups.
Mildly elevated TSH levels (TSH ≥ 2.5 mIU/L) after COH did not affect IVF/ICSI outcomes, and strict control of TSH levels within 2.5 mIU/L after COH might not be necessary. Additionally, strictly controlled TSH levels (TSH < 2.5 mIU/L) may increase preterm delivery risk.
妊娠前和妊娠期间母体甲状腺功能减退与不良妊娠结局风险增加相关；许多研究表明，控制性卵巢过度刺激（COH）会显著增加 TSH 水平；然而，尚无大规模前瞻性研究评估 COH 后 TSH 水平对辅助生殖技术结局的影响。本前瞻性研究旨在探讨在新鲜胚胎移植（ET）的妇女中，COH 后 TSH 水平是否会影响受精/卵胞浆内单精子注射（IVF/ICSI）结局。
本研究纳入了 664 名在北京大学第三医院接受 IVF/ICSI 治疗并接受新鲜 ET 的患者。分析了临床妊娠率、流产率、活产率和早产率。
根据 COH 后血清 TSH 水平（0.55 mIU/L<TSH<2.5 mIU/L：n=449，2.5 mIU/L≤TSH≤4.78 mIU/L：n=215），将患者分为两组。两组间的临床妊娠率、流产率和活产率无显著差异，即使在调整年龄、体重指数（BMI）、甲状腺抗体阳性和 COH 方案后也是如此。然而，TSH<2.5 mIU/L 的女性早产率显著高于 TSH≥2.5 mIU/L 的女性，即使在调整了相关混杂因素后也是如此。两组间的活产儿体重无显著差异。
COH 后轻度升高的 TSH 水平（TSH≥2.5 mIU/L）不会影响 IVF/ICSI 结局，因此 COH 后严格控制 TSH 水平在 2.5 mIU/L 以内可能没有必要。此外，严格控制 TSH 水平（TSH<2.5 mIU/L）可能会增加早产风险。
