在接受辅助生殖技术治疗的不孕妇女中，正常游离甲状腺素浓度与卵巢储备之间的关联。

Associations between a normal-range free thyroxine concentration and ovarian reserve in infertile women undergoing treatment via assisted reproductive technology.

机构信息

Department of Reproduction and Genetics, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China.

Department of Endocrinology, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China.

出版信息

Reprod Biol Endocrinol. 2024 Jun 22;22(1):72. doi: 10.1186/s12958-024-01226-6.

DOI:10.1186/s12958-024-01226-6

PMID:38909259

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11193230/

Abstract

BACKGROUND

Some recent studies have shown that female subclinical hypothyroidism (SCH) is associated with diminished ovarian reserve (DOR). In this study, we aimed to investigate whether serum-free thyroxine (fT4) concentrations within the reference range are associated with ovarian reserve in women.

METHODS

This cross-sectional study included 4933 infertile women with normal-range fT4 concentrations who received assisted reproductive technology treatment in our clinic. The data of women in different fT4 concentration tertiles (namely 12-15.33, 15.34-18.67, and 18.68-22 pmol/L) were compared with ovarian reserve markers, namely the anti-Müllerian hormone (AMH) concentration, the antral follicle count (AFC), and the number of aspirated oocytes. The primary outcomes were the AMH concentration and the risk of DOR, diagnosed as an AMH concentration < 1.1 ng/mL.

RESULTS

The average ages of women in the low-normal, middle-normal, and high-normal fT4 tertiles were 33.20 (standard deviation [SD]: 5.11), 32.33 (SD: 5.13), and 31.61 (SD: 5.10) years, respectively (p < 0.0001). AMH concentrations (adjusted mean: 3.32 [95% confidence interval {CI}: 3.16 to 3.50] vs. 3.51 [3.40 to 3.62] vs. 3.64 [3.50 to 3.80] ng/mL, p = 0.022) were significantly different between the fT4 concentration tertiles. The risk of DOR was significantly increased in the low-normal (adjusted odds ratio: 1.61 [95% CI: 1.01 to 2.58]) and middle-normal (1.47 [95% CI: 1.00 to 2.16]) tertiles compared with the high-normal tertile. Subgroup analysis showed that AMH concentrations were significantly different among the fT4 concentration tertiles in women aged < 35 years (adjusted mean: 3.94 [95% CI: 3.70 to 4.20] vs. 4.25 [4.11 to 4.39] vs. 4.38 [4.18 to 4.58], p = 0.028), whereas this difference was not significant in women aged ≥ 35 years (p = 0.534). The general additive models using fT4 as a continuous variable indicated that a lower fT4 concentration within the normal range was significantly associated with a lower AMH concentration (p = 0.027), a lower AFC (p = 0.018), a lower number of aspirated oocytes (p = 0.001), and a higher risk of DOR (p = 0.007).

CONCLUSION

Low-normal fT4 concentrations are associated with lower ovarian reserve in infertile women.

摘要

背景

一些最近的研究表明，女性亚临床甲状腺功能减退症（SCH）与卵巢储备功能降低（DOR）有关。在这项研究中，我们旨在探讨血清游离甲状腺素（fT4）浓度在参考范围内是否与女性的卵巢储备有关。

方法

这是一项横断面研究，纳入了在我院接受辅助生殖技术治疗的 4933 名 fT4 浓度正常的不孕女性。比较了不同 fT4 浓度三分位组（即 12-15.33、15.34-18.67 和 18.68-22 pmol/L）的女性与卵巢储备标志物，即抗苗勒管激素（AMH）浓度、窦卵泡计数（AFC）和抽吸卵数。主要结局是 AMH 浓度和 DOR 的风险，DOR 诊断标准为 AMH 浓度＜1.1ng/ml。

结果

低正常、中正常和高正常 fT4 三分位组的女性平均年龄分别为 33.20（标准差[SD]：5.11）、32.33（SD：5.13）和 31.61（SD：5.10）岁（p＜0.0001）。AMH 浓度（调整平均：3.32[95%置信区间{CI}：3.16 至 3.50] vs. 3.51[3.40 至 3.62] vs. 3.64[3.50 至 3.80]ng/ml，p=0.022）在 fT4 浓度三分位组之间有显著差异。与高正常三分位组相比，低正常（调整比值比：1.61[95%CI：1.01 至 2.58]）和中正常（1.47[95%CI：1.00 至 2.16]）三分位组的 DOR 风险显著增加。亚组分析显示，在年龄＜35 岁的女性中，fT4 浓度三分位组之间的 AMH 浓度有显著差异（调整平均：3.94[95%CI：3.70 至 4.20] vs. 4.25[4.11 至 4.39] vs. 4.38[4.18 至 4.58]，p=0.028），而在年龄≥35 岁的女性中，这种差异不显著（p=0.534）。使用 fT4 作为连续变量的一般加性模型表明，正常范围内较低的 fT4 浓度与较低的 AMH 浓度（p=0.027）、较低的 AFC（p=0.018）、较低的抽吸卵数（p=0.001）和较高的 DOR 风险（p=0.007）显著相关。