scholarly journals SAT-433 The Influence of Thyroid Autoimmunity on Pregnancy Outcome in Infertile Women

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ken Takeshima ◽  
Yuko Inagaki ◽  
Masahiro Nishi ◽  
Hiroyuki Ariyasu ◽  
Shinsuke Uraki ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Live Birth ◽  
Intrauterine Insemination ◽  
Thyroid Autoimmunity ◽  
Multiple Logistic Regression Analysis ◽  
Thyroid Peroxidase ◽  
Infertile Women ◽  
Fertility Treatments ◽  
Tsh Levels

Abstract Background: Women with subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) reportedly have high risks of miscarriage and preterm birth. Infertile women undergoing assisted reproductive technology (ART) are recommended for levothyroxine (L-T4) supplementation to maintain TSH levels below 2.5 mIU/mL according to ATA guideline; however, insufficient evidence exists to determine whether L-T4 treatment for infertile women with TSH levels between 2.5 and 5.0 mIU/mL. Objective: To clarify the influence of TAI on pregnancy in infertile women under L-T4 treatment to maintain TSH levels below 2.5 mIU/mL, and to compare its influence depending on fertility treatments. Methods: A total of 595 infertile women who visited a fertility clinic between January 2013 and December 2015 were prospectively recruited to this study. Five patients with Graves’ disease were excluded and remained 590 women were included in the analysis. Infertile women with TSH levels above 2.5 mIU/mL were treated with L-T4 followed by evaluation of fertility status and pregnancy outcomes. Factors affecting pregnancy were analyzed statistically depending on fertility treatments. Written informed consent was obtained from all patients, and the study protocol was approved by the Ethics Committee. Results: The proportion of SCH and thyroid peroxidase antibodies (TPOAb).positivity was 19.6% and 10.4%, respectively. Women who did not become pregnant were older than those who became pregnant (p=0.003), but no influence of thyroid-associated factors on pregnancy was confirmed. Pregnancy outcome contrarily showed that women who had a miscarriage were older (p<0.001) and higher TPOAb titers (p=0.038) than those who had a live birth. In addition, higher age (OR 26.4, p<0.001) and high TPOAb titer (OR 11.8, p=0.043) were decided as risk factors for miscarriage through multiple logistic regression analysis. Among women who treated with intrauterine insemination, TPOAb titers were higher in women who had a miscarriage than in those who had a live birth (p=0.040). We further focused on the difference between ART methods including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Women undergoing IVF had higher TPOAb titers in women who had miscarriage than those who had a live birth (p=0.023), but in women undergoing ICSI there was no association between TPOAb titers and pregnancy outcome. Conclusion: Infertile women with high TPOAb titers are susceptible to miscarriage despite appropriate L-T4 treatment. The influence of TPOAb titers as well as TPOAb positivity on pregnancy should be considered, when undergoing fertility treatments.

scholarly journals Functional Ovarian Reserve in Women With Infertility and Euthyroidism: What Is the Role of Thyroid Autoimmunity?

2021 ◽  
Author(s):  
Diana Festas Silva ◽  
Tânia Carvalho ◽  
Leonor Gomes ◽  
Isabel Paiva ◽  
Paulo Cortesão ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Polycystic Ovary ◽  
Thyroid Autoimmunity ◽  
Univariate Analysis ◽  
Human Reproduction ◽  
Thyroid Peroxidase ◽  
Childbearing Age ◽  
Autoimmune Pathology ◽  
Cervical Surgery ◽  
Tsh Levels

Abstract Background: Thyroid dysfunction is the most common endocrine disorder in women of childbearing age, and is associated with menstrual irregularities, anovulation and infertility. Whether it is thyroid function, thyroid autoimmunity (AI) or both that affects functional ovarian reserve remains to be clarified. The aim of this study was to evaluate the association between functional ovarian reserve and thyroid AI in women with infertility in euthyroidism.Methods: retrospective study of women with infertility, in euthyroidism, followed in a Human Reproduction Department, between May 2016 and January 2020. TSH, anti-thyroid peroxidase (TPO) antibodies, anti-thyroglobulin (TG) antibodies were measured. Functional ovarian reserve was assessed by anti-Müllerian hormone (AMH) levels with antral follicle count (AFC) performed by endovaginal ultrasound. Women with at least one of the following criteria were excluded: prior thyroidectomy, radioactive iodine treatment, cervical surgery/radiotherapy, oophorectomy, malignant/autoimmune pathology, chronic kidney disease, liver disease, polycystic ovary syndrome, current pregnancy and current medication with levothyroxine, methimazole or propylthiouracil. Results with p<0.05 were considered statistically significant.Results: 730 women were evaluated, with mean age of 34.9±3.9 years, with positive thyroid AI (≥ 1 positive antibody) present in 14.8% of cases. Anti-TPO antibodies were positive in 11.0% of patients and anti-TG antibodies in 7.0%. Mean TSH level was 1.6±0.7 µIU/mL (NR: 0.4-4.0). Median body mass index (BMI) was 22.8 kg/m2 (IQR 5.1). Median AMH was 1.7ng/mL (IQR 2.1), and mean AFC was 10.2±6.3. Patients with positive and negative thyroid AI did not differ significantly with age (p=0.133), BMI (p=0.784], AFC (p=0.508) and AMH (p=0.825). TSH levels were significantly higher in the positive AI group (2.0±0.8 vs 1.5±0.7µIU/mL; p<0.001).In the univariate and multivariate analysis, only patient's age and AFC were predictive of AMH levels (p<0.001; p<0.001, respectively). TSH levels, BMI and thyroid AI were not predictive of AMH levels.In regard to AFC, in the univariate analysis, only age was predictive (p<0.001). TSH levels, BMI and thyroid AI were not predictive of AFC.Conclusions: In this study we found that thyroid autoimmunity, in women with infertility and TSH levels in the normal range, apparently, do not have a predictive role for functional ovarian reserve.

P–711 The association between thyroid autoimmunity and serum level of anti-Müllerian hormone in infertile patients with normal ovarian reserve undergoing in vitro fertilisation

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Albu ◽  
D Albu
Keyword(s):  
Serum Level ◽  
Ovarian Reserve ◽  
Thyroid Autoimmunity ◽  
In Vitro Fertilisation ◽  
Free T4 ◽  
Infertile Women ◽  
Group 2 ◽  
Infertile Patients ◽  
Group 1

Abstract Study question Is there a relationship between thyroid autoimmunity and serum level of anti-müllerian hormon (AMH) in infertile women with normal ovarian reserve undergoing in vitro fertilisation (IVF)? Summary answer In infertile women with normal ovarian reserve serum AMH level above 5ng/ml is associated with higher level of thyroid hormones and less frequent thyroid autoimmunity What is known already Previous studies suggest that thyroid autoimmunity is associated with a decreased ovarian reserve. Moreover, it was reported that thyroid hormone administration could improve serum AMH level. However, the relationship between serum AMH level and thyroid autoimmunity and function in infertile women with normal ovarian reserve undergoing IVF is largely unknown. Since in IVF the serum AMH level is an important marker which dictate the management of the couple, the identification of all the factors possibly related to this parameter is very important. Study design, size, duration: We performed a retrospective study in the Department of Reproductive Medicine of a private hospital. The medical records of all consecutive patients who underwent IVF between January 2015 and December 2018 with all causes of infertility were reviewed. Study group included 581patients with a mean age of 34.4±4.1 years, mean AMH of 3.78±2.4 ng/mL, mean serum TSH level of 1.89±1 microUI/ml and mean serum free T4 level of 1.05±0.98 ng/dl. Participants/materials, setting, methods Patients with known thyroid disorders or under thyroid hormone treatment at the moment of evaluation were excluded. Only patients with serum level of thyroid stimulating hormone (TSH), free tyroxine (free T4), anti thyroid peroxidase antibodies (ATPO,) anti thyroglobulin antibodies (ATG), AMH and age available for analysis were included in the study. This parameters are evaluated on a systematic basis in all the patients undergoing IVF in our Department, except very few cases. Main results and the role of chance Patients were divided according to their serum AMH level in two groups: group 1 with AMH level 5 ng/ml and below (n = 450 patients) and group 2 with AMH above 5 ng/ml (n = 131 patients). When the two groups were compared we found that patients in group 2 were younger in comparison with patients in group 1 (32.9±3.8 versus 35±4 years, p &lt; 0.0001). After adjustment for age, patients in group 2 had significantly higher serum free T4 level (1.07±0.12 versus 1.04±0.14 ng/dl, p = 0.015), lower ATG (17.59±41.8 UI/ml versus 39.4±136.16 UI/ml, p &lt; 0.018) and presented less frequently with high ATPO antibodies (35% versus 41.8%, p = 0.047). In a logistic regression model with AMH as a dependent variable, free T4, but not TSH was independently and positively associated with higher AMH levels (above 5 ng/ml) (p = 0.025) after adjustment for anti thyroid antibodies levels. Morever, in this logistic model the presence of high ATPO, but not ATG, were negatively related to higher AMH level (p = 0.037). Limitations, reasons for caution Patients included in this study are infertile patients with indication for IVF treatment. Therefore, the results of this study should be used with caution in other populations Wider implications of the findings: Our study suggest that serum AMH level might be related to thyroid autoimmunity, but also to thyroid hormones levels. If confirmed by further studies, this findings could offer a way to improve serum AMH level and to better understand the markers of ovarian reserve in an IVF setting. Trial registration number NA

scholarly journals Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease

2018 ◽  
Vol 178 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Flora Veltri ◽  
Pierre Kleynen ◽  
Lidia Grabczan ◽  
Alexandra Salajan ◽  
Serge Rozenberg ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Pregnancy Outcomes ◽  
Thyroid Disease ◽  
Thyroid Autoimmunity ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
Baseline Characteristics ◽  
Serum Tsh ◽  
Tsh Levels

ObjectiveIn the recently revised guidelines on the management of thyroid dysfunction during pregnancy, treatment with thyroid hormone (LT4) is not recommended in women without thyroid autoimmunity (TAI) and TSH levels in the range 2.5–4.0 mIU/L, and in a recent study in that particular group of pregnant women, more complications were observed when a treatment with LT4 was given. The objective of the study was therefore to investigate whether variation in thyroid function within the normal (non-pregnant) range in women free of thyroid disease was associated with altered pregnancy outcomes?DesignCross-sectional data analysis of 1321 pregnant women nested within an ongoing prospective collection of pregnant women’s data in a single centre in Brussels, Belgium.MethodsThyroid peroxidase antibodies (TPO-abs), thyroid-stimulating hormone (TSH), free T4 (FT4) and ferritin levels were measured and baseline characteristics were recorded. Women taking LT4, with TAI and thyroid function outside the normal non-pregnant range were excluded. Pregnancy outcomes and baseline characteristics were correlated with all TSH and FT4 levels within the normal range and compared between two groups (TSH cut-off < and ≥2.5 mIU/L).ResultsTobacco use was associated with higher serum TSH levels (OR: 1.38; CI 95%: 1.08–1.74);P = 0.009. FT4 levels were inversely correlated with age and BMI (rho = −0.096 and −0.089;P < 0.001 and 0.001 respectively) and positively correlated with ferritin levels (rho = 0.097;P < 0.001). Postpartum haemorrhage (>500 mL) was inversely associated with serum FT4 levels (OR: 0.35; CI 95%: 0.13–0.96);P = 0.040. Also 10% of women free of thyroid disease had serum TSH levels ≥2.5 mIU/L.ConclusionsVariation in thyroid function during the first trimester within the normal (non-pregnant) range in women free of thyroid disease was not associated with altered pregnancy outcomes. These results add evidence to the recommendation against LT4 treatment in pregnant women with high normal TSH levels and without TPO antibodies.

scholarly journals Does foetal gender influence maternal thyroid parameters in pregnancy?

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Georgiana Sitoris ◽  
Flora Veltri ◽  
Pierre Kleynen ◽  
Malika Ichiche ◽  
Serge Rozenberg ◽  
...  
Keyword(s):  
Reference Range ◽  
Thyroid Autoimmunity ◽  
First Trimester ◽  
Thyroid Peroxidase ◽  
Reference Ranges ◽  
Free T4 ◽  
Cross Sectional ◽  
Maternal Thyroid ◽  
Serum Tsh ◽  
Tsh Levels

Objective It is unknown if foetal gender influences maternal thyroid function during pregnancy. We therefore investigated the prevalence of thyroid disorders and determined first-trimester TSH reference ranges according to gender. Methods A cross-sectional study involving 1663 women with an ongoing pregnancy was conducted. Twin and assisted pregnancies and l-thyroxine or antithyroid treatment before pregnancy were exclusion criteria. Serum TSH, free T4 (FT4) and thyroid peroxidase antibodies (TPOAb) were measured at median (interquartile range; IQR) 13 (11–17) weeks of gestation. Subclinical hypothyroidism (SCH) was present when serum TSH levels were >3.74 mIU/L with normal FT4 levels (10.29–18.02 pmol/L), and thyroid autoimmunity (TAI) was present when TPOAb were ≥60 kIU/L. Results Eight hundred and forty-seven women were pregnant with a female foetus (FF) and 816 with a male foetus (MF). In women without TAI and during the gestational age period between 9 and 13 weeks (with presumed high-serum hCG levels), median (IQR range) serum TSH in the FF group was lower than that in the MF group: 1.13 (0.72–1.74) vs 1.24 (0.71–1.98) mIU/L; P = 0.021. First-trimester gender-specific TSH reference range was 0.03–3.53 mIU/L in the FF group and 0.03–3.89 mIU/L in the MF group. The prevalence of SCH and TAI was comparable between the FF and MF group: 4.4% vs 5.4%; P = 0.345 and 4.9% vs 7.5%; P = 0.079, respectively. Conclusions Women pregnant with an MF have slightly but significantly higher TSH levels and a higher upper limit of the first-trimester TSH reference range, compared with pregnancies with a FF. We hypothesise that this difference may be related to higher hCG levels in women pregnant with a FF, although we were unable to measure hCG in this study. Further studies are required to investigate if this difference has any clinical relevance.

scholarly journals Using Uterine Biophysical Profile as a Predictor of Endometrial Receptivity and Pregnancy in Stimulated IUI Cycles

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Rawaa Saad Hasan Abunayla ◽  
◽  
Lubna Amer Al-Anbari ◽  
Muayad S, Abood ◽  
Huda A. R. Hussaini ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Pulsatility Index ◽  
Uterine Artery ◽  
Assisted Reproductive Technologies ◽  
Intrauterine Insemination ◽  
Reproductive Technologies ◽  
Endometrial Receptivity ◽  
Infertile Women ◽  
Biophysical Profile ◽  
The Mean

Implantation failure and disorders of endometrial receptivity represent an essential cause of infertility; multiple parameters were needed to predict the uterine receptivity understanding that no sole parameter could predict the same. A score was termed as (Uterine Biophysical Profile) could be utilized as a predictor of endometrial receptivity. To evaluate the predictive potential of Uterine biophysical profile of both endometrial receptivity and pregnancy outcome in infertile women undergoing Intrauterine Insemination (IUI). The current cross-sectional study was conducted in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Al Nahrain University, Baghdad, Iraq from the 1st of Oct. 2018 till 1st of May 2019 involving seventy women of infertile couples with the same inclusion and exclusion criteria. Uterine biophysical profile was evaluated using a doppler ultrasound examination and then a score was calculated and correlated to pregnancy outcome. The mean Uterine Artery Pulsatility Index (UAPI) was significantly lower in women with positive pregnancy in comparison to women with negative pregnancy, 2.10±0.19 versus 2.47±0.65, respectively (P=0.032). Moreover, no women with Pulsatility Index (PI) score (0) succeeded to get pregnant and the higher the score, the higher the rate of pregnancy (P=0.006). Furthermore, Spearman correlation showed significant positive correlation between positive pregnancy outcome and UAPI (r=0.365; P=0.002). The mean total score was significantly higher for pregnant women than in women with negative pregnancy, 18.27±1.33 versus 16.35±2.47, respectively (P=0.005). The cutoff value was >17 with an acceptable accuracy level of 74.2. The sensitivity of that cutoff vale was 80 % and the specificity was 65.5%. Uterine artery pulsatility index and total uterine biophysical score are the principal predictors of positive pregnancy outcomes in infertile women undergoing IUI.

scholarly journals Fertility Preserving Surgery in A Woman with Synchronous Endometrial and Ovarian Cancer Followed by Successful Pregnancy Outcome: Case Report and Review of Literature

2020 ◽  
Author(s):  
Vanita Suri ◽  
Ramandeep Bansal ◽  
Neelam Aggarwal ◽  
Pooja Sikka ◽  
Seema Chopra ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Pregnancy Outcome ◽  
Intrauterine Insemination ◽  
Exploratory Laparotomy ◽  
Elective Cesarean Section ◽  
High Dose ◽  
Successful Pregnancy ◽  
Tumor Spread ◽  
Vitro Fertilization

Abstract Background: Successful pregnancy outcome in women with synchronous ovarian and endometrial cancers is very rare. We report successful pregnancy outcome in a young woman managed conservatively for synchronous endometrial and ovarian cancer. Case presentation: 30 years old nulliparous lady presented following exploratory laparotomy, left salpingo-oophorectomy and hysteroscopic polypectomy for left adnexal mass. Histology revealed endometrioid carcinoma of left ovary and moderately differentiated adenocarcinoma in the resected polyp. She underwent staging laparotomy along with hysteroscopy which confirmed above findings without any evidence of further tumor spread. She was treated conservatively with high dose oral progestin (megestrol acetate, 160mg) and leuprolide acetate 3.75mg monthly injections for three months along with four cycles of carboplatin and paclitaxel based chemotherapy followed by monthly injection of leuprolide for further three months. After failure of spontaneous conception, she underwent ovulation induction for six cycles along with intrauterine insemination which failed. She underwent in vitro fertilization with donor egg followed by elective cesarean section at 37weeks of gestation. She delivered a healthy baby of weight 2.7 Kg. Intraoperatively 5×6cm right ovarian cyst was found which drained chocolate coloured fluid on puncture and cystectomy was carried out. Histological examination revealed endometrioid cyst of right ovary. Uterus was spared as she wanted to preserve her fertility. She is being followed periodically and is normal nine months following delivery. She is on injection Depot medroxy progesterone acetate once every three months.

scholarly journals Prematurely ruptured dominant follicles often retain competent oocytes in infertile women

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
S. Teramoto ◽  
H. Osada ◽  
M. Shozu
Keyword(s):  
Live Birth ◽  
Large Scale ◽  
Oocyte Retrieval ◽  
Window Of Opportunity ◽  
Dominant Follicle ◽  
Live Births ◽  
Infertile Women ◽  
Follicle Rupture ◽  
Fertilisation Treatment

Abstract Ovulation consists of a follicle’s rupture and subsequent oocyte extrusion, although there is a paucity of evidence regarding whether every follicle’s rupture is associated with extrusion of its oocyte. We examined this issue in a large-scale window-of-opportunity study by attempting aspiration of single dominant follicles that were found to have ruptured before a scheduled oocyte retrieval during in vitro fertilisation and embryo transfer treatment of infertile women. We were able to aspirate 587 of 1,071 ultrasonographically confirmed post-rupture dominant follicles from 1,071 women (i.e. one dominant follicle per woman) and retrieved 225 oocytes (oocyte recovery ratio: 43.4% of aspirated follicles), which yielded 28 live births (live birth ratio: 11.0% of retrieved oocytes). Interestingly, the live birth ratio for post-rupture dominant follicles was not statistically different from that achieved using regular pre-rupture aspiration of dominant follicles (1,085/8,977, 12.1%). These findings suggest that oocyte extrusion frequently does not occur after follicle rupture in infertile women undergoing in vitro fertilisation treatment, although the oocyte retained in the follicle can remain competent for use during that treatment.

scholarly journals The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study

2020 ◽  
Vol 67 (8) ◽  
pp. 859-868
Author(s):  
Yuko Inagaki ◽  
Ken Takeshima ◽  
Masahiro Nishi ◽  
Hiroyuki Ariyasu ◽  
Asako Doi ◽  
...  
Keyword(s):  
Prospective Study ◽  
Pregnancy Outcome ◽  
Thyroid Autoimmunity ◽  
Infertile Women ◽  
A Prospective Study
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