A retrospective study on IVF outcome in euthyroid patients with anti-thyroid antibodies: effects of levothyroxine, acetyl-salicylic acid and prednisolone adjuvant treatments

Abstract

BackgroundAnti-thyroid antibodies (ATA), even if not associated with thyroid dysfunction, are suspected to cause poorer outcome of in vitro fertilization (IVF).MethodsWe retrospectively analyzed: (a) the prevalence of ATA in euthyroid infertile women, (b) IVF outcome in euthyroid, ATA+ patients, and (c) the effect of adjuvant treatments (levothyroxine alone or associated with acetylsalicylic acid and prednisolone) on IVF results in ATA+ patients. One hundred twenty-nine euthyroid, ATA+ women undergoing IVF were compared with 200 matched, ATA-controls. During IVF cycle, 38 ATA+ patients did not take any adjuvant treatment, 55 received levothyroxin (LT), and 38 received LT +acetylsalicylic acid (ASA)+prednisolone (P).ResultsThe prevalence of ATA among euthyroid, infertile patients was 10.5%, similar to the one reported in euthyroid women between 18 and 45 years. ATA+ patients who did not receive any adjuvant treatment showed significantly poorer ovarian responsiveness to stimulation and IVF results than controls. ATA+ patients receiving LT responded better to ovarian stimulation, but had IVF results as poor as untreated ATA+ women. Patients receiving LT+ASA+P had significantly higher pregnancy and implantation rates than untreated ATA+ patients (PR/ET 25.6% and IR 17.7% vs. PR/ET 7.5% and IR 4.7%, respectively), and overall IVF results comparable to patients without ATA (PR/ET 32.8% and IR 19%).ConclusionThese observations suggest that euthyroid ATA+ patients undergoing IVF could have better outcome if given LT+ASA+P as adjuvant treatment. This hypothesis must be verified in further randomized, prospective studies.

Thyroid stimulating hormone levels rise after assisted reproductive technology

“…However, 16 % of our subjects tested positive for anti-thyroid antibodies. This is higher than the 5-10 % prevalence quoted in the literature for women of reproductive age [24,28]. This finding might be explained by the fact that infertile women are proposed to have a higher prevalence of thyroid autoimmunity [24].…”

Thyroid disorders and fertility

“…54 Revell et al has emphasized in their study that during IVF, in order to increase pregnancy and implantation rates and reduce abortus rate ATA positive patients must be treated even if they are eutyhroid. 55 …”

Identification and management of conditions detrimental to IVF outcome

“…Women with subclinical hypothyroidism 82 and/or raised thyroid antibodies 75 have been shown to have significantly lower ovarian reserve irrespective of their age.…”