Effect of levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism and thyroid autoimmuneity undergoing in vitro fertilization/intracytoplasmic sperm injection: an updated meta-analysis of randomized controlled trials

Abstract

BackgroundEvidence suggests that subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) are associated with adverse pregnancy outcomes. This systematic review and meta-analysis was conducted to determine whether levothyroxine (LT4) supplementation would improve pregnancy outcomes among infertile women with SCH and/or TAI who underwent in vitro fertilization (IVF) or intracytoplastic sperm injection (ICSI).MethodsWe searched databases of PubMed, EMBASE, Web of Science, Cochrane Controlled Trials Register databases, and Clinicaltrials.gov up to April 2018 to identify eligible studies. Studies that focused on the treatment effect of LT4 on pregnancy outcomes of women with SCH and/or TAI who underwent IVF/ICSI were included in the data synthesis. We only included randomized controlled trials (RCTs). Relative risks (RR) and 95% confidence intervals (CI) were calculated using a random-effects model to assess the results of pregnancy outcomes, including clinical pregnancy rate, miscarriage rate, live birth rate and preterm birth rate.ResultsFour published RCTs including 787 infertile couples undergoing IVF/ICSI were included in this meta-analysis. Notably, the study observed no significant associations of LT4 treatment with the clinical pregnancy rate (RR = 1.46, 95% CI: 0.86–2.48), live birth rate (RR = 2.05, 95% CI: 0.96–4.36), or preterm birth rate (RR = 1.13, 95% CI: 0.65–1.96). However, patients receiving LT4 supplementation had a significantly decreased miscarriage rate relative to those receiving a placebo or no treatment (RR = 0.51, 95% CI: 0.32–0.82). A further sub-group analysis showed that LT4 supplementation did not improve the miscarriage rates among patients with SCH (RR = 0.67, 95% CI: 0.39–1.15) or TAI (RR = 0.28, 95% CI: 0.07–1.06).ConclusionsGiven its potential to reduce the miscarriage rate, LT4 supplementation is recommended for infertile women with SCH and/or TAI who are undergoing IVF/ICSI. However, additional population-based RCTs are needed to confirm this recommendation.Electronic supplementary materialThe online version of this article (10.1186/s12958-018-0410-6) contains supplementary material, which is available to authorized users.

Effect of antithyroid antibodies on women with recurrent miscarriage: A meta‐analysis

“…But they paid no attention to treatment. Several meta‐analyses of studies of ART patients with higher levels of TPO‐Ab showed that substitution of thyroid hormones decreased the rate of miscarriages, 10,58,59 and increased the delivery, clinical pregnancy, and fertilization rates 60 . However, other studies such as the study by Wang published in 2017 27 were unable to demonstrate the effect.…”

Thyroid and Fertility: Recent Advances

“…Most importantly, the authors excluded the populations most likely to benefit, and therefore their findings are only potentially applicable to women at low risk of miscarriage. Nevertheless, this study was included in a recent meta-analysis, along with three prior much smaller RCTs studying the impact of levothyroxine on obstetrical outcomes in euthyroid patients with subclinical hypothyroidism or thyroid autoimmunity undergoing IVF (20). With the inclusion of this study, the meta-analysis concluded that levothyroxine treatment has no statistically significant impact on live births in women with subclinical hypothyroidism or thyroid autoimmunity undergoing IVF; however, it does decrease miscarriage rates by *50% (20).…”

The efficiency of IVF/ICSI protocols in female subclinical hypothyroidism and thyroid autoimmunity

“…Самый последний систематический обзор, посвященный данной проблеме, проведен Rao et al в 2018 г. [43] на основании вышеперечисленных статей [38][39][40]42]. Путем метаанализа исходов циклов ВрТ у 787 бесплодных пар не был установлен положительный эффект тироксина на такие показатели, как частота наступления клинической беременности (Ор 1,46; 95 % ДИ 0,86-2,48; р = 0,16), частота живорождения на цикл ЭКО/ИКСИ (Ор 2,05; 95 % ДИ 0,96-4,36; р = 0,06), преждевременные роды до 37 нед.…”