Thyroid Autoimmunity and Intracytoplasmic Sperm Injection Outcome: A Systematic Review and Meta-Analysis

Poppe, Kris; Autin, Candice; Veltri, Flora; Kleynen, Pierre; Grabczan, Lidia; Rozenberg, Serge; Ameye, Lieveke

doi:10.1210/jc.2017-02633

Cited by 50 publications

(63 citation statements)

References 62 publications

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“…In the present study, TPOAb positivity and titers were not significantly different between delivery group and miscarriage group in women undergoing ICSI or FET/ICSI, in contrast with those treated with IUI or IVF. This result is compatible with the previous report [46].…”

Section: Discussionsupporting

confidence: 94%

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

et al. 2020

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Thyroid dysfunction and thyroid autoimmunity (TAI) have been reported to be linked to infertility, pregnancy loss and preterm birth. Infertile women undergoing assisted reproductive technology are recommended to maintain thyroid stimulating hormone (TSH) levels below 2.5 μIU/mL. It is unclear, however, whether levothyroxine (L-T4) treatment decreases the effects of TAI on fertility and pregnancy outcome in infertile women. We therefore aimed to clarify the influence of TAI on pregnancy undergoing L-T4 treatment for hypothyroidism. Prospectively recruited to this study were the 595 infertile women who visited the Utsunomiya Ladies Clinic between January 2013 and December 2015. Five patients with Graves' disease were excluded. Clinical profiles of 590 women were as follows: proportion of SCH = 19.6%, thyroid peroxidase antibody (TPOAb) positivity = 10.4%, and thyroglobulin antibody (TgAb) positivity = 15.1%. Fertility was not affected by any thyroid-associated factors. Regarding pregnancy outcomes, TPOAb titers were significantly higher in women who had miscarriage than in those progressed to delivery (46.4 ± 114.1 vs. 18.9 ± 54.6 IU/mL, p = 0.039), notably in those undergoing intrauterine insemination (p = 0.046) and in vitro fertilization (p = 0.023). Multivariate logistic regression analysis revealed that higher age (odds ratio 26.4, p < 0.001) and higher TPOAb titer (odds ratio 11.8, p = 0.043) were risk factors for miscarriage. Higher TPOAb titer should be considered as one of the risk factors for miscarriage in infertile women, even if they have been treated with L-T4 for hypothyroidism.

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Section: Discussionsupporting

confidence: 94%

“…TAI has also been discussed in association with miscarriage in women treated with ICSI. Recent metaanalysis by Poppe (2018), however, showed that TAI is not a risk factor for miscarriage when infertile women were treated with ICSI [46]. They therefore proposed ICSI as their recommended ART technique for women with TAI.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Although Zhong et al reported that women with positive ATA had significantly lower clinical pregnancy rate [17], other studies did not confirm this finding [19,22,23]. In two recent meta-analysis, authors observed similar clinical pregnancy rates between presence and absence of thyroid autoimmunity [24,25]. We did not also observe any significant differences in terms of the clinical pregnancy rates among ATA-positive and ATA- negative patients.…”

Section: Discussioncontrasting

confidence: 79%

The impact of thyroid autoantibodies on the cycle outcome and embryo quality in women undergoing intracytoplasmic sperm injection

Tokgöz

Isim

Tekin

2020

Middle East Fertil Soc J

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Background: The influence of thyroid autoimmunity in in-vitro fertilization/intracytoplasmic sperm injection (ICSI) cycles is still a controversial issue. Although some women are euthyroid, some studies found thyroid dysfunction and thyroid autoimmunity increased the incidence of infertility. We aimed to evaluate the impact of anti-thyroid antibodies on the cycle parameters, embryo quality, and pregnancy outcomes in women who underwent ICSI cycles. Results: Fertilization rate was significantly higher in anti-thyroid antibody-negative patients than in anti-thyroid antibody-positive patients (97.1 ± 10.5 vs. 91.5 ± 19.8, respectively, p = 0.003). Clinical pregnancy, miscarriage, and ongoing pregnancy rates were not different among study groups. The presence of top-quality embryo was lower in anti-thyroid antibody-positive patients but it did not reach any statistical significance (56.5% vs. 67.8%, p = 0.09). In the subgroup analysis, there were no significant differences except for the miscarriage rate according to the TSH threshold. Conclusion: The clinical pregnancy and ongoing pregnancy were not affected by the positivity of anti-thyroid antibodies. We showed that thyroid autoimmunity may have an impact on fertilization rate and embryo quality in patients undergoing ICSI cycles. Miscarriage rate also increases with thyroid autoimmunity and TSH levels above 2.5 μIU/L.

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“…Our results showed that the difference in the rates of SA in women with positive and negative TPO‐Ab was statistically insignificant. The results of a recent meta‐analysis study indicated that the rate of SA in infertile women, who became pregnant via intracytoplasmic sperm injection method in the first trimester of pregnancy, was similar in groups with and without thyroid autoimmunity . However, another meta‐analysis reported that the risk of miscarriage in women with thyroid autoimmunity was significantly higher than women with isolated subclinical hypothyroidism (RR 2.74) .…”

Section: Discussionmentioning

confidence: 99%

Thyroid‐stimulating hormone (TSH) serum levels and risk of spontaneous abortion: A prospective population‐based cohort study

Kianpour

Aminorroaya

Amini

et al. 2019

Clinical Endocrinology

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Objective: Thyroid dysfunction, a common complication of pregnancy, is associated with adverse obstetric and neonatal consequences. This study aimed to determine the effect of TSH levels on early pregnancy outcome in a prospective populationbased cohort study. Design and methods:The serum TSH, free thyroxine, free triiodothyronine, thyroid peroxidase antibody levels and urinary iodine concentration of 418 pregnant women in their first trimester of pregnancy were measured. According to the American Thyroid Association (ATA) and the local reference ranges for TSH, women were divided into two groups of 0.1-2.5, >2.5 mIU/L and 0.2-4.6, >4.6 mIU/L. The risk of spontaneous abortion (SA) was calculated for each group.Results: Spontaneous abortion was detected in 7.2% (n = 30) of total 418 pregnancies. Women with TSH levels > 2.5 mIU/L had an increased risk of SA, compared to women with TSH levels of 0.1-2.5 mIU/L (relative risk [RR] 3.719, 95% confidence interval [CI]:1.713-8.074). The risk of SA was increased in women with TSH levels > 4.6 mIU/L (RR 5.939, 95% CI: 1.711-20.620). The rate of SA was increased by 78% for every unit increase in standard deviation of TSH concentration (RR 1.35, 95% CI: 1.09-1.70). The rate of miscarriages in the treated group by levothyroxine was 9.8% (n = 6) compared to 28.6% (n = 8) in the untreated group (P = 0.024). Conclusions:Our finding suggests that the upper limit for the TSH normal range should be redefined to <2.5 mIU/L during the first trimester of gestation. The local upper limit was 4.6 mIU/L, consistent with 4.0 mIU/L cut-off value recommended by the ATA. K E Y W O R D Sfirst trimester, hypothyroidism, pregnancy, pregnancy loss, pregnancy outcome, spontaneous abortion, thyroid-stimulating hormone levels

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Thyroid Autoimmunity and Intracytoplasmic Sperm Injection Outcome: A Systematic Review and Meta-Analysis

Abstract: Infertile women with TAI treated with ICSI had no increased risk of a first trimester miscarriage compared with women without TAI.

Cited by 50 publications

References 62 publications

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

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

The impact of thyroid autoantibodies on the cycle outcome and embryo quality in women undergoing intracytoplasmic sperm injection

Thyroid‐stimulating hormone (TSH) serum levels and risk of spontaneous abortion: A prospective population‐based cohort study

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