Subclinical Hypothyroidism and Intracytoplasmic Sperm Injection Outcomes

• Published in: Revista Brasileira de ginecologia e obstetrícia Vol. 38; no. 11; pp. 552 - 558
• Main Authors: Coelho Neto, Marcela de Alencar, Martins, Wellington de Paula, Melo, Anderson Sanches de, Ferriani, Rui Alberto, Navarro, Paula Andrea
• Format: Journal Article
• Language: English; Portuguese
• Published: Rio de Janeiro, Brazil Thieme Publicações Ltda 01.11.2016; Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
• Subjects: Adult; Asymptomatic Diseases; Cohort Studies; Female; Humans; Hypothyroidism - blood; intracytoplasmic sperm injection (ICSI); live birth; miscarriage; OBSTETRICS & GYNECOLOGY; Original; Original Article; Pregnancy; Pregnancy Outcome; Retrospective Studies; Sperm Injections, Intracytoplasmic; subclinical hypothyroidism; thyrotropin (TSH); Thyrotropin - blood; aborto; intracytoplasmic sperm injection (ICSI); live birth; miscarriage; injeção intracitoplasmática de espermatozoide (ICSI); nascido vivo; subclinical hypothyroidism; thyrotropin (TSH); tireotropina (TSH); hipotireoidismo subclínico
• ISSN: 0100-7203; 1806-9339; 1806-9339
• DOI: 10.1055/s-0036-1593986

Abstract Purpose  Whether preconception elevated concentrations of thyroid-stimulating hormone (TSH) compromises reproductive outcomes in patients undergoing assisted reproduction techniques (ARTs) remains unclear. This study therefore compared the reproductive outcomes in patients with TSH concentrations of < 2.5 mIU/L, 2.5–4.0 mIU/L, and 4.0–10.0 mIU/L undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods  This retrospective cohort study evaluated the medical records of all women with measured TSH concentrations who underwent IVF/ICSI between January 2011 and December 2012. The patients were divided into three groups: TSH < 2.5 mIU/L (group 1); THS ≥2.5 and < 4.0 mIU/L (group 2); and THS ≥4 mIU/L and < 10.0 mIU/L (group 3). Patients who were administered levothyroxine for treating hypothyroidism were excluded from the analysis. The primary endpoints were clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. Results  During the study period, 787 women underwent IVF/ICSI. Sixty were excluded because their TSH concentrations were unavailable, and 77 were excluded due to their use of levothyroxine. The prevalence of patients presenting elevated concentrations of TSH was of 5.07% (using a TSH threshold of 4.0 mIU/L) and of 29.99% (using a TSH threshold of 2.5 mIU/L). Patient characteristics, type of COS, and response to COS did not differ among the three groups, and there were no differences in clinical pregnancy (24.4% versus 25.9% versus 24.2%, p  = 0.93); miscarriage (17.1% versus 14.3% versus 12.5%, p  = 0.93); live birth (20.2% versus 22.2% versus 21.2%, p  = 0.86); and multiple pregnancy rates (27.0% versus 21.4% versus 25.0%, p  = 0.90) respectively. Conclusion  Response to COS, live birth, and miscarriage rates were not altered in women with elevated concentrations of TSH undergoing IVF/ICSI, regardless of using a TSH threshold of 2.5 mIU/L or 4.0 mIU/L. These findings reinforce the uncertainties related to the impact of subclinical hypothyroidism on reproductive outcomes in women undergoing COS for ARTs.