Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study.
BACKGROUND
Infertile women positive for thyroid antibodies suffer from a poor pregnancy/delivery outcome, although conflicting data have been published. Our objective was to investigate if levothyroxine (LT4) exerts any effect on pregnancy and/or delivery rates in thyroid peroxidase antibody (TPOAb)-positive (+) women undergoing assisted reproductive technologies.


METHODS
Patients undergoing treatment were screened for TPOAb, thyroid-stimulating hormone (TSH) and free thyroxine (FT4). A total of 72 (15%) out of the 484 euthyroid women selected were TPOAb (+). These 72 patients were randomly divided into two groups: group A (n = 36) underwent LT4 treatment, group B (n = 36) placebo. Group C consisted of 412 women (85%) who were TPOAb negative (-). All patients received controlled ovarian stimulation. The endpoints of treatment were pregnancy rate, miscarriage rate and delivery rate.


RESULTS
No differences in pregnancy rate were observed between the three groups. Miscarriage rate was higher in TPOAb (+) in comparison to TPOAb (-) [relative risk: 2.01 (95% CI = 1.13-3.56), P = 0.028].


CONCLUSIONS
The pregnancy rate is not affected either by presence of TPOAb or treatment with LT4. However, TPOAb (+) women show a poorer delivery rate compared to TPOAb (-). LT4 treatment in TPOAb (+) does not affect the delivery rate.
Negro
Roberto
R
Department of Internal Medicine, Division of Physiopathology of Human Reproduction, Casa di Cura Salus, Brindisi. robnegro@tiscali.it
Mangieri
Tiziana
T
Coppola
Lamberto
L
Presicce
Giovanni
G
Casavola
Eugenio Caroli
EC
Gismondi
Riccardo
R
Locorotondo
Giancarlo
G
Caroli
Paolo
P
Pezzarossa
Antonio
A
Dazzi
Davide
D
Hassan
Haslinda
H
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001723:Birth Rate; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D007453:Iodide Peroxidase / Q000097:blood*; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted; D013959:Thyroid Diseases / Q000188:drug therapy; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use*
D001323:Autoantibodies; C056626:thyroid microsomal antibodies; D013972:Thyrotropin; D007453:Iodide Peroxidase; D013974:Thyroxine