A retrospective study on IVF outcome in euthyroid patients with anti-thyroid antibodies: effects of levothyroxine, acetyl-salicylic acid and prednisolone adjuvant treatments.
BACKGROUND
Anti-thyroid antibodies (ATA), even if not associated with thyroid dysfunction, are suspected to cause poorer outcome of in vitro fertilization (IVF).


METHODS
We 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).


RESULTS
The 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%).


CONCLUSIONS
These 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.
Revelli
Alberto
A
Reproductive Medicine and IVF Unit, Department of Obstetrical and Gynecological Sciences, University of Torino, OIRM-S, Anna Hospital, Torino, Italy. fertisave@yahoo.com
Casano
Simona
S
Piane
Luisa Delle
LD
Grassi
Giuseppina
G
Gennarelli
Gianluca
G
Guidetti
Daniela
D
Massobrio
Marco
M
D000293:Adolescent; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage* / Q000494:pharmacology; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications / Q000453:epidemiology; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage* / Q000494:pharmacology; D011247:Pregnancy; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies; D013959:Thyroid Diseases / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D013961:Thyroid Gland / Q000276:immunology* / Q000502:physiology; D013974:Thyroxine / Q000008:administration & dosage* / Q000494:pharmacology; D016896:Treatment Outcome; D055815:Young Adult
D001323:Autoantibodies; D011239:Prednisolone; D013974:Thyroxine; D001241:Aspirin