title: Thyroxine replacement during super-ovulation for in vitro fertilization: a potential gap in management?
abstract: OBJECTIVE
  Our objective is to report observed changes in thyroid-stimulating hormone (TSH) in two patients undergoing super-ovulation for IVF.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Private assisted reproduction practices.
  
  
  METHODS
  Two hypothyroid women taking thyroxine replacement therapy undergoing super-ovulation for IVF.
  
  
  METHODS
  Laboratory records for TSH taken during ovulation induction cycles were retrieved retrospectively for six cycles and measured prospectively for one cycle each in both women.
  
  
  METHODS
  To document changes in thyroid status during super-ovulation.
  
  
  RESULTS
  Despite being euthyroid at the start of the super-ovulation cycle, both patients demonstrated a rise in TSH to hypothyroid levels during ovulation induction, even in the absence of ongoing pregnancy.
  
  
  CONCLUSIONS
  High circulating E(2) during super-ovulation for IVF induces increased thyroxine-binding globulin binding of thyroxine. In women taking thyroxine replacement therapy, hypothyroidism develops during a super-ovulation cycle. Whether such acute biochemical hypothyroidism is a hindrance to ovum quality, fertilization, conception, or ongoing pregnancy and whether thyroxine dose adjustment during a super-ovulation cycle would improve IVF outcomes requires further study. These case studies identify a potential management gap in assisted reproduction for women taking thyroxine therapy.
authors.affiliation: Keogh Institute for Medical Research, Nedlands, Western Australia, Australia 6009. bstuckey@cyllene.uwa.edu.au
authors.forename: Bronwyn G A
authors.initials: BG
authors.lastname: Stuckey
authors.forename: Doreen
authors.initials: D
authors.lastname: Yeap
authors.forename: Simon R
authors.initials: SR
authors.lastname: Turner
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000187:drug effects; D006301:Health Services Needs and Demand / Q000592:standards; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000188:drug therapy*; D007231:Infant, Newborn; D007247:Infertility, Female / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D012189:Retrospective Studies; D013480:Superovulation / Q000187:drug effects*; D013974:Thyroxine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013974:Thyroxine