title: In vitro fertilization outcomes in treated hypothyroidism.
abstract: BACKGROUND
  Levothyroxine has been shown to enhance pregnancy outcomes in women with hypothyroidism requiring in vitro fertilization (IVF). However, the precise magnitude of these benefits remains to be determined. In particular, it has yet to be clarified whether levothyroxine may fully overcome the detrimental effects of hypothyroidism or, conversely, whether affected women remain at reduced prognosis for pregnancy outcomes.
  
  
  METHODS
  Patients who underwent IVF-intracytoplasmic sperm injection (ICSI) over a 3-year period were reviewed. Cases were deemed eligible if they were diagnosed with clinical or subclinical hypothyroidism and were receiving levothyroxine. Controls were two subsequently age-matched euthyroid women for every case. Both cases and controls were selected only if serum thyrotropin was ≤2.5 mIU/L.
  
  
  RESULTS
  In total, 137 women with treated hypothyroidism and 274 controls were included. Baseline characteristics of the two study groups were similar with the exception of body mass index, which was slightly higher among the cases (22.9±3.9 vs. 21.9±3.3 kg/m2, p=0.013). Most IVF-ICSI cycle outcome variables were also similar, with the exception of a higher rate of cancellation for poor response (3.6% vs. 0.7%, p=0.04), a longer duration of stimulation (10.9±2.2 vs. 10.1±2.0 days, p=0.001), a higher proportion of women failing to obtain viable embryos (17% vs. 7%, p=0.006), and a lower fertilization rate (75% vs. 86%, p=0.017) among cases. Conversely, the clinical pregnancy rate per started cycle, the implantation rate, and the live birth rate per started cycle did not differ; they were 36% and 34% (p=0.93), 28% and 22% (p=0.11), and 30% and 27% (p=0.50) in cases and controls, respectively. Subgroup analyses comparing women with (n=79) and without (n=58) thyroid autoimmunity and comparing women who were diagnosed with overt hypothyroidism (n=70) or subclinical hypothyroidism (n=67) failed to identify relevant differences.
  
  
  CONCLUSIONS
  In our population, IVF-ICSI outcome was not significantly hampered in women with adequately treated hypothyroidism. The magnitude of the detected differences in cycle outcome was mild, and we failed to document any differences for the most relevant outcomes, i.e., pregnancy rate, implantation rate, and delivery rate. In conclusion, adequate levothyroxine treatment maintaining thyrotropin serum levels below 2.5 mIU/L may overcome the detrimental effects of hypothyroidism.
authors.affiliation: 1 Department of Obstetrics and Gynecology, Fondazione Ca' Granda , Ospedale Maggiore Policlinico, Milan, Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Busnelli
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.forename: Laura
authors.initials: L
authors.lastname: Benaglia
authors.forename: Marta
authors.initials: M
authors.lastname: Leonardi
authors.forename: Guido
authors.initials: G
authors.lastname: Ragni
authors.forename: Luigi
authors.initials: L
authors.lastname: Fedele
mesh_terms: D000328:Adult; D004477:Ectogenesis / Q000187:drug effects; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects* / Q000494:pharmacology; D005307:Fertilization in Vitro / Q000187:drug effects; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007247:Infertility, Female / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D050498:Live Birth; D010053:Ovary / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology; D010060:Ovulation / Q000187:drug effects; D011247:Pregnancy; D018873:Pregnancy Rate; D015203:Reproducibility of Results; D020554:Sperm Injections, Intracytoplasmic / Q000187:drug effects; D013961:Thyroid Gland / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology; D013967:Thyroiditis, Autoimmune / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D005300:Fertility Agents, Female; D013972:Thyrotropin; D013974:Thyroxine