title: Thyroid stimulating hormone levels rise after assisted reproductive technology.
abstract: OBJECTIVE
  The goal of this study was to determine whether high E2 levels after controlled ovarian hyperstimulation affect TSH.
  
  
  METHODS
  Patients completing ART cycles between April-October 2010 were eligible for this cohort study. 180 patients were recruited however those with known thyroid disease were excluded. The final analysis included 154 subjects. Blood was collected at each visit during the ART cycle as well as at the pregnancy test. Samples were frozen at -20 °C and analyzed together for E2 and TSH using the same assay kit once all patients had completed their cycles. All participants were treated at the McGill University Health Center. A paired t-test was used to study the difference in TSH levels recorded at maximal and minimal Estradiol levels during ovarian stimulation. Multiple regression analysis was then used to determine if factors such as anti-thyroid antibodies and ovarian reserve measures affect this change in TSH. We used multiple imputation methods to account for missing data.
  
  
  RESULTS
  As E2 levels rose from low to supra-physiologic levels during treatment, TSH levels also rose significantly. This increase was clinically significant by the time of pregnancy test. The factors that potentially affected the change in TSH were: male factor/tubal factor infertility, type of protocol used as well as the presence of thyroid antibodies.
  
  
  CONCLUSIONS
  Although TSH increases during ART, this change only becomes clinically significant on the day of pregnancy test. Future studies should examine TSH changes specifically in certain "at-risk" sub-groups such as those with antibodies and known thyroid disease.
authors: MUHC Reproductive Center, Department of Obstetrics and Gynecology, McGill University Health Center, 687 Pine Avenue West, F6.58, Montreal, QC, Canada, H3A 1A1, shauna.reinblatt@muhc.mcgill.ca.
authors: Shauna
authors: S
authors: Reinblatt
authors: Belen
authors: B
authors: Herrero
authors: José A
authors: JA
authors: Correa
authors: Einat
authors: E
authors: Shalom-Paz
authors: Baris
authors: B
authors: Ata
authors: Amir
authors: A
authors: Wiser
authors: David
authors: D
authors: Morris
authors: Hananel
authors: H
authors: Holzer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000097:blood; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D013972:Thyrotropin / Q000097:blood*
chemical_list: D013972:Thyrotropin
references: Nat Clin Pract Endocrinol Metab. 2008 Jul;4(7):394-405
references: 18506157
references: Reprod Biol Endocrinol. 2009 Nov 27;7:137
references: 19941670
references: Fertil Steril. 2010 Dec;94(7):2920-2
references: 20655528
references: Fertil Steril. 2012 Mar;97(3):585-91
references: 22260853
references: J Clin Endocrinol Metab. 2012 Aug;97(8):2543-65
references: 22869843
references: Eur J Endocrinol. 2011 Jan;164(1):107-13
references: 20956436
references: Thyroid. 2005 Jan;15(1):44-53
references: 15687823
references: J Clin Endocrinol Metab. 1990 Aug;71(2):276-87
references: 2116437
references: Fertil Steril. 2011 Jul;96(1):241-5
references: 21565336
references: Int J Gynaecol Obstet. 1996 Oct;55(1):49-58
references: 8910083
references: N Engl J Med. 2001 Jun 7;344(23):1743-9
references: 11396440
references: J Clin Endocrinol Metab. 2000 Feb;85(2):545-8
references: 10690853
references: J Clin Endocrinol Metab. 2002 Feb;87(2):489-99
references: 11836274
references: Gynecol Endocrinol. 2008 Nov;24(11):649-55
references: 19031223
references: J Clin Endocrinol Metab. 1952 Jul;12(7):846-55
references: 14938422
references: Am J Obstet Gynecol. 2006 Jun;194(6):1668-74; discussion 1674-5
references: 16731084
references: Soc Psychiatry Psychiatr Epidemiol. 2005 Apr;40(4):291-9
references: 15834780
references: Hum Reprod. 2005 Jun;20(6):1529-33
references: 15878930
references: J Endocrinol Invest. 2007 Jan;30(1):3-8
references: 17318015
references: N Engl J Med. 2004 Jul 15;351(3):241-9
references: 15254282
references: Hum Reprod. 2000 Mar;15(3):545-8
references: 10686194
references: Arch Intern Med. 2000 Feb 28;160(4):526-34
references: 10695693
references: Hum Reprod Update. 2003 Mar-Apr;9(2):149-61
references: 12751777
references: Best Pract Res Clin Endocrinol Metab. 2011 Oct;25(5):745-57
references: 21925075
references: Endocr Rev. 1997 Jun;18(3):404-33
references: 9183570
references: Fertil Steril. 2010 May 1;93(7):2414.e1-3
references: 20079900
references: Thyroid. 2002 Jan;12(1):63-8
references: 11838732
references: Fertil Steril. 2011 Sep;96(3):780-5
references: 21742326
references: Thyroid. 2007 Aug;17(8):773-7
references: 17725435