title: The impact of thyroid function and thyroid autoimmunity on embryo quality in women with low functional ovarian reserve: a case-control study.
abstract: BACKGROUND
  Women with hyper-and hypothyroidism are at increased risk for infertility and adverse pregnancy outcomes. Whether in women considered euthyroid thyroid function (TSH values) and thyroid autoimmunity (thyroid antibodies) influence in vitro fertilization (IVF) cycle outcome has, however, remained controversial. Any such effect should be easily visible in women with low functional ovarian reserve (LFOR) and thus small oocyte and embryo numbers.
  
  
  METHODS
  We evaluated the relationship between TSH levels and embryo quality in euthyroid women with LFOR undergoing IVF. Mean age for the study population was 39.9±4.6 years. Embryo quality was assessed in 431 embryos from 98 first IVF cycles according to TSH levels (with cut-off 2.5μIU/mL), and to presence versus absence of thyroid autoantibodies.
  
  
  RESULTS
  Mean Anti Mullerian hormone (AMH) was 0.8±0.8 ng/mL and mean TSH was 1.8±0.9 μIU/mL. Comparable embryo quality was observed in women with TSH≤ and >2.5μIU/mL. TPO antibodies significantly affected embryo quality in women with low-normal TSH levels (P=0.045). In women with high-normal TSH levels, increasing TSH had a negative impact on embryo quality (P=0.027). A trend towards impaired embryo quality with TPO antibodies was also observed in these patients (p=0.057).
  
  
  CONCLUSIONS
  TPO antibodies affect embryo quality in euthyroid women with low-normal TSH≤2.5 μIU/mL. In women with high-normal TSH levels, increasing TSH levels, and possibly TPO antibodies, appear to impair embryo quality. These results suggest that the negative impact of thyroid autoimmunity becomes apparent, once thyroid hormone function is optimized.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. andrea.weghofer@meduniwien.ac.at.|The Center for Human Reproduction, 21E 69th street, New York, NY, 10021, USA. andrea.weghofer@meduniwien.ac.at.
authors.forename: Andrea
authors.initials: A
authors.lastname: Weghofer
authors.affiliation: Department of Obstetrics and Gynecology, Hospitalier de l'Université de Montréal, 2065, Rue Alexandre-de Sève, Montréal, Canada. ehimaya@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Himaya
authors.affiliation: The Center for Human Reproduction, 21E 69th street, New York, NY, 10021, USA. vkushnir@thechr.com.
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.affiliation: The Center for Human Reproduction, 21E 69th street, New York, NY, 10021, USA. dbarad@thechr.com.|The Foundation for Reproductive Medicine, 69th street, New York, NY, 10021, USA. dbarad@thechr.com.
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
authors.affiliation: The Center for Human Reproduction, 21E 69th street, New York, NY, 10021, USA. ykizawa@thechr.com.|The Foundation for Reproductive Medicine, 69th street, New York, NY, 10021, USA. ykizawa@thechr.com.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D015551:Autoimmunity; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000276:immunology*; D065851:Ovarian Reserve; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012044:Regression Analysis; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000276:immunology / Q000502:physiology; D013963:Thyroid Hormones / Q000097:blood*
chemical_list: D001323:Autoantibodies; D013963:Thyroid Hormones; D054304:Anti-Mullerian Hormone