title: Subclinical Hypothyroidism and Intracytoplasmic Sperm Injection Outcomes.
abstract: PurposeWhether preconception elevated concentrations of thyroid-stimulating hormone (TSH) compromises reproductive outcomes in patients undergoing assisted reproduction techniques (ARTs) remains unclear. This study therefore compared the reproductive outcomes in patients with TSH concentrations of < 2.5 mIU/L, 2.5-4.0 mIU/L, and 4.0-10.0 mIU/L undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).MethodsThis retrospective cohort study evaluated the medical records of all women with measured TSH concentrations who underwent IVF/ICSI between January 2011 and December 2012. The patients were divided into three groups: TSH < 2.5 mIU/L (group 1); THS ≥2.5 and < 4.0 mIU/L (group 2); and THS ≥4 mIU/L and < 10.0 mIU/L (group 3). Patients who were administered levothyroxine for treating hypothyroidism were excluded from the analysis. The primary endpoints were clinical pregnancy, miscarriage, live birth and multiple pregnancy rates.ResultsDuring the study period, 787 women underwent IVF/ICSI. Sixty were excluded because their TSH concentrations were unavailable, and 77 were excluded due to their use of levothyroxine. The prevalence of patients presenting elevated concentrations of TSH was of 5.07% (using a TSH threshold of 4.0 mIU/L) and of 29.99% (using a TSH threshold of 2.5 mIU/L). Patient characteristics, type of COS, and response to COS did not differ among the three groups, and there were no differences in clinical pregnancy (24.4% versus 25.9% versus 24.2%,p= 0.93); miscarriage (17.1% versus 14.3% versus 12.5%,p= 0.93); live birth (20.2% versus 22.2% versus 21.2%,p= 0.86); and multiple pregnancy rates (27.0% versus 21.4% versus 25.0%,p= 0.90) respectively.ConclusionResponse to COS, live birth, and miscarriage rates were not altered in women with elevated concentrations of TSH undergoing IVF/ICSI, regardless of using a TSH threshold of 2.5 mIU/L or 4.0 mIU/L. These findings reinforce the uncertainties related to the impact of subclinical hypothyroidism on reproductive outcomes in women undergoing COS for ARTs.
authors.affiliation: Department of Obstetrics and Gynecology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (DGO-FRMP-USP), Ribeirão Preto, SP, Brazil.
authors.forename: Marcela de Alencar
authors.initials: MA
authors.lastname: Coelho Neto
authors.affiliation: Department of Obstetrics and Gynecology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (DGO-FRMP-USP), Ribeirão Preto, SP, Brazil.
authors.forename: Wellington de Paula
authors.initials: WP
authors.lastname: Martins
authors.affiliation: Department of Obstetrics and Gynecology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (DGO-FRMP-USP), Ribeirão Preto, SP, Brazil.
authors.forename: Anderson Sanches de
authors.initials: AS
authors.lastname: Melo
authors.affiliation: Department of Obstetrics and Gynecology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (DGO-FRMP-USP), Ribeirão Preto, SP, Brazil.
authors.forename: Rui Alberto
authors.initials: RA
authors.lastname: Ferriani
authors.affiliation: Department of Obstetrics and Gynecology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (DGO-FRMP-USP), Ribeirão Preto, SP, Brazil.
authors.forename: Paula Andrea
authors.initials: PA
authors.lastname: Navarro
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D013972:Thyrotropin / Q000097:blood
chemical_list: D013972:Thyrotropin