目的:分析与TAI阴性ICSI周期相比,甲状腺自身免疫(TAI)对ICSI周期生殖结局参数的影响。
方法:在这项单一IVF中心回顾性研究中,86名TPOAb或TGAb水平升高的不孕妇女,但甲状腺素替代后甲状腺功能正常(研究组),与69例无甲状腺异常的女性患者(对照)进行比较。ICSI处理后的受精率(FR),临床妊娠率(CPR),分析流产率(MR)和活产率(LBR)。
方法:所有患有各种不孕因素的受试者均在大学IVF中心接受ICSI治疗。研究组患者接受甲状腺素替代治疗,并在IVF治疗中接受甲状腺素。在IVF周期之前,对内分泌参数进行了统一评估:甲状腺功能和抗体,生殖激素(AMH,FSH,LH,E2,PRL,睾丸激素,DHEAS,17-OHP,AD)和OGTT(0-60-120分钟葡萄糖和胰岛素)。在对实验室参数进行描述性比较之后,年龄调整后的FR分析,CPR,进行MR和LBR。
结果:TAI阳性女性年龄较大(平均年龄35.31±4.95vs.32.15±4.87年;p=0.002),FSH较高(8.4±3.4vs.7.4±2.32U/L;p=0.024),更高的E2(53.94±47.61vs.42.93±18.92pg/ml;p=0.025)水平,而AMH(2.88±2.62vs.3.61±1.69ng/ml;p=0.0002)较低。TSH水平无差异(1.64±0.96vs.两组之间为1.66±0.65uIU/ml;p=0.652)。FT3(2.63±0.58vs.2.98±0.55pg/ml;p=0.002)较低,FT4(1.3±0.29vs.1.13±0.21ng/dl;p=0.0002)在TAI阳性组中较高,反映了临床上无关紧要的差异。卵细胞计数(6±3.8vs.7.5±3.95;p=0.015)在TAI中更低,并且在年龄调整后仍然如此。尽管总体ICSIFR没有差异(62.9%与69.1%,p=0.12),对于35岁以下TAI患者,这一数值较低,显示出与年龄相关的差异逐渐减小.CPR(36.04%vs.69.56%;p<0.001),LBR(23.25%与60.86%;p<0.001)较低,MR(35.48%与12.5%;p=0.024)在TAI组中较高,并且在年龄调整后这些差异仍然存在。
结论:由于研究组的年龄较高可能会干扰TAI的作用,为了消除这一混杂因素,需要进行年龄调整计算。
结论:尽管在临床或亚临床甲状腺功能减退症中补充甲状腺功能最佳,TAI的存在对临床妊娠率产生负面影响,并与较高的流产率有关,因此导致ICSI后活产率降低。TAI患者ICSI受精率降低也可能导致预后较差,尤其是年轻女性。
OBJECTIVE: The objective of this
study was to analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of intracytoplasmic sperm injection (ICSI) cycles as compared to TAI-negative ICSI cycles.
METHODS: In this single in vitro fertilization (IVF) center retrospective
study, 86 infertile women with elevated thyroid peroxidase or TGAb levels, but euthyroid after thyroxine replacement (
study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR) were analyzed.
METHODS: All subjects with various infertility factors were treated with ICSI in university-based IVF center. Patients in the
study group received thyroxine replacement and were euthyroid at IVF treatment. Before the IVF cycles, endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (anti-Müllerian hormone [AMH], follicular stimulating hormone [FSH], luteinizing hormone, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0-60-120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age-adjusted analyses of FR, CPR, MR, and LBR were performed.
RESULTS: TAI-positive women were older (mean age 35.31 ± 4.95 vs. 32.15 ± 4.87 years; p = 0.002), had higher FSH (8.4 ± 3.4 vs. 7.4 ± 2.32 U/L; p = 0.024), higher E2 (53.94 ± 47.61 vs. 42.93 ± 18.92 pg/mL; p = 0.025) levels, while AMH (2.88 ± 2.62 vs. 3.61 ± 1.69 ng/mL; p = 0.0002) was lower. There were no differences in TSH levels (1.64 ± 0.96 vs. 1.66 ± 0.65 µIU/mL; p = 0.652) between the two groups. FT3 (2.63 ± 0.58 vs. 2.98 ± 0.55 pg/mL; p = 0.002) was lower and FT4 (1.3 ± 0.29 vs. 1.13 ± 0.21 ng/dL; p = 0.0002) was higher in the TAI-positive group, reflecting clinically irrelevant differences. Egg cell counts (6 ± 3.8 vs. 7.5 ± 3.95; p = 0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9% vs. 69.1%, p = 0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04% vs. 69.56%; p < 0.001) and LBR (23.25% vs. 60.86%; p < 0.001) were lower, the MR (35.48% vs. 12.5%; p = 0.024) was higher in the TAI group, and these differences remained after age adjustment.
CONCLUSIONS: Since the higher age of the
study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor.
CONCLUSIONS: Despite optimal thyroid supplementation in clinical or subclinical hypothyroidism, the presence of TAI negatively influences CPR and is connected to a higher MR, thus resulting in a lower LBR after ICSI. Decreased FR with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.