背景:累积活产率(CLBR)被认为是评估婴儿在完整的体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗周期中的可能性的最重要终点。许多先前的研究都集中在甲状腺自身免疫(TAI)与第一个胚胎移植周期后的活产率之间的关联。然而,缺乏关于TAI的存在是否影响CLBR的证据。这项研究的目的是调查TAI对CLBR的影响在一个完整的IVF/ICSI周期。
方法:这项回顾性研究包括2019年1月至2021年2月期间接受首次IVF/ICSI治疗的12,796名妇女。根据甲状腺抗体的水平,2,603名妇女被分配到TAI组,10,193名女性被分配到对照组。根据不育的不同原因进行亚组分析(仅包括男性因素,排卵障碍,输卵管因素,子宫内膜异位症和无法解释的不孕症)以及甲状腺抗体的不同类型和滴度。这项研究的主要结果是CLBR,其中包括来自新鲜胚胎移植周期的活产和2021年12月之前进行的所有随后的冻融胚胎移植周期.
结果:TAI组和对照组之间的CLBR没有显着差异,即使在调整了相关的混杂因素,包括年龄,身体质量指数,不孕的原因,甲状腺功能,控制性卵巢刺激的方案,转移类型(新鲜与冻结),移植胚胎的类型(卵裂期胚胎与胚泡),和受精方法(试管婴儿与ICSI)(累计活产:50.6%52.1%,OR0.94,95%CI0.86-1.02,调整后OR0.97,95CI0.89-1.06)。亚组分析显示,TAI组和对照组在所有不孕原因的CLBR中没有观察到显著差异,除了由子宫内膜异位症引起的不孕症。在子宫内膜异位症的女性中,TAI组的CLBR明显低于对照组;在调整了包括年龄在内的潜在混杂因素后,这一差异并不显著,身体质量指数,甲状腺功能,控制性卵巢刺激的方案,转移类型(新鲜与冻结),移植胚胎的类型(卵裂期胚胎与胚泡),和受精方法(试管婴儿与ICSI)(累计活产:43.1%51.0%,OR0.73,95%CI0.53-0.99,调整后OR0.74,95%CI0.53-1.02)。另一个亚组分析表明,甲状腺抗体的类型和滴度不影响TAI女性的CLBR。
结论:在我们的研究中,有TAI的女性和没有TAI的女性之间的CLBR没有显着差异,这表明TAI不会影响在完整的IVF/ICSI治疗周期中生育婴儿的机会。
BACKGROUND: Cumulative live birth rate (CLBR) is considered as the most important endpoint for assessing the probability of having a baby in a complete in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycle. Many previous studies have focused on the association between thyroid autoimmunity (TAI) and live birth rate after first embryo transfer cycle, however, evidence on whether the presence of TAI affects the CLBR is lacking. The purpose of this study is to investigate the impact of TAI on the CLBR in a complete IVF/ICSI cycle.
METHODS: This retrospective study included 12,796 women who underwent their first IVF/ICSI treatment between January 2019 and February 2021. Based on the levels of thyroid antibodies, 2,603 women were assigned to the TAI group, and 10,193 women were assigned to the control group. Subgroup analysis was performed according to the different causes of infertility (including male factor only, ovulation disorder, tubal factor, endometriosis and unexplained infertility) and different types and titres of thyroid antibodies. The primary outcome in this study was CLBR, which included live births from the fresh embryo transfer cycle and all subsequent frozen-thawed embryo transfer cycles performed before December 2021.
RESULTS: There was no significant difference in the CLBR between the TAI and control groups, even after adjusting for relevant confounders including age, body mass index, cause of infertility, thyroid function, protocols of controlled ovarian stimulation, type of transfer (fresh vs. frozen), type of transferred embryo (cleavage-stage embryo vs. blastocyst), and fertilization method (IVF vs. ICSI) (cumulative live birth: 50.6% vs. 52.1%, OR 0.94, 95% CI 0.86-1.02, adjusted OR 0.97, 95%CI 0.89-1.06). Subgroup analysis showed that no significant difference was observed in CLBR between the TAI and control groups for all causes of infertility, except for infertility attributed to endometriosis. Among women with endometriosis, the CLBR was significantly lower in the TAI group than that in the control group; however, this difference was not significant after adjusting for potential confounders including age, body mass index, thyroid function, protocols of controlled ovarian stimulation, type of transfer (fresh vs. frozen), type of transferred embryo (cleavage-stage embryo vs. blastocyst), and fertilization method (IVF vs. ICSI) (cumulative live births: 43.1% vs. 51.0%, OR 0.73, 95% CI 0.53-0.99, adjusted OR 0.74, 95% CI 0.53-1.02). Another subgroup analysis demonstrated that the type and titre of thyroid antibody did not affect CLBR in women with TAI.
CONCLUSIONS: In our study, there was no significant difference in the CLBR between women with TAI and those without TAI, which suggests that TAI did not affect the chances of having a baby in a complete IVF/ICSI treatment cycle.