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 1. Healio
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 3. Women's Health & OB/GYN
 4. Reproductive Health


REPRODUCTIVE & MATERNAL HEALTH RESOURCE CENTER

ByErin T. Welsh, MA
Perspective from Caroline T. Nguyen, MD
Fact checked byRichard Smith
Source/Disclosures
Source:

Rao MV, et al. Thyroid. 2023;doi:10.1089/thy.2022.0184.

Disclosures: The authors report no relevant financial disclosures.

Read next
Q&A: Concerns about future may be driving declining US birth rate
Read next
VIDEO: Check thyroid autoimmunity for women with infertility
May 02, 2023
2 min read
Save


THYROID AUTOIMMUNITY NOT LINKED TO EMBRYO QUALITY, BIRTH RATE WITH ASSISTED
REPRODUCTION

ByErin T. Welsh, MA
Perspective from Caroline T. Nguyen, MD
Fact checked byRichard Smith
Source/Disclosures
Source:

Rao MV, et al. Thyroid. 2023;doi:10.1089/thy.2022.0184.

Disclosures: The authors report no relevant financial disclosures.
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KEY TAKEAWAYS :

 * No differences were seen in embryo quality or live birth rate for women with
   vs. without thyroid autoimmunity undergoing assisted reproduction.
 * Clinical pregnancy and early pregnancy loss rates were similar.

Thyroid autoimmunity among women with infertility was not associated with embryo
quality or cumulative live birth rate after IVF or intracytoplasmic sperm
injection, researchers reported in Thyroid.

“Associations between thyroid autoimmunity and pregnancy outcomes have long been
investigated, and several meta-analyses have shown increased risks of pregnancy
loss and preterm birth in women with thyroid autoimmunity,” Meng V. Rao, MD,
from the department of reproduction and genetics at First Affiliated Hospital of
Kunming Medical University, China, and colleagues wrote in study background.
“However, recently published population-based studies have not supported any
detrimental effects of thyroid autoimmunity on pregnancy outcomes following
assisted reproductive technology.”

Data were derived from Rao MV, et al. Thyroid. 2023;doi:10.1089/thy.2022.0184.

Rao and colleagues aimed to evaluate any associations between maternal thyroid
autoimmunity and embryo development among women with infertility undergoing
assisted reproduction. In a retrospective cohort study, they enrolled 499
thyroid autoimmunity-positive (mean age, 31.6 years) and 2,945 thyroid
autoimmunity-negative (mean age, 30.9 years) women with infertility. Thyroid
autoimmunity was defined as a serum thyroperoxidase concentration of at least 34
IU/mL or a thyroglobulin concentration of at least 115 IU/mL. All participants
underwent their first complete IVF or intracytoplasmic sperm injection cycle
between April 2016 and February 2022. Researchers compared embryo quality
measurements and clinical outcomes between those with and without thyroid
autoimmunity.

Researchers observed no significant differences between participants with and
without thyroid autoimmunity in the high-quality cleavage embryo rate (52.8% vs.
53.4%; P = .66) and cumulative live birth rate (53.4% vs. 56.2%; P = .31). In
addition, researchers noted no significant differences between those with and
without thyroid autoimmunity in rates of oocyte retrieval (69.1% vs. 69.4%; P =
.65), fertilization (61.1% vs. 62.2%; P = .34), embryo utilization (80.2% vs.
80.8%; P = .61), blastocyte formation (48.5% vs. 48.4%; P = .97) and
high-quality blastocysts (29.9% vs. 29.4%; P = .73).

Clinical pregnancy rate (46.7% vs. 44.6%; P = .4), early pregnancy loss rate
(13.5% vs. 11.5%; P = .44) and live birth rate (37.4% vs. 36%; P = .55) of the
first transfer cycle were also not significantly different between participants
with and without thyroid autoimmunity.

Read next
Q&A: Concerns about future may be driving declining US birth rate
VIDEO: Check thyroid autoimmunity for women with infertility

“These findings need to be confirmed in large prospective studies,” the
researchers wrote.


PERSPECTIVE

Back to Top

Caroline T. Nguyen, MD

Rao and colleagues conducted a retrospective study to investigate the impact of
thyroid autoimmunity on embryo quality and pregnancy outcomes in patients
undergoing IVF, in which the egg and sperm are left to fertilize in a petri
dish, or intracytoplasmic semen injection, in which the sperm is directly
injected into the egg. The study compared 499 thyroid autoimmunity-positive and
2,945 thyroid autoimmunity-negative euthyroid women whose first oocyte retrieval
cycle resulted in live birth after embryo transfer or failed to result in live
birth after all embryos were transferred.

The reason for the study is that data have been mixed as to the significance of
thyroid autoimmunity and its effects on fertility and assisted reproductive
technology (ART) outcomes. Some studies have shown increased risks of pregnancy
loss and preterm birth in women with thyroid autoimmunity while others have not
supported these findings. The 2017 American Thyroid Association thyroid and
pregnancy guidelines recommend treating patients with TSH above 2.5 mIU/L
undergoing ART but does not have any specific recommendations regarding patients
with thyroid autoimmunity in the preconception period.

The study results showed no significant difference in embryo quality or
cumulative live birth rate, defined as the rate of live births per oocyte
retrieval cycle, following IVF/intracytoplasmic semen injection. Strengths of
this study include it being the first study to investigate the association
between thyroid autoimmunity and cumulative live birth rate. In addition, it is
a large cohort study conducted at a single center looking at the effect of
thyroid autoimmunity on embryo quality. Weaknesses of the study include its
retrospective design, the absence of population-specific reference ranges, small
sample sizes in the subgroup analyses and absence of etiologies of infertility.

Nevertheless, the study results are clinically important because they add to the
growing number of studies that suggest thyroid autoimmunity in the absence of
hypothyroidism does not have a detrimental effect on ART outcomes. Prior studies
have suggested that the increased use of intracytoplasmic semen injection may
help explain the conflicting results in the literature suggesting
intracytoplasmic semen injection may be preferred in patients with thyroid
autoimmunity. However, in this study, there was no significant difference in the
subgroup analysis comparing IVF and intracytoplasmic semen injection methods.

Notably, the study excluded patients with recurrent pregnancy loss of at least
two times. The authors explain that this is because such patients may be more
susceptible to thyroid autoimmunity, referencing recent studies that have
demonstrated in patients with recurrent pregnancy loss, thyroid autoimmunity was
associated with significantly lower live birth rate compared with those without
thyroid autoimmunity and treatment with levothyroxine resulted in similar live
birth rate to thyroid autoimmunity-negative women.

Once pregnant, patients with thyroid autoimmunity have a blunted response in
thyroxine levels compared to thyroid autoimmunity-negative patients and may be
at risk for inadequate thyroid hormone production in pregnancy. Seven percent to
20% of euthyroid patients with thyroid autoimmunity preconception develop
elevated TSH in pregnancy. However, in this study, thyroid hormone levels after
embryo implantation and throughout pregnancy were not reported.

Overall, the results of this study suggest that thyroid autoimmunity alone may
not affect embryo quality and cumulative live birth rate in general patients
presenting for IVF/intracytoplasmic semen injection, but that this should not be
extended to patients with a history of recurrent pregnancy loss for whom thyroid
autoimmunity may play a more significant role.



Caroline T. Nguyen, MD
Assistant Professor of Clinical Medicine, Obstetrics and GynecologyDivision of
Endocrinology, Diabetes and MetabolismKeck School of MedicineUniversity of
Southern California
Disclosures: Nguyen reports no relevant financial disclosures.


READ MORE ABOUT

birth rate
autoimmunity
reproduction
thyroid
pregnancy
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