| Objective: To compare the pregnancy outcome of In Vitro Fertilization andEmbryo Transfer(IVF-ET) between Anti-thyroid Autoantibodies(ATA) positive womenand ATA negative women, and explore the impact of ATA on the pregnancy outcome ofIVF–ET.Method: Collected patients in Dalian Reproductive Medicine Center of MaternityHospital from November2012to June2013, who receive IVF-ET therapy for the firsttime,Inclusion criteria:(1) pure tubal factor;(2)≤38years old;(3) FSH(Follicle-Stimulating Hormone)≤10mIU/ml;(4) TSH(thyroid stimulating hormone)were normal:0.51-4.94mIu/ml; while Exclusion criteria:(1)chromosomal abnormalities;(2) TORCH (+);(3) PCO/PCOS;(4) EMS/adenomyosis;(5) uterine fibroids/uterinemalformation;(6) history of ovarian or uterine surgery;(7) hydrosalpinx;(8) metabolicdiseases or autoimmune diseases. Collected patient serum at the second or third day ofthe menstrual cycle before ovulation period, for basal Endocrine: E2(Estradiol), FSH,LH (Luteinizing Hormone), PRL (Prolactin), TSH, free T3, free T4, and detection ofserum ATA: TPO-Ab (Anti-thyroid Peroxidase Antibody), TG-Ab (Anti-thyroglobulinAntibody) by immunofluorescence technology; Collected patient serum the day thatHCG was administration(HCG day)and the14th day after ET (ET14day) for TSHdetection.108cases who were positive in ATA with normal thyroid function as study group,272cases who were negative in ATA with normal thyroid function as controlgroup,Compared ovarian reactivity, pregnancy outcome and the changes in TSH levelbetween two groups; In Study Group,52cases who were positive in only TPO-Ab oronly TG-Ab as TPO-Ab only/TG-Ab only group,56cases who is positive in bothTPO-Ab and TG-Ab as TPO-Ab and TG-Ab group, compared pregnancy rate，miscarriage rate and live delivery rate between two groups; In Study Group,60cases inwhich the titer of TPO-Ab is less than504u/ml and the titer of TG-Ab is less than221u/ml as low titer group,48cases in which the titer of TPO-Ab is no less than504u/ml or the titer of TG-Ab no is less than221u/ml as high titer group, pregnancyrate，miscarriage rate and live delivery rate between two groups.Results:(1) ATA positive group (study group):108cases, pregnancy:64cases; miscarriage:18cases, miscarriage rate:28.13%; live delivery:46cases, live delivery rate:71.87%.ATA negative group (control group):272cases, Pregnancy:152cases; miscarriage:20cases, miscarriage rate:13.16%; live delivery:131cases, the other one case inducedlabor because of fetal malformations at the time of5months pregnant, live delivery rate:86.18%. The miscarriage rate of ATA positive group was significantly higher than ATAnegative group, the difference was statistically significant (p <0.01); live delivery rate ofATA positive group was significantly lower than ATA negative group, the difference wasstatistically significant (p <0.01).(2) low titer group (Low group):60cases, pregnancy:32cases, pregnancyrate:53.33%; miscarriage:5cases, miscarriage rate:15.63%; live delivery:27cases,live delivery rate:84.37%. high titer group:48cases, pregnancy:32cases, pregnancyrate:66.67%; miscarriage:13cases, miscarriage rate:40.63%; live delivery:19cases,live delivery rate:59.37%. The miscarriage rate of High group was significantly higherthan Low group, the difference was statistically significant (p <0.05); The live deliveryrate of High group was significantly lower than Low group, the difference wasstatistically significant (p <0.05).(3) ET14day serum TSH levels in ATA positive women (study group) were significantly higher than ATA negative women (control group), the difference wasstatistically significant (4.26±0.54VS2.28±0.64, p <0.05).Conclusion:(1) The risk of miscarriage in ATA positive patients was significantly increased.(2) the risk of miscarriage in ATA positive patients increases with antibody titerincreasing.(3) ATA positive patients were accompanied with thyroid regulation functionimpaired, which may be another mechanism for the risk of miscarriage increasing. |
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