The Effect Of Thyroid Dysfunction And Antibodies On Femaleinfertility And IVF/ICSI Outcomes

Purpose: Analyzing the clinical characteristics of thyroxine, tri-iodothyronine, thyroid stimulating hormone(TSH) and thyroid antibody in infertile women and the outcomes of assisted reproductive technology for women with positive thyroid autoantibodies(autoimmune thyroiditis). To investigate the influence of thyroxine, tri-iodothyronine, thyroid stimulating hormone(TSH) aberration and positive thyroid autoantibodies to female infertility and the outcomes of Assisted Reproductive Technology.Method: Part1: Collected the clinical date, thyroid function(T3, T4, TSH), thyroid autoantibodies(TG-Ab、TPO-Ab or TM-Ab), reproductive endocrinology, vagina ultrasound, ANA, ACA, blood sugar, blood fat, insulin, spouses’ semen examination of female infertility patients in General Hospital of Ningxia Medical University from January 2012 to December 2014. All patients divided into 5 groups according to diagnostic criteria, polycystic ovary syndrome, recurrent abortion, premature ovarian failure, endometriosis and control group. Analysed the level of T3, T4, TSH and the percentage of subclinical hypothyroidism and autoimmune thyroiditis.Part2: Selected infertility patients due to oviduct factors and spouse with oligo-atheno-terato-spermia and aspermia from patients accepted assistive reproduction in General Hospital of Ningxia Medical University from January 2012 to December 2014. Among them, 18 patients with any one or two thyroid antibodies positive were as the AIT groups, 47 patients with all thyroid antibodies negative and normal level of T3, T4 and TSH were as the control group. Analysed the difference between the two groups including the level of thyroid antibodies, ANA, ACA, Basal luteinizing hormone, Basal follicle stimulating hormone, ovulation induction project, ovulation induction time, category and volume dose of ovulation induction drugs, E2 in day of HCG, antral follicle count, number of retrieved eggs,number of MII eggs,portable embryo number, high quality embryo number, total number of migration cycle,and number of pregnancies and abortions.Result: 1. The level of T4 in Polycystic ovarian syndrome and premature ovarian failure groups was higher than other groups(t=2.230, 4.232;P<0.05)2. The percentage of subclinical hypothyroidism and autoimmune thyroiditis was no significant difference in polycystic ovarian syndrome, recurrent spontaneous abortion, premature ovarian failure, endometriosis and control group(X2=-0.089,-0.881,-0.543,-0.030,-0.330,-1.034,-0.353,-0.399;P>0.05).3. The percentage of subclinical hypothyroidism in PCOS patients with IR were higher than those without(X2=4.165,P=0.041).Thyroid function of patients in polycystic ovarian syndrome was not influenced by BMI, blood fat, abnormal glucose metabolism, testosterone level(P>0.05).4. PCOS group was divided into 6 groups according to the level of LH/FSH. Group A, C and E ≥1.0, 3.0 and 3.5. Group B, D and F <1.0, 3.0 and 3.5. Analysed the level of T3, T4 and TSH between group A and B, C and D, E and F. T4 level of group C was significant lower than group D(t=-3.381, P=0.001), the same as group E to group F(t=-2.282, P=0.025).5. Compared to no-SCH group,MII ocyte numbers were less in patients with SCH who received fertility treatment(t=-3.597;P=0.010).6. Compared to no-AIT, T4 level was significant higher and Gn time was less in patients who undergoing IVF/ICSI with AIT(t=2.797,-2.075, P=0.007, 0.042).Conclusion: 1. PCOS and POF patients may have potential hyperthyroidism..2. The proportion of SCH and AIT may have no significant difference among patients with different cause of infertility.3. IR may cause SCH in patients with PCOS.4. Latent insufficient T4 may exist in PCOS patients with high LH/FSH level.5. SCH patients who undergoing IVF/ICSI may have defects of ocyte maturation.6. AIT patients may have better ovarian reponse during PVF/ICSI.