| Objective : To study the effects of the administration of long-acting gonadotropin-releasing hormone agonist(GnRH-a)on thyroid function in euthyroid patients of IVF/ICSI-ET and the change of thyroid stimulating hormone(TSH)level during controlled ovarian stimulation(COS).Compare the outcome of IVF/ICSI in groups with different serum TSH levels.Materials and Methods:This is a prospective cohort study performed in 207 patients recruited by the Second Affiliated Hospital of Hebei Medical University from January2016 to December 2016.All subjects are female euthyroid patients of IVF/ICSI with no history of thyroid diseases.Long GnRH-a protocol was chosen as the COS protocol.Patients are divided into two groups based on basal serum TSH level;Group A with 0.35mIU/L < TSH <2.5mIU/L(N=137);Group B with 2.5mIU/L≤TSH<4.5mIU/L(N=70).Serum hormone level(TSH)is tested on 6 time points:(1)before COS(2-5days in menstrual cycle,before Gn RH-a injection)(2)Gn injection day 1(after GnRH-a injection)(3)Gn injection day 5(4)HCG day(5)14 days after transplantation(6)28 days after transplantation.Record the change of serum TSH level before and after long-acting GnRH-a injection.Compare the clinical pregnancy rate and abortion rate between group A and group B.Observe the variation of serum TSH level during COS.SPSS19.0 software is used for statistical analysis and P<0.05 is considered statistically significant.Result:Basic characteristics such as age,body mass index,duration of infertility,basal hormone and AFC in both groups were matched(P>0.05).(1)The serum TSH level was significantly higher than that before GnRH-a injection(P < 0.05).Both group A and group B had a significant increase inserum TSH level.(P<0.05).In total,131(63.3%)patients showed an increase of TSH level after long-acting GnRH-a injection.20(15.3%)of the 131 patients were diagnosed as subclinical hypothyroidism with TSH level over4.5 mIU/L.76(36.7%)patients showed decreased level of TSH with 2patients’ TSH level below 0.35mIU/L.17(8.2%)patients had simultaneous rise of TPOAb.In group A,79(57.7%)patients showed an increase of TSH after long-acting GnRH-a injection,including 3 patients(3.8%)with simultaneous rise of TPOAb.4(5.1%)of the 79 patients were diagnosed as subclinical hypothyroidism with TSH level over 4.5 mIU/L.58(42.3%)patients in group A showed decreased level of TSH with 1 patient of both elevated level of TPOAb and diagnosis of subclinical hyperthyroidism.In group B,52(74.3%)patients showed an increase of TSH,including 13(25%)patients with elevated TPOAb.16(30.8%)of the 52 patients were diagnosed as subclinical hypothyroidism with TSH level over 4.5 mIU/L.18(25.7%)patients in group B showed decreased level of TSH with 1 patient diagnosed with subclinical hyperthyroidism.Group B had a significant higher proportion of patients with elevated serum TSH than group A(P<0.05).(2)Compared to the baseline level,serum TSH ascended distinctly and reached peak level on HCG day in both group A and group B with similar trend.(3)Patients in group A had significantly higher clinical pregnancy rate than that in group B(P<0.05).No difference of abortion rate between patients in group A and group B were observed(P>0.05).Conclusion:Serum TSH level is significantly higher than that before long-acting GnRH-a injection.Serum TSH level showed diverse change in individuals with a severe cases displaying subclinical hyperthyroidism,subclinical hyperthyroidism and autoimmune thyroid disorders,etc.Patients with TSH>2.5mIU/L are more easily affected by long-acting Gn RH-a.During COS and before HCG day,the serum TSH showed a tendency of elevation.Patients with a low level of baseline TSH(<2.5IU/ml)may benefit with a higher clinical pregnancy rate in IVF/ICSI. |
PDF Full Text Request