| Background and objectives:In recent years,the number of infertile people in China has increased year by year,and the incidence of infertility is about 15%[1].Assisted reproductive technology(ART)is an important method for infertility treatment,helping more and more infertile couples to have their babies.Many factors affect the pregnancy outcomes of in vitro fertilization/follicle intracytoplasmic sperm injection-implantation(IVF/ICSI-ET)[2],including female age,ovarian function,embryo quality,endometrial receptivity,and endocrine diseases,etc[3].The thyroid gland is the largest endocrine gland in the human body.Studies have shown that[4]thyroid dysfunction can increase the risk of female infertility and perinatal complications.Thyroid cancer is one of the common malignant tumors in women of reproductive age.Compared with other tumors,the prognosis of thyroid cancer is better,and the five-year survival rate is as high as 90%or even more[5-6].Total or partial thyroidectomy is usually associated with hypothyroidism,leading to endocrine disturbance,associated with an increased risk of reproductive-related diseases,such as menstrual disorders,ovulation disturbance,infertility,miscarriage,etc.It has been reported that hypothyroidism may result in neonatal hypothyroidism,causing abnormal neurodevelopment of brain,and mental retardation Therefore,women with thyroid cancer need long-term use of levothyroxine tablets replacement therapy.Women in the pre-pregnant stage and during pregnancy should pay more attention to the monitoring and follow-up of thyroid function.Does thyroid cancer surgery affect ovarian function,which in turn affects ovarian response and pregnancy outcome during IVF/ICSI-ET,and increases the risk of maternal and neonatal complications?In this study,we aim to observe the ovarian response,pregnancy outcome,maternal and neonatal complications in women after thyroid cancer surgery during IVF/ICSI-ET treatment,and to determine the impact of thyroid cancer surgery on female fertility.Materials and methods:Forty-two patients who underwent IVF/ICSI-ET after thyroid cancer surgery from January 2012 to December 2016 in Reproductive Hospital affiliated to Shandong University were retrospectively analyzed.Ninety women with normal thyroid hormone level and thyroid ultrasound images who underwent IVF/ICSI-ET treatment due to tubal factor or male factor were included as control group.The total dose of gonadotropin(Gn),endometrial thickness on human chorionic gonadotropin(HCG)day,the number of retrieved oocytes were compared between cases and controls.The normal fertilization rate,high quality embryo rate,implantation rate,clinical pregnancy rate,miscarriage rate,live birth rate,maternal and neonatal complications and other indicators were also compared.Results:The level of serum TSH(ulU/ml)was significantly lower in cases than controls(1.70±1.50 ulU/ml vs 2.64±2.57 uIU/ml,P<0.05).The total dose of Gn(2048.22±774.40 U vs.1867.64±899,79 IU),the endometrial thickness on HCG day(1.08±0.16 cm is.1.10±0.17 cm),the number of retrieved oocytes(12.19±7.91),the normal fertilization rate(57.30%vs 58.09%),the high quality embryo rate(61.38%vs 65.10%)had no statistial differences(P>0.05)between cases and controls.No difference was observed in the clinical pregnancy rate(61.11%vs.61.67%),implantation rate(41.43%vs.43.14%),abortion rate(9.09%vs.10.81%),and live birth rate(55.55%vs.50.0%).Compared with the control group,the incidence of gestational complications,including gestational diabetes mellitus and gestational hypertension,in the case group increased,but there was no statistical difference(25.0%vs.6.45%,p>0.05).One baby from case group was diagnosed with neonatal hypothyroidism.There was no recurrence of thyroid carcinoma during IVF/ICSI-ET treatment.Conclusions:Thyroid cancer surgery has no significant effect on the incidences of ovarian response,pregnancy outcome and maternal complications during IVF/ICSI-ET treatment.However,in women after thyroid surgery,the offspring have a risk of hypothyroidism. |
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