Effect Of Antithyroid Antibodies On The Outcome Of IVF/ICSI:a Meta-analysis

Background:Thyroid autoimmunity,characterized by the presence of antithyroglobulin and/or antithyroid peroxidase antibodies,affects 5-20%of women of childbearing age.Thyroid autoimmunity and thyroid dysfunction have been associated with adverse pregnancy outcomes during all trimesters of pregnancy including miscarriage,placental abruption,preterm birth and increased risk of perinatal mortality.Objective:The aim of this paper was to conduct a systematic review and meta-analysis on the impact of the presence of serum antithyroid antibodies on the outcome of in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI).Methods:A thorough search was conducted on PubMed and Web of Science for relevant research articles on this topic.Only English language literatures published between 1998 and 2018 were selected for the study.The primary outcomes of interest were clinical pregnancy rates(CPR),live birth rates(LBR)and miscarriage rates(MR)whereas the secondary outcomes measured were the number of oocytes retrieved per woman(NOR),fertilization rates(FR)and implantation rates(IR).The statistical software RevMan 5 was used to obtain the pooled odds ratios(OR)for the meta-analysis.Results:Nine studies were included in the quantitative analysis.The analysis revealed no significant association between thyroid autoimmunity and CPR(OR=0.92;95%CI,0.77 to 1.09;P=0.33),LBR(OR 0.84;95%CI,0.60 to 1.17;P=0.30),MR(OR=1.20;95%CI,0.85 to 1.69;P=0.29),NOR(SMD 0.10;95%CI,-0.09 to 0.29;P=0.29),FR(OR 0.96;95%CI,0.75 to 1.22;P=0.73)or IR(OR=0.98;95%CI,0.73 to 1.32;P=0.91)in women undergoing IVF/ICSI.The mean age of women with and without autoimmunity was also similar(SMD=0.18;95%CI,-0.15 to 0.52;P=0.29).However,significantly higher levels of basal serum TSH levels(SMD=0.24;95%CI,0.10 to 0.38;P=0.0007)were detected in women with antithyroid antibodies.Conclusion:Thyroid autoimmunity per se does not impair the outcome of IVF or ICSI.Nonetheless,further research is warranted to establish the association between thyroid autoimmunity and ART outcome for appropriate patient counseling and management.