Effects Of Thyroid Autoimmune Antibodies And TSH On Pregnancy Outcomes In IVF/ICSI Patients

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Effects of TPO-Ab and TSH on pregnancy outcomes in IVF/ICSI patientsBackground:Euthyroid autoimmune thyroiditis is prevalent in women with infertility.During the assisted reproductive technology(ART)cycle,a transient increase in thyroid-stimulating hormone(TSH)has been documented during controlled ovarian hyperstimulation.In addition,the h CG injection for oocyte maturation triggering stimulates the TSH receptors,causing changes in the secretion of TSH.Tpo-ab may adversely affect pregnancy as an autoimmune antibody.However,the influence of Tpo-ab and TSH on the pregnancy outcome of IVF/ ICSI patients is still controversial.Purpose:Our study aims to investigate the influence of thyroid peroxidase antibody(Tpo-ab)and TSH levels on IVF pregnancy outcomes,It is hoped that the clinical basis can be found for the clinical treatment of such patients.Method:Retrospective analysis was performed on infertility patients who were treated with in vitro fertilization and embryo transfer(IVF-ET)in the reproductive medicine center of Henan provincial people's hospital from September 2016 to December 2017.A total of 1107 patients who were enrolled in the study were divided into four groups based on serum TSH level and TPO-Ab status: Group A,0.3? TSH <2.5 mIU/L and TPO-Ab-(n=649);Group B,0.3? TSH <2.5 mIU/L and TPO-Ab+(n=54);Group C,2.5?TSH <4.2 mIU/L,and TPO-Ab-(n=378);and Group D,2.5? TSH <4.2 mIU/L(n=26),TPO-Ab+.The differences in ART cycles and pregnancy outcomes were analyzed between study groups.Results:The fertilization rate in group D(73%)was significantly lower than those in groups A(83% P < 0.001),B(84% P = 0.001),and C(82% P = 0.002).The biochemical pregnancy rates of groups B(7%)and D(12%)were significantly higher than that of group A(2%)(P=0.028 and P=0.017,respectively).There were no statistically significant differences in implantation rate,clinical pregnancy rate,early abortion rate and live birth rate among the four groups(P > 0.05).Logistic regression analysis found that TPO-Ab was a high risk factor for biochemical pregnancy in IVF assisted pregnancy patients(P=0.002,OR=5.311,95%CI 1.859 – 15.169).Receiver operating characteristic(ROC)curve analysis found that the area under the curve(AUC)for TSH level(?2.5mIU/L)and TPO-Ab+ together for fertilization rate was 0.653(95% CI 0.260-0.765,P=0.008)and the AUC for TPO-Ab+ for biochemical pregnancy was 0.651(95% CI 0.505-0.796,P=0.024),with statistical significance.Conclusions:2.5?TSH <4.2 mIU/L with tpo-ab + can reduce the fertilization rate of IVF/ICSI assisted pregnancy patients,and tpo-ab + can improve the biochemical pregnancy rate of such patients.TPO-Ab and TSH levels between 0.3 < TSH <4.2 mIU/L had no effect on implantation rate,clinical pregnancy rate,early abortion rate and live birth rate of IVF/ICSI assisted pregnancy patients.Part ? The effect of thyroglobulin antibody(TG-Ab)and basic serum TSH on pregnancy outcomes of IVF/ICSI patientsBackground:Studies have shown that ATA positive women not only have an increased incidence of infertility but also an increased risk of pregnancy complications.Current ATA studies typically include two antibodies,TPO-Ab and TG-Ab,or analyze the effects of TPO-Ab alone on IVF/ICSI outcomes,while there are few studies on the effects of TG-Ab on IVF/ICSI outcomesObjective:To investigate the effect of thyroglobulin antibody(TG-Ab)and serum TSH on pregnancy outcomes of IVF/ICSI patients,It is hoped that the clinical basis can be found for the clinical treatment of such patients.Methods:Retrospective analysis was performed on infertility patients who were treated with in vitro fertilization and embryo transfer(IVF-ET)in the reproductive medicine center of Henan provincial people's hospital from September 2016 to December 2017.A total of 1083 patients who were enrolled in the study were divided into four groups based on serum TSH level and TG-Ab status:group A(0.3 mIU/L?TSH<2.5 mIU/L,TG-Ab is negative,n=649);group B(0.3 mIU/L?TSH<2.5 mIU/L,TG-Ab is positive,n=24): group C(2.5mIU/L?TSH<4.2mIU/L,TG-Ab is negative,n=378);group D(2.5mIU/L?TSH<4.2mIU/L,TG-Ab is positive,n=32).Clinical data and pregnancy outcomes were compared between the four groups.Results:There was no significant difference in clinical data between the four groups except for the TSH level.The implantation rate(38.04%),clinical pregnancy rate(53.12%)and live birth rate(43.75%)in group D were lower than those in group A(48.94%,66.72%,55.93%),group B(55.33%,66.67%,58.33%),and group C(47.08%,63.49%,51.85%),there were no significantly differences(P >0.05).Logistic regression analysis found that TSH and TG-Ab had no significant effect on the fertilization rate,implantation rate,biochemical pregnancy rate,early abortion rate,clinical pregnancy rate and live birth rate of IVF assisted pregnancy patients.Conclusion:Patients with serum TSH between 2.5-4.2 mIU/L,TG-Ab positive were assisted with IVF-ET,the implantation rate,clinical pregnancy rate and live birth rate decreased to a certain extent,However,its specific impact still needs to be studied in a larger sample.