ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
Dergisi

Turkish Journal of Reproductive Medicine and Surgery

Dernek Sitesi
Kayıtlı İndexler
ORİJİNAL ARAŞTIRMALAR

Tiroid Otoimmünitesinin ICSI Sonuçlarına Etkisi; Retrospektif Kohort Çalışma İle Tek Merkez Deneyimi
The Impact of Thyroid Autoimmunity on ICSI Outcome; A Retrospective Cohort Study From Single Referral Center Experience
Received Date : 15 Dec 2020
Accepted Date : 03 Jan 2021
Available Online : 03 Feb 2021
Doi: 10.24074/tjrms.2020-80628 - Makale Dili: TR
TJRMS. 2020;4(3):78-83
ÖZET
Amaç: Tiroid otoimmünitesi (TAI), üreme çağındaki kadınlarda en sık görülen ve tiroid disfonksiyonuna en sık neden olan otoimmün patolojidir. Özellikle, gebeliğin tüm dönemlerinde olumsuz obstetrik sonuçlarla ilişkilendirilmiştir. Ayrıca, çoğu çalışma infertilite kliniklerine başvuran kadınlar arasında artan TAI prevalansını gösterdiğinden, bu durumun gerek doğal doğurganlık gerekse yardımcı üreme tekniklerinin başarı oranı üzerinde zararlı bir etkisi olduğunu düşündürmüştür. Bu çalışmanın amacı, kendi başına TAI ile intrasitoplazmik sperm enjeksiyonu (ICSI) sikluslarının sonucu arasındaki ilişkiyi tanımlamaktır. Gereç ve Yöntemler: Çalışma Ege Üniversitesi Rektörlüğü Aile Planlaması ve Kısırlık Uygulama Araştırma Merkezinde retrospektif kohort olarak yapıldı. Birincil sonuç elde edilen oosit ve embriyo sayısı iken ikincil sonuç TSH seviyesine göre klinik gebelik oranları idi. Hastalar tiroid fonksiyon testleri, antitiroid peroxidase (TPO) ve anti tiroglobulin (TG) sonuçları açısından değerlendirildi. Bulgular:Anti tpo pozitif ve negatif gruplar değerlendirildiğinde edilen metafaz 2 oosit sayısı her iki grupta benzer iken embryo sayısı ise antikor negatif grupta istatistiksel olarak anlamlı oranda yüksek saptandı Anti tiroglobulin negatif grupta ise hem elde edilen metafaz 2 oosit sayısı hem de elde edilen embriyo sayısı istatistiksel olarak anlamlı oranda yüksek saptandı. Her iki antikor pozitifliği de gebelik sonuçlarını istatistiksel olarak anlamlı oranda kötü etkilediği saptandıi TSH değerleri açısından yapılan değerlendirmede ise, TSH değeri 2.5 μIU/mL olduğunda IVF sonuçlarının daha iyi olduğu tespit edildi. Sonuç: Bu sonuçlara göre tiroid otoantikorlarının varlığının, IVF sonuçları üzerinde olumsuz bir etkiye sahip olabileceği düşünüldü.
ABSTRACT
Objective: Thyroid autoimmunity (TAI) is the most frequent autoimmune condition and the most commonly encountered cause of thyroid dysfunction among women of reproductive age. Notably, it has been associated with adverse obstetric outcomes during all trimesters of pregnancy. Furthermore, since most studies show an increased prevalence of TAI among women attending infertility clinics, a detrimental impact of this condition on natural fertility and on the rate of success of assisted reproductive techniques has been suggested. However, to date, the results have been inconsistent. The objective of this study was to define the relation between TAI per se and the outcome of in vitro fertilisation intracytoplasmic sperm injection (ICSI) cycles. Material and Methods: The study was conducted as a retrospective cohort at Ege University Family Planning Infertility and Research Center. The primary outcome was the number of oocytes and embryos obtained, while the secondary outcome was clinical pregnancy rates according to TSH level. Patients were evaluated in terms of thyroid function tests, anti-tiroid peroxidase (TPO) and antithyroglobulin (TG) antibodies. Results: While the number of retrieved metaphase 2 oocytes in anti-tpo positive and negative groups was similar, the number of embryo’s were statistically significantly higher in the antibody negative group. The number of the metaphase 2 oocytes obtained and the number of embryos obtained were statistically significantly higher in the anti-thyroglobulin negative group than anti-thyroglobulin positive group. The IVF results were found to be better when TSH levels were below 2.5 μIU/mL. Conclusion: The presence of thyroid autoantibodies may have a detrimental effect on the IVF outcomes.
SITE.TEXT.RESOURCES
  1. Vissenberg R, Manders VD, Mastenbroek S, Fliers E, Afink GB, Ris-Stalpers C, et al. Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update. 2015;21:378-87.[Crossref] [PubMed] 
  2. Poppe K, Velkeniers B, Glinoer D. The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab. 2008;4:394-405.[Crossref] [PubMed] 
  3. Krassas GE, Perros P, Kaprara A. Thyroid autoimmunity, infertility and miscarriage. Expert Rev Endocrinol Metab. 2008:3;127-36.[Crossref] [PubMed] 
  4. Wakim AN, Polizotto SL, Buffo MJ, Marrero MA, Burholt DR. Thyroid hormones in human follicular fluid and thyroid hormone receptors in human granulosa cells. Fertil Steril. 1993;59:1187-90.[Crossref] 
  5. Cecconi S, Rucci N, Scaldaferri ML. Thyroid hormone effects on mouse oocyte maturation and granulosa cell aromatase activity. Endocrinology. 1999;140:1783-8.[Crossref] [PubMed] 
  6. Monteleone P, Parrini D, Faviana P, Carletti E, Casarosa E, Uccelli A, et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol. 2011;66:108-14.[Crossref] [PubMed] 
  7. Twig G, Shina A, Amital H, Shoenfeld Y. Pathogenesis of infertility and recurrent pregnancy loss in thyroid autoimmunity. J Autoimmun. 2012;38:J275-J81.[Crossref] [PubMed] 
  8. Vissenberg R, Manders VD, Mastenbroek S, Fliers E, Afink GB, Ris-Stalpers C, et al. Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update. 2015;21:378-87.[Crossref] [PubMed] 
  9. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21:1081-125.[Crossref] [PubMed] [PMC] 
  10. Michalakis KG, Mesen TB, Brayboy LM, Yu B, Richter KS, Levy M, et al. Subclinical elevations of thyroid-stimulating hormone and assisted reproductive technology outcomes. Fertil Steril. 2011;95:2634-7.[Crossref] [PubMed] [PMC] 
  11. Van den Boogaard E, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17:605-19.[Crossref] [PubMed] 
  12. Geva E, Vardinon N, Lessing JB, Lerner-Geva L, Azem F, Yovel I, et al. Organ-specific autoantibodies are possible markers for reproductive failure: a prospective study in an in-vitro fertilizationembryo transfer programme. Hum Reprod. 1996;11:1627-31.[Crossref] [PubMed] 
  13. Kutteh WH, Schoolcraft WB, Scott RT Jr. Antithyroid antibodies do not affect pregnancy outcome in women undergoing assisted reproduction. Hum Reprod. 1999;14:2886-90.[Crossref] [PubMed] 
  14. Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro R, Tarlatzis BC, Papadimas I: Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur J Endocrinol. 2010;162:643-52.[Crossref] [PubMed] 
  15. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:2543-65.[Crossref] [PubMed] 
  16. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21:1081-25.[Crossref] [PubMed] [PMC] 
  17. Stuckey BG, Yeap D, Turner SR. Thyroxine replacement during super-ovulation for in vitro fertilization: a potential gap in management? Fertil Steril. 2010;93:2414.e1-2414.e3.[Crossref] [PubMed]