亚临床甲状腺功能减退对患者体外受精胚胎移植结局影响分析
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摘要
目的:分析亚临床甲状腺功能减退(亚甲减)患者行体外受精胚胎移植治疗时的胚胎情况。方法:选取2014年6月至2017年10月于安徽省皖南医学院弋矶山医院生殖医学中心接受第一次体外受精-胚胎移植(IVF-ET)助孕的患者249人为研究对象,其中亚甲减67例,甲状腺功能正常患者182例,所有亚甲减患者在进周期时给予左旋甲状腺素片(优甲乐)治疗。利用回顾性分析方法,比较两组患者的获卵数、体外成熟(MⅡ)卵数、受精率、卵裂率、补救卵泡浆内单精子注射(ICSI)率、优胚率等。结果:两组患者受精率、卵裂率和补救ICSI率差异有统计学意义(P<0.05),而获卵数、MⅡ卵数及优胚率差异无统计学意义(P>0.05)。结论:亚甲减患者进周期时虽给予治疗,维持TSH水平2.5 m IU/mL,但仍有可能会降低受精率、卵裂率及增加补救ICSI率,故认为给予患者药物治疗亚甲减,维持甲状腺功能的稳定是必要的。
AIM: To investigate the effects of in vitro fertilization( IVF) on embryo acquisition in patients with subclinical hypothyroidism. METHODS: A total of 249 human subjects who received in vitro fertilization and embryo transfer( IVF-ET)for the first time in the reproductive medicine center of Wannan Medical College affiliated Yijishan Hospital from June 2014 to October 2017 were included and divided into two groups,with 67 cases of subclinical hypothyroidism,and 182 cases of normal thyroid function. Patients with subclinical hypothyroidism received levothyroxine sodium tablets at the beginning of treatment. Retrospective analysis was used to compare the number of retrieved oocytes,MII eggs,fertilization rate,cleavage rate,rescue ICSI rate,and high quality embryo rate between two groups. RESULTS: There were significant differences in fertilization rate,cleavage rate and salvage ICSI rate between the two groups( P < 0. 05),but there was no significant difference in the number of retrieved oocytes,the number of MII eggs and the rate of high quality embryos( P > 0. 05). CONCLUSION: Though patients with subclinical hypothyroidism received treatment to maintain TSH≤2. 5 m IU/m L,they may still present lower fertilization rate,cleavage rate and higher rescue ICSI rate,hence drug maintenance is essential for subclinical hypothyroidism to maintain thyroid function.
AIM: To investigate the effects of in vitro fertilization( IVF) on embryo acquisition in patients with subclinical hypothyroidism. METHODS: A total of 249 human subjects who received in vitro fertilization and embryo transfer( IVF-ET)for the first time in the reproductive medicine center of Wannan Medical College affiliated Yijishan Hospital from June 2014 to October 2017 were included and divided into two groups,with 67 cases of subclinical hypothyroidism,and 182 cases of normal thyroid function. Patients with subclinical hypothyroidism received levothyroxine sodium tablets at the beginning of treatment. Retrospective analysis was used to compare the number of retrieved oocytes,MII eggs,fertilization rate,cleavage rate,rescue ICSI rate,and high quality embryo rate between two groups. RESULTS: There were significant differences in fertilization rate,cleavage rate and salvage ICSI rate between the two groups( P < 0. 05),but there was no significant difference in the number of retrieved oocytes,the number of MII eggs and the rate of high quality embryos( P > 0. 05). CONCLUSION: Though patients with subclinical hypothyroidism received treatment to maintain TSH≤2. 5 m IU/m L,they may still present lower fertilization rate,cleavage rate and higher rescue ICSI rate,hence drug maintenance is essential for subclinical hypothyroidism to maintain thyroid function.
引文
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[14]Onal H,Ercan O,Adal E,et al.Subclinical hypothyroidism in in vitro fertilization babies[J].Acta Paediatrica,2012,101(6):e248-252.
[15]Kim CH,Ahn JW,Kang SP,et al.Effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome in infertile womenwith subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection[J].Fertil Steril,2011,95(5):1650-1654.
[16]Busnelli A,Somigliana E,Benaglia L,et al.In vitro fertilization outcomes in treated hypothyroidism[J].Thyroid,2013,23(10):1319-1325.
[17]Cai Y,Zhong L,Guan J,et al.Outcome of in vitro fertilization in women with subclinical hypothyroidism[J].Reprod Biol Endocrinol,2017,15(1):39.
[18]Korevaar TIM,Medici M,Visser TJ,et al.Thyroid disease in pregnancy:new insights in diagnosis and clinical management[J].Nat Rev Endocrinol,2017,13(10):610-622.
[19]刘云,陈媛媛,张西艺,等.左旋甲状腺素片治疗妊娠合并甲状腺功能减退的安全性及对妊娠结局影响[J].疑难病杂志,2016,15(4):405-408.
[2]Sun SC,Hsu PJ,Wu FJ,et al.Thyrostimulin,but not thyroidstimulating hormone(TSH),acts as a paracrine regulator to activate the TSH receptor in mammalian ovary[J].J Biol Chem,2010,285:3758-3765.
[3]Alexander EK,Pearce EN,Brent GA,et al.2017Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid,2017,27(3):315-389.
[4]Kilic S,Tasdemir N,Yilmaz N,et al.The effect of anti-thyroid antibodies on endometrial volume,embryo grade and IVF outcome[J].Gynecol Endocrinol,2008,24(11):649-655.
[5]Leiva P,Schwarze JE,Pamela Vasquez P,et al.There is no association between the presence of antithyroid antibodies and increased reproductive loss in pregnant women after ART:a systematic review and meta-analysis[J].JBRA Assist Reprod,2017,21(4):361-365.
[6]Martina C,Luisa C,Enke B,et al.Molecular basis of thyrotropin and thyroid hormone action during implantation and early development[J].Hum Reprod Update,2014,20(6):884-904.
[7]Wakim AN,Polizotto SL,Buffo MJ,et al.Thyroid hormones in human follicular fluid and thyroid hormone receptors in human granulosa cells[J].Fertil Steril,1993,59(6):1187-1190.
[8]Marziyeh A,Homa A,Ashraf A,et al.Effects of thyroid stimulating hormone(TSH)level on clinical pregnancy rate via in vitro fertilization(IVF)procedure[J].Med J Islam Repub Iran,2014,15;28:46.
[9]Cramer DW,Sluss PM,Powers RD,et al.Serum prolactin and TSH in an in vitro fertilization population:is there a link between fertilization and thyroid function[J]?J Assist Reprod Genet,2003,20(6):210-215.
[10]陈玉竹,赵淑云.原发性甲状腺功能减退治疗后患者体外受精胚胎移植的妊娠结局分析[J].中国医药指南,2014,12(31):86-87.
[11]Karmon AE,Cardozo ER,Souter,et al.Donor TSH level is associated with clinical pregnancy among oocyte donation cycles[J].J Assist Reprod Genet,2016,33(4):489-494.
[12]Garber JR,Cobin RH,Gharib H,et al.Clinical practice guidelines for hypothyroidism in adults:cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association[J].Endocrinol Am Assoc Clin Endocrinologist,2012,18(6):988-1028.
[13]Coelho Neto MA,Martins WP,Melo AS,et al.Subclinical hypothyroidism and intracytoplasmic sperm injection outcomes[J].Rev Bras Ginecol Obstet,2016,38(11):552-558.
[14]Onal H,Ercan O,Adal E,et al.Subclinical hypothyroidism in in vitro fertilization babies[J].Acta Paediatrica,2012,101(6):e248-252.
[15]Kim CH,Ahn JW,Kang SP,et al.Effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome in infertile womenwith subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection[J].Fertil Steril,2011,95(5):1650-1654.
[16]Busnelli A,Somigliana E,Benaglia L,et al.In vitro fertilization outcomes in treated hypothyroidism[J].Thyroid,2013,23(10):1319-1325.
[17]Cai Y,Zhong L,Guan J,et al.Outcome of in vitro fertilization in women with subclinical hypothyroidism[J].Reprod Biol Endocrinol,2017,15(1):39.
[18]Korevaar TIM,Medici M,Visser TJ,et al.Thyroid disease in pregnancy:new insights in diagnosis and clinical management[J].Nat Rev Endocrinol,2017,13(10):610-622.
[19]刘云,陈媛媛,张西艺,等.左旋甲状腺素片治疗妊娠合并甲状腺功能减退的安全性及对妊娠结局影响[J].疑难病杂志,2016,15(4):405-408.