促甲状腺激素(TSH)水平对IVF/ICSI妊娠结局的影响

Correlation of Thyroid Stimulating Hormone (TSH) Level with Pregnancy Outcome in Women Undergoing in vitro Fertilization or Intracytoplasmic Sperm Injection

目的：探讨在IVF/ICSI-ET周期中患者基础促甲状腺激素（thyroid stimulating hormone,TSH）水平与临床妊娠结局的关系。方法：回顾性分析第1次行IVF/ICSI-ET不孕患者的促排卵结局与TSH的相关性。结果：①在1 832个IVF/ICSI周期中,TSH与PRL水平呈正相关（r=0.080,P=0.002）,而与获卵数、受精卵子数、受精率、可移植胚胎数、优质胚胎数、孕囊与心芽搏动数、种植率、生化妊娠率、流产率、活产率无明显相关性（P〉0.05）;PRL与获卵数呈正相关（r=-0.050,P=0.032）,但不影响后期的受精、可移植胚胎数、优质胚胎数、着床及后期的生化妊娠率、临床妊娠率及活产率。控制PRL后对TSH本身与获卵数行相关性分析,结果两者间无相关性（r=0.004,P=0.874）。②分别比较不同TSH界值下高于界值与低于界值组的获卵数、受精卵子数、受精率、可移植胚胎数、优质胚胎数、孕囊与心芽搏动数、种植率的情况,结果界值上、下组间实验室及临床相关指标无明显差异。但当TSH界值分别为2.7 mIU/L、3.3 mIU/L、3.9 mIU/L时,低、高组间的活产率分别为83.1%和81.0%,82.3%和78.9%,83.9%和70.3%,流产率分别为16.1%和19.0%,17.7%和21.1%,16.1%和19.7%,虽未达到统计学差异,但低水平TSH组的流产率较高水平TSH组相对较低,活产率较高,并随着界值的增大,界值上、下组间的活产率与流产率差距增大。结论：在0.3~4.2 mIU/L区间,TSH水平对于IVF/ICSI-ET的妊娠结局无明显影响。当基础TSH水平〉2.7 mIU/L时,流产率有上升趋势,活产率有下降趋势,需对孕妇孕期情况进行密切随访。

Objective： To explore whether pregnancy outcome for women undergoing in vitro fertilization（IVF） or intracytoplasmic sperm injection（ICSI） is correlated with pre-conception baseline thyroid-stimulating hormone（bTSH） level.Methods： A total of 1 832 IVF/ICSI cycles with serum bTSH level available in their first IVF/ICSI cycle were analyzed retrospectively.Results： There were no association between TSH and retrieved oocytes,high-quality embryos,chemical pregnancy rate and clinical pregnancy rate.The differences of some related laboratory results and clinical outcomes between lower and higher bTSH groups at different threshold values did not reach the statistic significance.When the thresholds came to 2.7 mIU/L,3.3 mIU/L,3.9 mIU/L,the rates of live birth and abortion were 83.1% and 16.9%,82.3% and 17.7%,83.9% and 16.1% in lower TSH group;81.0% and 19.0%,78.9% and 21.1%,70.3% and 19.7% in higher TSH threshold values group,respectively.Though there were no significant differences,the live birth rate seemed higher in lower TSH threshold values group,the abortion rate seemed lower.Conclusion： This study did not prove the correlation ship between TSH and IVF/ICSI pregnancy outcome.Whether to treat the women with TSH at the level of 2.5-4.2 mIU/L have to be further determined.When the women with the bTSH level higher than 2.7 mIU/L get pregnant,doctors could follow up the cases.