甲状腺癌术后行IVF/ICSI-ET助孕临床结局

Clinical outcomes of IVF/ICSI-ET after thyroid cancer surgical treatment

目的观察甲状腺癌对体外受精/卵泡浆内单精子注射-胚胎移植(IVF/ICSI-ET)妊娠结局及孕产期、新生儿并发症有无影响。方法回顾性分析2012年1月1日至2016年12月31日接受甲状腺癌手术治疗后行IVF/ICSI-ET的患者42例(病例组),另选取甲状腺激素检测及甲状腺超声影像均正常者90例(对照组),比较两组超促排卵过程中促性腺激素(Gn)总量、注射人绒毛膜促性腺激素(HCG)日内膜厚度、获卵数、正常受精率、优胚率、着床率、临床妊娠率、流产率、种植率,以及孕产期并发症、新生儿出生体质量、新生儿并发症等指标。结果 (1)病例组血清促甲状腺激素(TSH)水平低于对照组[(1.70±1.50)μIU/m L vs(2.20±0.84)μIU/m L,P<0.05];(2)两组患者的超促排卵过程Gn总量[(2 084.22±774.40)U vs(1 867.64±899.79)U]、HCG日内膜厚度[(1.08±0.16)cm vs(1.10±0.17)cm]、获卵数[(12.19±7.91)枚vs(10.92±4.65)枚]、正常受精率(57.30%vs 58.09%)、优胚率(61.38%vs 65.10%)差异均无统计学意义(P>0.05);(3)两组患者的临床妊娠率(61.11%vs 61.67%)、种植率(41.43%vs 43.14%)、流产率(9.09%vs 10.81%)、首次移植周期累积活产率(55.55%vs 50.00%)、妊娠期并发症发生率(25.0%vs 6.45%)、新生儿出生体质量[(3.21±0.63)kg vs(3.10±0.56)kg]差异均无统计学意义(P>0.05),病例组新生儿诊断为新生儿甲状腺功能减退症1例;(4)病例组助孕治疗及随访过程中无癌症复发病例。结论与对照组相比,甲状腺癌术后患者接受IVF/ICSI-ET助孕,卵巢反应性及妊娠结局均无明显差异,但甲状腺癌术后患者的新生儿有发生甲状腺功能减退风险,孕期需密切随访。

Objective To investigate the effect of thyroid carcinoma on the pregnancy outcomes,obstetric and neonatal complications during in vitro fertilization/follicle intracytoplasmic sperm injection-embryo transfer（ IVF/ICSI-ET）treatment. Methods Forty-two patients who underwent IVF/ICSI-ET after thyroid cancer surgery from January 1,2012 to December 31,2016 were retrospectively analyzed. Ninety patients with normal thyroid hormone level and thyroid ultrasound images were included as control group. The total amount of Gn,endometrial thickness on HCG day,and the number of retrieved oocytes were compared between cases and controls. The normal fertilization rate,good quality embryo rate,implantation rate,clinical pregnancy rate,miscarriage rate,live birth rate,and maternal and neonatal complications were also compared. Results The level of serum thyroid stimulating hormone（ TSH） was significantly lower in cases than controls [（1. 70 ± 1. 50） μIU/m L vs（2. 20 ± 0. 84） μIU/m L,P 〈0. 05]. The total Gn[（2 048. 22 ± 774. 40） U vs（1 867. 64 ± 899. 79） U],endometrial thickness on HCG day [（1. 08 ± 0. 16） cm vs（1.10 ± 0. 17） cm ],number of oocytes [（12. 19 ± 7. 91） vs（10. 92 ± 4. 65）],normal fertilization rate（57. 30% vs 58.09%） and good quality embryo rate（61. 38% vs 65. 10%） were comparable between cases and controls. No difference was observed in the clinical pregnancy rate（ 61. 11% vs 61. 67%）,implantation rate（ 41. 43% vs 43. 14%）,abortion rate（9. 09% vs 10. 81%）,and live birth rate（55. 55% vs 50. 0%）. The incidence of obstetric complications（25. 0% vs 6. 45%） and birth weight of newborns [（3. 21 ± 0. 63） kg vs（3. 10 ± 0. 56） kg]were not statistically different（ P 〉0. 05）. One baby from case group was diagnosed with neonatal hypothyroidism. There was no recurrence of thyroid carcinoma during IVF/ICSI-ET treatment. Conclusion Compared with controls,patients with history of thyroid cancer surgery present normal ovarian response and pregnancy outcomes undergoing IVF/ICSI-ET treatment. How-ever,more attention is needed for neonatal hypothyroidism after maternal thyroid surgery.