不明原因复发性流产患者促甲状腺激素对IVF/ICSI-ET妊娠结局的影响

Impact of thyroid-stimulating hormone levels on outcomes of IVF/ICSI in women with unexplained recurrent spontaneous abortion

目的探讨不明原因的复发性流产(RSA)患者促甲状腺激素(TSH)对其IVF/ICSI-ET妊娠结局的影响。方法回顾性分析2014年1月至2017年12月就诊于我院生殖医学中心行IVF/ICSI-ET治疗并胚胎移植的87例不明原因的RSA患者,其基础甲状腺功能三项:游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)及TSH,甲状腺过氧化物酶抗体(TPOAb)及甲状腺球蛋白抗体(TgAb)均在正常范围内。根据研究对象的TSH水平分为两组:A组:0.27mU/L≤TSH≤2.5mU/L,62例;B组:2.5mU/L<TSH≤4.2mU/L,25例。记录患者年龄、BMI、不孕年限、流产次数、双侧AFC数目、获卵数、MⅡ卵数、2PN胚胎数、可移植胚胎数及优质胚胎数,比较两组患者的妊娠结局。结果两组间获卵数、MⅡ卵数、2PN胚胎数、可移植胚胎数、优质胚胎数、临床妊娠率、早期流产率及活产率均无统计学差异(P>0.05)。结论不明原因的RSA、甲状腺功能正常患者,其TSH水平高低对IVF-ET妊娠结局影响不显著。

Objective： To investigate the effect of thyroid stimulating hormone（TSH）level on outcomes of IVF or ICSI in women with unexplained recurrent spontaneous abortion（RSA）. Methods： The data of 87 patients with unexplained RSA and normal thyroid function including free triiodothyronine（ FT3 ） , free tetraiodothyronine（FT4） and TSH, and thyroid peroxidase antibody （TPOAb） and thyroglobulin antibody（TgAb）in our clinical center of reproductive medicine from January 2014 to December 2017 were retrospectively analyzed. According to the TSH level, the patients were divided into two groups： group A（ n 62,0. 27 mU/L≤TSH≤2. 5 mU/L）and group B （ n =2 5 , 2. 5 mU/L 〈TSH ≤ 4. 2 mU/L）. The patients＇ age, duration of infertility, number of miscarriage, body mass index（BMI） , antral follicle count（AFC） , numbers of oocyte retrieved, M II oocyte, 2PN embryo, transferable embryo and high quality embryo were recorded. The pregnancy outcomes of two groups were analyzed. Results： There were no significant differences in numbers of oocyte retrieved, M II oocyte, 2PN embryo, transferable embryo, high quality embryo, and the rates of clinical pregnancy, miscarriage and live birth between group A and group B（P〉0. 05）. Conclusions： The serum level of TSH in the normal rage does not affect IVF/ICSI ET pregnancy outcome in women with unexplained RSA ＆ normal thyroid function.