甲状腺球蛋白抗体及基础TSH对IVF/ICSI妊娠结局的影响

Effect of thyroglobulin antibody and basic serum TSH level on pregnancy outcomes of IVF/ICSI

目的探讨甲状腺球蛋白抗体(TG-Ab)与血清促甲状腺激素(TSH)对IVF/ICSI患者妊娠结局的影响。方法回顾性分析2016年9月至2017年12月间在河南省人民医院生殖医学中心行IVF-ET助孕治疗的1 083例不孕症患者的临床资料,根据血清TSH和TG-Ab水平不同将纳入研究的患者分为4组:A组(0.3 mIU/L≤TSH<2.5 mIU/L,TG-Ab阴性,n=649);B组(0.3 mIU/L≤TSH<2.5 mIU/L,TG-Ab阳性,n=24);C组(2.5 mIU/L≤TSH<4.2 mIU/L,TG-Ab阴性,n=378);D组(2.5 mIU/L≤TSH<4.2 mIU/L,TG-Ab阳性,n=32)。比较4组患者的一般资料、促排卵相关指标和妊娠结局。结果 4组患者的年龄、不孕年限、体重指数、基础性激素水平、基础窦卵泡数等比较均无显著性差异(P>0.05);C、D组的TSH水平显著高于A、B组(P<0.05)。Gn总剂量、Gn天数、获卵数、平均移植胚胎数等促排卵指标4组间比较均无显著性差异(P>0.05)。4组患者的受精率、种植率、生化妊娠率、临床妊娠率、早期流产率、双胎率及活产率比较亦无显著性差异(P>0.05);D组的种植率、临床妊娠率、活产率略低于A、B、C三组,ICSI周期率略高于A、B、C三组,但无显著性差异(P>0.05)。结论血清基础TSH水平在2.5~4.2 mIU/L之间、TG-Ab阳性的患者行IVF-ET助孕时,其种植率、临床妊娠率、活产率有下降趋势,但仍需扩大样本量进一步研究探讨。

Objective:To investigate the effect of thyroglobulin antibody(TG-Ab)and basic serum TSH level on pregnancy outcomes of IVF/ICSI.Methods:Retrospective analysis was performed on infertility patients who were treated with IVF-ET in the Reproductive Medicine Center of Henan Provincial People’s Hospital from September 2016 to December 2017.The patients were divided into four groups according to basic serum TSH and TG-Ab levels:group A(0.3 mIU/L≤TSH<2.5 mIU/L,TG-Ab negative,n=649),group B(0.3 mIU/L≤TSH<2.5 mIU/L,TG-Ab positive,n=24),group C(2.5 mIU/L≤TSH<4.2 mIU/L,TG-Ab negative,n=378),group D(2.5 mIU/L≤TSH<4.2 mIU/L,TG-Ab positive,n=32).The clinical data and pregnancy outcomes were compared among the four groups.Results:There was no significant difference in age,infertility years,body mass index,basic hormone level,basic antral follicle number among the four groups(P>0.05).The basic serrum TSH level in group C and D was significantly higher than that in group A and B(P<0.05).There was no significant difference in the total doses and days of Gn used,the number of oocytes retrieved and the average number of embryos transferred among the four groups(P>0.05).There were no significant differences in the fertilization rate,implantation rate,biochemical pregnancy rate,clinical pregnancy rate,early abortion rate,twin rate and live birth rate among the four groups(P>0.05).The implantation rate,clinical pregnancy rate and live birth rate in group D were slightly lower than those in group A,B,and C,but there were no significantly differences(P>0.05).Conclusions:When the patients with basic serum TSH levels of 2.5-4.2 mIU/L and TG-Ab positive were assisted with IVF-ET,there is a downward trend in the implantation rate,clinical pregnancy rate and live birth rate.However,it is still necessary to expand the sample size for further study.