甲状腺自身免疫抗体和促甲状腺激素对行体外受精/卵胞浆内单精子注射患者妊娠结局的影响

Effect of thyroid autoimmune antibody and thyroid stimulating hormone on pregnancy outcomes of patients undergoing in vitro fertilization/intracytoplasmic sperm injection

目的探究甲状腺自身抗体(ATA)与血清促甲状腺激素(TSH)对体外受精/卵胞浆内单精子注射(IVF/ICSI)患者妊娠结局的影响。方法选择2016年9月至2017年12月在河南省人民医院生殖中心首次接受IVF/ICSI助孕的1221例患者为研究对象,根据血清TSH水平(以2.5 mU·L^-1为分界)及ATA状态将患者分为4组。A组(n=649):0.3 mU·L^-1≤TSH<2.5 mU·L^-1,ATA(-);B组(n=106):0.3 mU·L^-1≤TSH<2.5 mU·L^-1,ATA(+);C组(n=378):2.5 mU·L^-1≤TSH≤4.2 mU·L^-1,ATA(-);D组(n=88):2.5 mU·L^-1≤TSH≤4.2 mU·L^-1,ATA(+)。比较4组患者的基本资料和临床妊娠结局。结果4组患者的促性腺激素(Gn)总剂量、Gn应用时间、人绒毛膜促性腺激素(HCG)日雌二醇、HCG日孕激素、移植日内膜厚度、获卵数、受精卵数、正常卵裂数、移植胚胎数、受精率比较差异均无统计学意义(P>0.05),4组患者种植率、临床妊娠率、多胎率、早期流产率、晚期流产率及活产率比较差异均无统计学意义(P>0.05)。Logistic回归分析显示,TSH、ATA(+)均与临床妊娠、多胎妊娠、流产(早期流产、晚期流产)、活产无关(P>0.05)。结论患者在IVF/ICSI助孕治疗前血清TSH为2.5~4.2 mU·L^-1且ATA(+)时,对临床妊娠结局无影响。

Objective To investigate the effect of antithyroid antibodies(ATA)and serum thyroid stimulating hormone(TSH)on pregnancy outcome of patients who underwent in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI).Methods One thousand two hundred and twenty-one patients who received IVF/ICSI in the Reproductive Center of Henan Provincial People′s Hospital from September 2016 to December 2017 were selected as the study subjects.The patients were divided into four groups according to the serum level of TSH and ATA status.Group A(n=649):0.3 mU·L^-1≤TSH<2.5 mU·L^-1 and ATA(-);Group B(n=106):0.3 mU·L^-1≤TSH<2.5 mU·L^-1 and ATA(+);Group C(n=378):2.5 mU·L^-1≤TSH≤4.2 mU·L^-1 and ATA(-);Group D(n=88):2.5 mU·L^-1≤TSH≤4.2 mU·L^-1 and ATA(+).The differences in clinical data and pregnancy outcome were analyzed among the four groups.Results There was no significant difference in the total dose of gonadotropin(Gn),the total days of using Gn,estradiol on the human chorionic gonadotropin progesterone(HCG)day,progesterone on HCG day,the thickness of endometrium on the transplantation day,the number of eggs obtained,the number of fertilized eggs,the number of normal cleavage,the number of transferred embryos and the rate of fertilization among the four groups(P>0.05).There was no significant difference in the implantation rate,fertilization rate,clinical pregnancy rate,multiple pregnancy rate,implantation rate,early abortion rate,late abortion rate and live birth rate among the four groups(P>0.05).Logistic regression analysis showed that TSH and ATA(+)were not related to clinical pregnancy,multiple pregnancy,early abortion rate,late abortion rate and live birth(P>0.05).Conclusion The serum level of TSH is 2.5-4.2 mU·L^-1 and ATA(+)can not effect the clinical pregnancy outcome of patients undergoing IVF/ICSI.