合并自身免疫性甲状腺疾病对IVF-ET助孕结局的影响

Effect of autoimmune thyroid disease on IVF-ET assisted pregnancy outcome

目的探讨合并自身免疫性甲状腺疾病对体外受精-胚胎移植(IVF-ET)助孕结局的影响。方法选择2019年10月至2021年12月内蒙古自治区赤峰市妇产医院生殖医学中心接受IVF-ET治疗的94例甲状腺自身抗体阳性(ATA+)不孕患者为ATA+组,选择同期无自身免疫性甲状腺疾病的不孕症患者100例为对照组。两组均接受IVF-ET治疗,采用促性腺激素释放激素激动剂(GnRH-a)长方案。比较两组卵巢刺激情况,比较两组人绒毛膜促性腺激素(HCG)日优势卵泡数(≥14 mm)、雌二醇(E_(2))、黄体生成素(LH)、孕酮(P)水平,比较两组取卵日、移植第5天血清Th1细胞、Th2细胞水平;观察两组胚胎发育潜能及妊娠结局。结果两组HCG日优势卵泡数、E_(2)、P水平比较,差异无统计学意义(P>0.05);ATA+组HCG日LH水平低于对照组(P<0.01)。移植第5天,两组Th1、Th2、Th1/Th2均低于取卵日(P<0.01)。取卵日及移植第5天,ATA+组Th1高于对照组,Th2、Th1/Th2低于对照组(P<0.01)。两组获卵数、受精率、卵裂率比较,差异无统计学意义(P>0.05);ATA+组优质胚胎数、优质胚胎率低于对照组(P<0.01)。两组移植胚胎数、临床妊娠率比较,差异无统计学意义(P>0.05);ATA+组流产率高于对照组、活产率低于对照组(P<0.05)。结论合并自身免疫性甲状腺疾病会影响IVF-ET患者胚胎发育质量,增加流产风险,其发生机制可能与患者机体免疫改变有关。

Objective To explore the effect of autoimmune thyroid disease on in vitro fertilization-embryo transfer(IVF-ET)assisted pregnancy outcome.Methods From October 2019 to December 2021,94 infertile patients with anti-thyroid autoantibodies positive(ATA+)who received IVF-ET treatment in Reproductive Medical Center,Chifeng Maternity Hospital,Inner Mongolia Autonomous Region were selected as the ATA+group,and 100 infertile patients without autoimmune thyroid disease in the same period were selected as the control group.Both groups received IVF-ET treatment,and gonadotropin releasing hormone antagonist(GnRH-a)long regimen was used.Ovarian stimulation was compared between the two groups,and the number of dominant follicles(≥14 mm),and the levels of estradiol(E_(2)),luteinizing hormone(LH),progesterone(P)on the day of human chorionic gonadotropin(HCG)day between the two groups were analyzed,and the levels of serum Th1 cells and Th2 cells on the day of egg collection day and the fifth day of transplantation were analyzed;and the embryonic development potential and pregnancy outcome between the two groups were observed.Results There were no significant differences in the number of dominant follicles,and the levels of E_(2) and P on HCG day between the two groups(P>0.05);the level of LH on HCG day in the ATA+group was lower than that in the control group(P<0.01).On the fifth day of transplantation,Th1,Th2,and Th1/Th2 in both groups were lower than those in egg collection day(P<0.01).On egg collection day and the fifth day of transplantation,Th1 in the ATA+group was higher than that in the control group,but Th2 and Th1/Th2 in the ATA+group were lower than those in the control group(P<0.01).There were no significant differences in the number of eggs,fertilization rate,and cleavage rate between the two groups(P>0.05);the number of high-quality embryos and the rate of high-quality embryos in the ATA+group were lower than those in the control group(P<0.01).There were no significant differences in the number of transplanted embryos and clinical pregnancy rate between the two groups(P>0.05).The abortion rate in the ATA+group was higher than that in the control group,and the live birth rate was lower than that in the control group(P<0.05).Conclusion The combination of autoimmune thyroid disease will affect the quality of embryonic development and increase the risk of abortion in IVF-ET patients,and its mechanism may be related to the immune changes of patients.