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Assisted reproduction and thyroid autoimmunity: an unfortunate combination?
Kris Poppe1, Daniel Glinoer, Herman Tournaye
1Department of Endocrinology, Vrije Universiteit Brussel, Brussels 1090, Belgium. hemopek@az.vub.ac.be
The Journal of Clinical Endocrinology and Metabolism
|September 13, 2003
Summary
Positive thyroid peroxidase antibodies (TPO-Ab) in women undergoing assisted reproduction technology (ART) significantly increase miscarriage risk. Early screening for TPO-Ab before ART is crucial for managing pregnancy outcomes.
Area of Science:
- Reproductive Endocrinology
- Immunology
- Obstetrics & Gynecology
Background:
- The link between thyroid antibodies and miscarriage after assisted reproduction technology (ART) is debated.
- Thyroid peroxidase antibodies (TPO-Ab) are common and may impact fertility treatments.
Purpose of the Study:
- To investigate the association between TPO-Ab and miscarriage rates in women undergoing their first ART cycle.
- To clarify the role of TPO-Ab in pregnancy outcomes following assisted reproduction.
Main Methods:
- Prospective cohort study of 234 women screened for TPO-Ab, TSH, and FT4 before ART.
- Women with overt thyroid dysfunction were excluded from the analysis.
- Statistical analysis compared pregnancy and miscarriage rates between antibody-positive and antibody-negative groups.
Main Results:
- 14% of women had positive TPO-Ab; baseline characteristics were similar between groups.
- Pregnancy rates did not differ significantly (53% vs. 43%).
- Miscarriage rates were significantly higher in the TPO-Ab positive group (53% vs. 23%; OR 3.77, P=0.016). Age was also an independent risk factor for miscarriage.
Conclusions:
- Positive TPO-Ab before ART is associated with a significantly increased risk of miscarriage.
- Screening for TPO-Ab prior to ART may help identify women at higher risk for pregnancy loss.
- Further research into the mechanisms underlying TPO-Ab-associated miscarriage is warranted.