Thyroid disease and female reproduction

Area of Science:

• Endocrinology
• Reproductive Medicine
• Immunology

Background:

• Thyroid hormones influence menstrual patterns via direct ovarian effects and indirect modulation of sex hormone-binding globulin (SHBG), prolactin (PRL), gonadotropin-releasing hormone (GnRH), and coagulation factors.
• Autoimmune thyroid disease (AITD) is more prevalent in infertile women, particularly those with endometriosis and polycystic ovarian syndrome (PCOS).

Purpose of the Study:

• To investigate the impact of thyroid dysfunction and AITD on female fertility and pregnancy outcomes.
• To establish recommendations for screening and management of thyroid disorders in infertile women undergoing assisted reproductive technology (ART).

Main Methods:

• Review of existing literature on thyroid function, menstrual abnormalities, infertility, AITD, and ART outcomes.
• Analysis of risks associated with AITD during pregnancy and the effects of controlled ovarian hyperstimulation (COH) on thyroid function.

Main Results:

• Thyroid dysfunction treatment can reverse menstrual abnormalities and improve fertility.
• While AITD does not impede implantation, it increases miscarriage risk in early pregnancy, even with pre-pregnancy euthyroidism.
• Controlled ovarian hyperstimulation (COH) significantly affects thyroid function, especially in women with AITD.

Conclusions:

• Screening for thyroid function and AITD in infertile women before ART is advisable, with follow-up during COH and pregnancy.
• Treatment with l-thyroxine is recommended for thyroid dysfunction in early pregnancy to prevent complications.
• The role of thyroid hormone supplementation in euthyroid women with AITD during pregnancy requires further investigation through randomized clinical trials.