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Levothyroxine for a high-normal TSH in unexplained infertility.

Francesca Galbiati1,2, Tahereh Orouji Jokar3, Lars M Howell3

  • 1Division of Endocrinology Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Clinical Endocrinology
|December 5, 2023
PubMed
Summary

Levothyroxine treatment for unexplained infertility with high-normal thyroid-stimulating hormone (TSH) showed higher conception rates but lower live birth rates. Further research is needed to confirm levothyroxine

Keywords:
birth rateinfertilitylive birthpregnancypregnancy ratethyrotropinthyroxine

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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Clinical Research

Background:

  • Unexplained infertility impacts a significant portion of infertile couples.
  • Elevated high-normal thyroid-stimulating hormone (TSH) levels (2.5-5 mIU/L) are observed more frequently in women with unexplained infertility.
  • Clinical guidelines differ on treating high-normal TSH in women attempting conception due to unknown levothyroxine effects.

Purpose of the Study:

  • To evaluate the impact of levothyroxine treatment on conception and live birth rates in women with unexplained infertility and high-normal TSH levels.
  • To compare outcomes between women treated with levothyroxine and those who were not.

Main Methods:

  • A retrospective study involving 96 women with unexplained infertility and high-normal TSH levels.
  • Participants were divided into two groups: those prescribed levothyroxine (n=31) and those not prescribed (n=65).
  • Conception and live birth rates were assessed for both groups.

Main Results:

  • The levothyroxine group exhibited a 100% conception rate versus 90% in the untreated group (p<0.05, adjusted for age).
  • The live birth rate was lower in the levothyroxine group (63%) compared to the untreated group (84%) (p=0.035, adjusted for TSH).
  • These results are limited by a small sample size.

Conclusions:

  • Levothyroxine treatment in women with unexplained infertility and high-normal TSH may increase conception rates but potentially decrease live birth rates.
  • The observed differences suggest a need for caution and further investigation.
  • Prospective, randomized studies are essential to definitively determine the benefits of levothyroxine treatment in this patient population.