Aimee Seungdamrong1, Anne Z Steiner2, Clarisa R Gracia3, Richard S Legro4, Michael P Diamond5, Christos Coutifaris6, William D Schlaff7, Peter Casson8, Gregory M Christman9, Randal D Robinson10, Hao Huang11, Ruben Alvero7, Karl R Hansen12, Susan Jin11, Esther Eisenberg13, Heping Zhang11, Nanette Santoro7. 1. Department of Obstetrics, Gynecology and Women's Health, Rutgers New Jersey Medical School, Newark, New Jersey; Damien Fertility Partners, Shrewsbury, New Jersey. 2. Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina. 3. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: cgracia@obgyn.upenn.edu. 4. Department of Obstetrics and Gynecology, Penn State University, Hershey, Pennsylvania. 5. Departments of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan. 6. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. 7. Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado. 8. Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont. 9. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan. 10. Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. 11. Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut. 12. Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, Oklahoma. 13. Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland.
Abstract
OBJECTIVE: To study whether preconceptual thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) antibodies are associated with poor reproductive outcomes in infertile women. DESIGN: Secondary analysis of data from two multicenter, randomized, controlled trials conducted by the Reproductive Medicine Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Multivariable logistic regression analyses were performed to assess the association between preconceptual TSH levels and anti-TPO antibodies. SETTING: Not applicable. PATIENT(S): Serum samples from 1,468 infertile women were utilized. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Cumulative conception, clinical pregnancy, miscarriage, and live birth rates were calculated. RESULT(S): Conception, clinical pregnancy, miscarriage, and live birth rates did not differ between patients with TSH ≥2.5 mIU/L vs. TSH < 2.5 mIU/L. Women with anti-TPO antibodies had similar conception rates (33.3% vs. 36.3%) but higher miscarriage rates (43.9% vs. 25.3%) and lower live birth rates (17.1% vs. 25.4%) than those without anti-TPO antibodies. Adjusted, multivariable logistic regression models confirmed elevated odds of miscarriage (odds ratio 2.17, 95% confidence interval 1.12-4.22) and lower odds of live birth (oddr ratio 0.58, 95% confidence interval 0.35-0.96) in patients with anti-TPO antibodies. CONCLUSION(S): In infertile women, preconceptional TSH ≥2.5 mIU/L is not associated with adverse reproductive outcomes; however, anti-TPO antibodies are associated with increased risk of miscarriage and decreased probability of live birth. CLINICAL TRIAL REGISTRATION NUMBER: PPCOS II NCT00719186; AMIGOS NCT01044862.
OBJECTIVE: To study whether preconceptual thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) antibodies are associated with poor reproductive outcomes in infertile women. DESIGN: Secondary analysis of data from two multicenter, randomized, controlled trials conducted by the Reproductive Medicine Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Multivariable logistic regression analyses were performed to assess the association between preconceptual TSH levels and anti-TPO antibodies. SETTING: Not applicable. PATIENT(S): Serum samples from 1,468 infertile women were utilized. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Cumulative conception, clinical pregnancy, miscarriage, and live birth rates were calculated. RESULT(S): Conception, clinical pregnancy, miscarriage, and live birth rates did not differ between patients with TSH ≥2.5 mIU/L vs. TSH < 2.5 mIU/L. Women with anti-TPO antibodies had similar conception rates (33.3% vs. 36.3%) but higher miscarriage rates (43.9% vs. 25.3%) and lower live birth rates (17.1% vs. 25.4%) than those without anti-TPO antibodies. Adjusted, multivariable logistic regression models confirmed elevated odds of miscarriage (odds ratio 2.17, 95% confidence interval 1.12-4.22) and lower odds of live birth (oddr ratio 0.58, 95% confidence interval 0.35-0.96) in patients with anti-TPO antibodies. CONCLUSION(S): In infertile women, preconceptional TSH ≥2.5 mIU/L is not associated with adverse reproductive outcomes; however, anti-TPO antibodies are associated with increased risk of miscarriage and decreased probability of live birth. CLINICAL TRIAL REGISTRATION NUMBER: PPCOS II NCT00719186; AMIGOS NCT01044862.
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