Thyroid Stimulating Hormone Concentration and Pregnancy Outcomes during Intra-Cytoplasmic Semen Injection Cycle

Background: The development in the reproductive medicine and revolution of Assisted Reproductive Technology (ART) have made significant changes in the global infertility science. There are many factors affecting the ovarian function (ovulation); thyroid disorders have made part of it.

Objective: This study aims to evaluate the prevalence of thyroid disorder and its effect on oocyte quality, implantation rate and pregnancy outcome.

Materials and Methods: This is a prospective study was conducted in the Libya National Fertility Centre. All participants were undergoing Intra-Cytoplasmic Semen Injection (ICSI). The inclusion criteria included cases with age less than 40 years and fresh embryo cycles. Cases with premature ovarian failure, endometriosis, Poly-Cytic Ovaries (PCO) and past history of ovarian surgery were excluded from the study.

Results: This study involved 627 cases. The cutoff value for Thyroid Stimulating Hormone (TSH) level (depending on the pregnancy rate, oocyte maturation and embryo quality) was 2.4 mIU/L. the participants were divided into two groups: TSH ≤2.4 mIU/L group (n=333) and TSH >2.4 mIU/L group (n=294). In the TSH ≤2.4 mIU/L group (36.69%) women achieved clinical pregnancy, while in the TSH >2.4 mIU/L group (31.37%) women achieved clinical pregnancy (P=0.038). No significant differences were observed between the two groups in pregnancy outcomes; Live Birth Rate (LBR) and abortion rate (P=0.052, P=0.258). With regard to oocyte maturation, women with TSH ≤2.4 mIU/L have a significant high chance to achieve better oocyte maturation in compare with another group (P=0.043).

Conclusion: The level of TSH (>2.4 mIU/L) is associated with poorer pregnancy outcome (low LBR and high miscarriage rate) and has determinantal effect on oocyte and embryo qualities. So, its recommended to prescribe the thyroxin therapy to infertile patients have TSH level (>2.4 mIU/L) before implementing ICSI cycle.