Thyroid Autoimmunity and Implantation Failure
Keywords:
Thyroid autoimmunity; Subclinical hypothyroidism; Recurrent implantation failure; Recurrent pregnancy loss.Abstract
Thyroid hormones directly affect reproductive hormones. Hypothyroidism and hyperthyroidism are common, important and often reversible or preventable causes of infertility. Subclinical hypothyroidism is a milder form of hypothyroidism defined as an elevated TSH concentration in conjunction with normal free thyroxine (FT4) levels. Hypothyroidism
is associated with decreased plasma concentrations of estrogens and androgens with deficient LH secretion. There may be reduced libido and anovulation. So, tight control of thyroid function is a must for better reproductive outcomes. Thyroid autoimmunity is associated with miscarriage and there is fair evidence that it is associated with infertility.
Levothyroxine is the recommended treatment to improve pregnancy outcomes in women with hypothyroidism and positive thyroid antibodies, especially if the TSH level is over 2.5 mIU/L. In hyperthyroidism, there may be inadequate mid-cycle LH surges leading to anovulation. With IVF stimulation, the condition might exacerbate. In hyperthyroidism, FT4
should upper-end reference range & low TSH level (0.1-0.4 mU/L) and propyl thiouracil (PTU) is recommended before pregnancy and in the 1st trimester and 2nd trimesters it is preferable to shift to methimazole (MMI)/ carbimazole (CMZ). In recurrent IVF failure, thyroid antibodies screening should be done in euthyroid women and intravenous immunoglobulins can be given in positive cases. Data were obtained from PubMed, Google scholar and individual searches.
How to cite this article:
Agarwal K, Banerjee K. Thyroid Autoimmunity and Implantation Failure. Int J Adv Res Gynaecol Obstet. 2022; 3(1): 1-4.
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