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Assisted Reproduction and Thyroid Autoimmunity: An Unfortunate Combination?

Departments of Endocrinology (K.P., B.V.), Reproductive Medicine (H.T., P.D., A.V.S.), and Biostatistics (L.K.), Vrije Universiteit Brussel, Brussels 1090, Belgium; and Department of Endocrinology (D.G.), Université Libre de Bruxelles, Brussels 1000, Belgium

Address correspondence and reprint requests to: K. Poppe, Department of Endocrinology, Free University Brussels (AZ-VUB), Laarbeeklaan 101, 1090 Brussels, Belgium. E-mail: hemopek{at}az.vub.ac.be.

The association between positive thyroid antibodies and an increased miscarriage rate in pregnancies after assisted reproduction technology (ART) remains controversial.

We wanted to clarify this issue by performing a prospective cohort study in 234 women by systematically screening for thyroid peroxidase antibodies (TPO-Ab), serum TSH, and free T₄(FT₄) before the first ART cycle. Women with overt thyroid dysfunction were excluded.

Fourteen percent of the cohort had positive TPO-Ab. Baseline characteristics [age, 33 ± 5 yr; TSH, 1.6 (0.02–4.1) mU/liter; and FT₄, 12.2 (9.1–18) ng/liter] were comparable to those of the 86% of women without antibodies [age, 32 ± 5 yr; TSH, 1.3 (0.05–3.6) mU/liter; and FT₄, 11.7 (9.5–16.5) ng/liter]. In the antibody-positive group, the pregnancy rate was 53% vs. 43% in the antibody-negative group, with an odds ratio of 0.67 [95% confidence interval (CI) (0.32–1.41); P = not significant]; however within the group that was pregnant, the miscarriage rate was 53% and 23%, respectively, with an odds ratio of 3.77 [95% CI (1.29–11.05); P = 0.016]. The age of the women was an independent risk factor for miscarriage, odds ratio 1.08 [95% CI (1.03–1.15); P = 0.005].

We conclude that women with positive TPO-Ab before the first ART cycle have a significantly increased risk for miscarriage.

This study was supported by grants from the Willy Gepts Foundation, Vrije Universiteit Brussels, AZ-VUB.

Abbreviations: ART, Assisted reproduction technology; CI, confidence interval; DR, delivery rates; FT₄, free T₄; IVF, in vitro fertilization; MR, miscarriage rate; NP, not pregnant; OR, odds ratio(s); PR, pregnancy rate; TAI, thyroid autoimmunity; TPO-Ab, thyroid peroxidase antibodies.

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