تأثیر اختلال در سطوح هورمون محرک تیروئید (TSH) بر میزان لقاح زنان نابارور مبتلا به اندومتریوز

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استاد گروه زنان و مامایی، مرکز تحقیقات بهداشت باروری و ناباروری، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران.

2 پزشک عمومی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی بابل، بابل، ایران.

3 استادیار پژوهشکده سلامت، مرکز تحقیقات بهداشت باروری و ناباروری، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران.

4 استاد علوم تشریحی، مرکز تحقیقات بهداشت باروری و ناباروری، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران.

چکیده

مقدمه: ارتباط بین اندومتریوز و اختلالات تیروئید و تأثیر متعاقب آن بر نتایج باروری، هنوز بحث‌برانگیز است. مطالعه حاضر با هدف ارزیابی تأثیر اختلال در سطوح هورمون محرک تیروئید (TSH) بر میزان لقاح زنان مبتلا به اندومتریوز انجام شد.
روش‌کار: در این آنالیز ثانویه داده ­های کوهورت، 179 زن نابارور مبتلا به اندومتریوز به‌عنوان گروه مورد و 200 زن با تشخیص فاکتور لوله‌ای یا ناباروری غیرقابل توجیه به‌عنوان گروه کنترل انتخاب شدند. دو زیرگروه سطوح TSH بالای 5/2 mlU/L (با یا بدون مصرف لووتیروکسین) و سطح TSH کمتر از 5/2 mlU/L با مصرف لووتیروکسین به‌عنوان بیماران مبتلا به اختلال عملکرد تیروئید و زنان با سطوح TSH کمتر از 5/2 mlU/L بدون مصرف لووتیروکسین به‌عنوان افراد سالم از نظر تیروئید در نظر گرفته شدند. تعداد فولیکول آنترال و میزان لقاح بین دو گروه مقایسه شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 24) و آزمون آنووا انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته ­ها: میانگینTSH در زنان مبتلا به اندومتریوز نسبت به گروه کنترل به‌طور معنی ­داری بالاتر بود (43/0-02/0 :CI 95%، 77/0=d Cohen، 02/0=p). وقتی که زنان بر اساس وجود یا عدم وجود اندومتریوز و سطوح سرمی TSH بالاتر از 5/2 mlU/L طبقه‌بندی شدند، سطح سرمی FSH (76/0=p)، LH(91/0=p) و میزان لقاح (51/0=p) بین دو گروه اختلاف معناداری نداشت.
نتیجه­ گیری: به‌نظر می ­رسد اختلالات تیروئید در زنان مبتلا به اندومتریوز شایع‌تر است. با این‌حال، هیچ تأثیر قابل توجهی بر نتایج روش‌های کمک باروری ثانویه به همراهی با اندومتریوز و سطوح بالاتر TSH وجود نداشت. 

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

The effect of impaired thyroid-stimulating hormone (TSH) levels on fertilization rate of infertile women with endometriosis

نویسندگان [English]

  • Sedighe Esmaeilzadeh 1
  • Mahsa Ghorbani 2
  • Parvaneh Mirabi 3
  • Sayed Gholamali Jorsaraei 4
1 Professor, Department of Obstetrics and Gynecology, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
2 General Practitioner, Student Research Committee, Babol University of Medical Sciences, Babol, Iran.
3 Assistant Professor of Health Research Institute, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
4 Professor, Department of Anatomical Sciences, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
چکیده [English]

Introduction: The relationship between endometriosis and thyroid disorders and the subsequent impact on fertility outcomes is still controversial. The present study was performed with aim to evaluate the effect of impaired thyroid-stimulating hormone (TSH) levels on fertilization rate of infertile women with endometriosis.
Methods: In this secondary analysis of cohort data, 179 infertile women with endometriosis were selected as the case group and 200 women with diagnosis of tubal factor or unexplained infertility were selected as the control group. Two subgroups of TSH levels above 2.5 mlU/L (with or without levothyroxine use) and TSH levels less than 2.5 mlU/L with levothyroxine use as patients with thyroid dysfunction and women with TSH levels less than 2.5 mlU/L without use of Levothyroxine were considered as thyroid-healthy subjects. Antral follicle count and fertilization rate were compared between the two groups. Data analysis was done using SPSS statistical software (version 24) and ANOVA test. P<0.05 was considered significant.
Results: The mean of TSH in women with endometriosis was significantly higher than the control group (P=0.02, Cohen d=0.77, 95% CI: 0.02-0.43). When women were classified based on the presence or absence of endometriosis and serum TSH levels above 2.5 mlU/L, serum levels of FSH (P=0.76), LH (P=0.91), and fertilization rate (P=0.51) did not significantly differ between the two groups.
Conclusion: It seems that thyroid disorders are more common in women with endometriosis. However, there was no significant effect on the results of assisted reproductive procedures related to the coexistence of endometriosis and higher TSH levels.

کلیدواژه‌ها [English]

  • Endometriosis
  • Fertilization rate
  • Thyroid stimulating hormone

مراجع

  1. Smolarz B, Szyłło K, Romanowicz H. Endometriosis: epidemiology, classification, pathogenesis, treatment and genetics (review of literature). International journal of molecular sciences 2021; 22(19):10554.
  2. Unuane D, Velkeniers B. Impact of thyroid disease on fertility and assisted conception. Best Practice & Research Clinical Endocrinology & Metabolism 2020; 34(4):101378.
  3. Anasti JN, Flack MR, Froehlich J, Nelson LM, Nisula BC. A potential novel mechanism for precocious puberty in juvenile hypothyroidism. The Journal of Clinical Endocrinology & Metabolism 1995; 80(1):276-9.
  4. Kuroda K, Uchida T, Nagai S, Ozaki R, Yamaguchi T, Sato Y, et al. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Müllerian hormone in infertile women of reproductive age. Journal of assisted reproduction and genetics 2015; 32:243-7.
  5. Aghajanova L, Stavreus-Evers A, Lindeberg M, Landgren BM, Sparre LS, Hovatta O. Thyroid-stimulating hormone receptor and thyroid hormone receptors are involved in human endometrial physiology. Fertility and sterility 2011; 95(1):230-7.
  6. Şerifoğlu H, Arinkan SA, Pasin O, Vural F. Is there an association between endometriosis and thyroid autoimmunity?. Revista da Associação Médica Brasileira 2023; 69:e20221679.
  7. Peyneau M, Kavian N, Chouzenoux S, Nicco C, Jeljeli M, Toullec L, et al. Role of thyroid dysimmunity and thyroid hormones in endometriosis. Proceedings of the National Academy of Sciences 2019; 116(24):11894-9.
  8. Shrestha S, Neupane S, Gautam N, Dubey RK, Jha AC, Doshi NR, et al. Association of thyroid profile and prolactin level in patient with secondary amenorrhea. The Malaysian journal of medical sciences: MJMS 2016; 23(5):51-6.
  9. Esmaeilzadeh S, Mirabi P, Basirat Z, Zeinalzadeh M, Khafri S. Association between endometriosis and hyperprolactinemia in infertile women. Iranian journal of reproductive medicine 2015; 13(3):155-60.
  10. Mirabi P, Alamolhoda SH, Golsorkhtabaramiri M, Namdari M, Esmaeilzadeh S. Prolactin concentration in various stages of endometriosis in infertile women. JBRA Assisted Reproduction 2019; 23(3):225-9.
  11. Esmaeilzadeh S, Ghorbani M, Abdolahzadeh M, Chehrazi M, Jorsaraei SG, Mirabi P. Stages of endometriosis: Does it affect oocyte quality, embryo development and fertilization rate?. JBRA Assisted Reproduction 2022; 26(4):620-6.
  12. Adewuyi EO, Mehta D, Nyholt DR. Genetic overlap analysis of endometriosis and asthma identifies shared loci implicating sex hormones and thyroid signalling pathways. Human Reproduction 2022; 37(2):366-83.
  13. Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Human reproduction 2002; 17(10):2715-24.
  14. Fumarola A, Grani G, Romanzi D, Del Sordo M, Bianchini M, Aragona A, et al. Thyroid function in infertile patients undergoing assisted reproduction. American Journal of Reproductive Immunology 2013; 70(4):336-41.
  15. Mintziori G, Goulis DG, Gialamas E, Dosopoulos K, Zouzoulas D, Gitas G, et al. Association of TSH concentrations and thyroid autoimmunity with IVF outcome in women with TSH concentrations within normal adult range. Gynecologic and Obstetric Investigation 2014; 77(2):84-8.
  16. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism 2012; 97(8):2543-65.
  17. International working group of AAGL, ESGE, ESHRE and WES, Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TT, Missmer S, Petrozza J, Tomassetti C, Zondervan KT. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification. Human Reproduction Open 2021; 2021(4):hoab025.
  18. Silva JF, Ocarino NM, Serakides R. Thyroid hormones and female reproduction. Biology of reproduction 2018; 99(5):907-21.
  19. Poppe K, Velkeniers B, Glinoer D. The role of thyroid autoimmunity in fertility and pregnancy. Nature clinical practice Endocrinology & metabolism 2008; 4(7):394-405.
  20. Ortiga-Carvalho TM, Sidhaye AR, Wondisford FE. Thyroid hormone receptors and resistance to thyroid hormone disorders. Nature Reviews Endocrinology 2014; 10(10):582-91.
  21. Brown ED, Obeng-Gyasi B, Hall JE, Shekhar S. The Thyroid Hormone Axis and Female Reproduction. International Journal of Molecular Sciences 2023; 24(12):9815.
  22. Petta CA, Arruda MS, Zantut-Wittmann DE, Benetti-Pinto CL. Thyroid autoimmunity and thyroid dysfunction in women with endometriosis. Human reproduction 2007; 22(10):2693-7.
  23. Poppe K, Glinoer D, Van Steirteghem A, Tournaye H, Devroey P, Schiettecatte J, et al. Thyroid dysfunction and autoimmunity in infertile women. Thyroid 2002; 12(11):997-1001.
  24. Tańska K, Gietka-Czernel M, Glinicki P, Kozakowski J. Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes. Frontiers in Endocrinology 2023; 13:1049665.
  25. Romitti M, Fabris VC, Ziegelmann PK, Maia AL, Spritzer PM. Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis. Endocrine Connections 2018; 7(11):1158-67.
  26. Andrisani A, Sabbadin C, Marin L, Ragazzi E, Dessole F, Armanini D, et al. The influence of thyroid autoimmunity on embryo quality in women undergoing assisted reproductive technology. Gynecological Endocrinology 2018; 34(9):752-5.
  27. Weghofer A, Himaya E, Kushnir VA, Barad DH, Gleicher N. The impact of thyroid function and thyroid autoimmunity on embryo quality in women with low functional ovarian reserve: a case-control study. Reproductive Biology and Endocrinology 2015; 13:1-6.
  28. Seungdamrong A, Steiner AZ, Gracia CR, Legro RS, Diamond MP, Coutifaris C, et al. Preconceptional antithyroid peroxidase antibodies, but not thyroid-stimulating hormone, are associated with decreased live birth rates in infertile women. Fertility and sterility 2017; 108(5):843-50.
  29. Inagaki Y, Takeshima K, Nishi M, Ariyasu H, Doi A, Kurimoto C, et al. The influence of thyroid autoimmunity on pregnancy outcome in infertile women: a prospective study. Endocrine journal 2020; 67(8):859-68.
  30. Grigoriadis S, Maziotis E, Simopoulou M, Sfakianoudis K, Giannelou P, Rapani A. The impact of thyroid autoantibodies positivity on in vitro fertilization outcome: a comprehensive review. Int Arch Clin Physiol 2019; 1(1).
  31. Venables A, Wong W, Way M, Homer HA. Thyroid autoimmunity and IVF/ICSI outcomes in euthyroid women: a systematic review and meta-analysis. Reproductive Biology and Endocrinology 2020; 18(1):1-16.
مجله زنان، مامایی و نازایی ایران
دوره 26، شماره 9
آذر 1402
صفحه 1-9

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