促甲状腺激素水平对新鲜IVF/ICSI周期妊娠结局的影响  

Influence of thyroid stimulating hormone levels on pregnancy outcomes in fresh IVF/ICSI cycle

作　　者：邓华丽[1] 周丹妮 裴莉[1] 叶虹[1] DENG Hua-li;ZHOU Dan-ni;PEI Li;YE Hong(Chongqing Genetic and Reproductive Institute,Chongqing Health Center for Women and Children,Chongqing 400013)

机构地区：[1]重庆市妇幼保健院遗传与生殖研究所,重庆400013

出　　处：《生殖医学杂志》2020年第6期728-732,共5页Journal of Reproductive Medicine

摘　　要：目的探讨控制性促排卵前血清促甲状腺激素(TSH)水平高于4.0 mU/L,对IVF/ICSI新鲜周期妊娠结局的影响。方法回顾性分析2017年6月1日至2018年12月31日在本院进行IVF/ICSI助孕的患者资料,共4457个周期。根据血清TSH水平,分为TSH≤4.0 mU/L组(n=4107)和TSH>4.0 mU/L组(n=350),比较两组患者的一般资料以及妊娠结局。同时又对TSH>4.0 mU/L组内的患者按照4.0 mU/L<TSH≤5.0 mU/L(n=280)和TSH>5.0 mU/L(n=70)再分组,进行助孕结局的比较。结果以4.0 mU/L为分割点的两组患者年龄、不孕年限、体重指数(BMI)、血清抗苗勒管激素(AMH)、基础FSH、基础E2、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平均无显著性差异(P>0.05);两组间的促排卵结局及临床妊娠率、异位妊娠率、活产率均无显著性差异(P>0.05);TSH>4.0 mU/L组的流产率(15.12%)略高于TSH≤4.0 mU/L组(12.80%),但无显著性差异(P>0.05)。TSH>4.0 mU/L的患者再分组后统计分析表明,各项助孕指标及妊娠结局均无显著性差异(P>0.05)。结论在甲状腺功能其他指标正常的情况下,患者控制性促排卵前的血清TSH水平高于4.0 mU/L不影响IVF/ICSI新鲜周期的妊娠结局。Objective:To investigate the effects of serum levels(>4.0 mU/L)of thyroid stimulating hormone(TSH)before controlled ovulation on the pregnancy outcomes of fresh cycles of IVF/ICSI.Methods:The clinical data of the female patients(4457 cycles)who underwent IVF/ICSI in our hospital from June 12017 to December 312018 were retrospectively analyzed.According to the serum level of TSH,the patients were divided into two groups:TSH≤4.0 mU/L group(n=4107)and TSH>4.0 mU/L group(n=350).The general information and pregnancy outcomes were compared between the two groups.Meanwhile,the patients in TSH>4.0 mU/L group were subdivided to 4.0 mU/L<TSH≤5 mU/L group(n=280)and TSH>5 mU/L group(n=70).The clinical outcomes were compared between the subgroups.Results:There were no significant differences in age,duration of infertility,BMI,the serum level of AMH,basal FSH,basal E2,FT3 and FT4 between the two groups of patients with 4.0 mU/L as the dividing point(P>0.05).Meanwhile,there was no significant difference in clinical pregnancy rate,ectopic pregnancy rate,and live birth rate between the two groups(P>0.05).The miscarriage rate of TSH>4.0 mU/L group(15.12%)was higher than that of TSH≤4.0 mU/L group(12.80%),but the difference was not significant(P>0.05).There were no significant differences in various assisted pregnancy indicators and pregnancy outcomes of IVF/ICSI between 4.0 mU/L<TSH≤5.0 mU/L group and TSH>5.0 mU/L group(P>0.05).Conclusions:When other indicators of thyroid function are normal,the patient’s serum TSH level(>4.0 mU/L)before controlled ovulation does not affect the pregnancy outcomes in fresh IVF/ICSI cycle.

关 键 词：亚临床甲状腺功能减退 血清促甲状腺激素水平 体外受精-胚胎移植 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]