亚临床甲状腺功能减退患者体外受精促排卵中促甲状腺素异常增高对临床结局的影响  

Effect of Abnormal Increase of TSH in Ovulation Induction on Clinical Outcome

作　　者：冯帆[1] 张霖[1] 朱大林[1] 倪亚莉[1] 胡颋 马莹 许思娟[1] 刘佳 刘月英 FENG Fan;ZHANG Lin;ZHU Dalin(Reproductive Medicine Center,Gansu Provincial Maternity and Child-Care Hospital,Lanzhou Gansu 730050,China)

机构地区：[1]甘肃省妇幼保健院生殖中心,甘肃兰州730050

出　　处：《实用妇产科杂志》2022年第4期301-304,共4页Journal of Practical Obstetrics and Gynecology

基　　金：甘肃省科技厅资助(编号:18JR3RA038)。

摘　　要：目的:观察亚临床甲状腺功能减退(SCH)患者在体外受精(IVF)促排卵中促甲状腺激素(TSH)不同程度升高对临床结局的影响。方法:对拟IVF且TSH> 4.0 m IU/L患者(428例)给予左甲状腺素(LT4) 25~100μg治疗,待TSH <2.5 m IU/L后进入超促排卵周期,定期监测TSH。根据扳机后次日TSH的水平将患者分为4组:A组(TSH <2.5 m IU/L,135例)、B组(2.5 m IU/L≤TSH <4.0 m IU/L,149例)、C组(4 m IU/L≤TSH <8 m IU/L,84例)、D组(TSH≥8 m IU/L,60例)。比较4组患者的助孕及妊娠结局。结果:4组患者的获卵数、MII卵率、2PN率、优质胚胎率、可利用胚胎率比较,差异无统计学意义(P> 0.05)。新鲜周期中,4组的临床妊娠率、活产率及流产率比较,差异均无统计学意义(P>0.05)。冷冻周期(FET)中,D组与其他3组比较,活产率降低,流产率升高,差异有统计学意义(P <0.05)。结论:SCH患者促排卵中,TSH <8 m IU/L不影响妊娠结局,但TSH≥8 m IU/L时可能降低FET周期的活产率,增加流产率。Objective: To observe the effects of increasing thyroid stimulating hormone( TSH) to varying degrees on clinical outcomes in patients with subclinical hypothyroidism during in vitro fertilization( IVF) and ovulation induction. Methods: Patients with TSH > 4. 0 m IU/L were treated with levothyroxine 25-100 μg and they entered the hyperstimulation cycleafter TSH < 2. 5 m IU/L,then TSH was monitored regularly. According to the level of TSH the day after the trigger,the patients were divided into four groups: group A( TSH < 2. 5 m IU/L),135 cases;group B( 2. 5 m IU/L≤ TSH < 4 m IU/L),149 cases,group C( 4 m IU/L ≤ TSH < 8 m IU/L),84 cases,Group D( TSH≥8 m IU/L),60 cases. The pregnancy rate,miscarriage rate,and live birth rate of the four groups were compared. Results: There was no significant difference in the number of oocytes,MII oocytes,2PN,high quality embryos and available embryos among the four groups( P > 0. 05). The clinical pregnancy rate and miscarriage rate were not significantly different among the four groups( P > 0. 05) in fresh cycles. Group D clearly had a lower live birth rate and a higher miscarriage rate than those of the other three groups,and the difference was statistically( P < 0. 05) in frozen-thawed embryo transfer( FET) cycles. Conclusions: TSH < 8 m IU/L does not affect the pregnancy outcome,but TSH≥8 m IU/L significantly increases the miscarriage rate and reduces the live birth rate in FET cycles.

关 键 词：亚临床甲状腺功能减退 左甲状腺素 体外受精 超促排卵 活产 

分 类 号：R714.2[医药卫生—妇产科学]