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- Title
Thyroïde et subfertilité féminine.
- Authors
Poppe, Kris G.; Veltri, Flora; Kleynen, Pierre
- Abstract
Severe thyroid dysfunction can lead to subfertility via different pathways like altered menstruations, changes in reproductive hormone levels and through a direct impact on the ovaries. Fertility problems may persist even after normalization of thyroid function, and then surgery and/or an assisted reproductive technology (ART) may be a solution. Several studies showed that women with the polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of thyroid autoim-munity (TAI) compared with fertile women or with other causes of sub-fertility. Prior to an ART treatment, an ovarian stimulation (OS) is performed, that leads to high oestradiol levels, in turn potentially leading to (subclinical) hypothyroidism in women with TAI, and necessitating thyroid hormone supplements (LT4) before pregnancy. Women with (subclinical) hypothy-roidism prior to OS and treated with LT4 should target a serum TSH level <2,5 mIU/L. Women of subfertile couples with hyperthyroidism planning an assisted pregnancy should be informed of the increased risk of maternal and fetal complications, and euthyroid-ism should be obtained and last for several months prior to it. The impact of thyroid disorders on the in vitro results such as the embryo quality and fertilization rate remain uncertain. In meta-analyses including women with mainly TSH levels >4,0 mIU//L, LT4 increased live birth rates, but this was not the case in euthyroid women with TAI; however, the use of intracyto-plasmic sperm injection seems to be promising in those women. Based on above-mentioned reasons, routinely screening for thyroid disorders in women of infertile couples is strongly advised.
- Subjects
INTRACYTOPLASMIC sperm injection; FERTILIZATION in vitro; REPRODUCTIVE technology; THYROIDITIS; HYPERTHYROIDISM
- Publication
Médecine de la Reproduction, 2023, Vol 25, Issue 3, p233
- ISSN
2650-8427
- Publication type
Article
- DOI
10.1684/mte.2023.0966