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Qual o impacto do hipotiroidismo subclínico no desfecho reprodutivo de casais inférteis?
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A literatura é controversa relativamente ao impacto do hipotiroidismo sublínico na infertilidade e qual o melhor cut off de TSH que deve justificar consulta com Endocrinologista e eventual tratamento.
Objetivos/Hipóteses: O objetivo primário foi avaliar se as mulheres com diferentes níveis de TSH apresentam diferenças na taxa de gravidez espontânea num ano após a primeira consulta. Como objetivo secundário pretendemos realizar uma subanálise do mesmo desfecho para os casais com infertilidade inexplicada na primeira consulta.
Metodologia: Estudo retrospetivo com revisão da base de dados da primeira consulta de apoio à fertilidade na Unidade de Medicina da Reprodução do Hospital Santa Maria, entre janeiro de 2018 e dezembro de 2022, incluindo todos os casais cujo elemento feminino realizou avaliação de TSH após a primeira consulta e não foi realizado nenhum tratamento no primeiro ano subsequente (indução de ovulação, IIU ou FIV/ICSI).
Resultados: No período do estudo, foram realizadas 3654 primeiras consultas de apoio à fertilidade, sendo que destas 1464 mulheres tinham resultado de TSH e não realizaram nenhum tratamento no primeiro ano após a primeira consulta. Verificaram-se 48 gravidezes espontâneas (3,3%) no primeiro ano após a consulta. Os fatores que se associaram a maior taxa de gravidez espontânea foram: menor duração da infertilidade (p <0,001), infertilidade secundária (p=0,001) e infertilidade inexplicada (p=0,047). Comparando os grupos de TSH (TSH<2,5 mIU/L, TSH 2,5-4,2 mIU/L, TSH> 4,2 mIU/L) não foram encontradas associações estatisticamente significativas entre nenhum deles e maior taxa de gravidez espontânea. No grupo com infertilidade inexplicada (n=420), 18 mulheres engravidaram espontaneamente (4,3%), não se tendo verificado diferenças estatisticamente significativas entre os grupos de TSH.
Conclusão: Na nossa amostra, não foi encontrada uma associação estatisticamente significativa entre os grupos de TSH avaliados e a taxa de gravidez espontânea, nem para o subgrupo com infertilidade inexplicada.
Introduction: The literature is controversial regarding the impact of subclinical hypothyroidism on infertility and which is the best TSH cut-off that should justify an appointment with an endocrinologist and eventual treatment. Objectives/Hypotheses: Primary objective was to evaluate if women with different TSH levels present differences in the rate of spontaneous pregnancy one year after the first appointment. As a secondary objective, we performed a subanalysis of the same outcome for couples with unexplained infertility at the first appointment. Methods: Retrospective study by reviewing the database of the first appointment at the Reproductive Medicine Unit of Santa Maria Hospital, between January 2018 and December 2022, including all couples whose female partner underwent TSH assessment after the first appointment and no treatment was performed in the subsequent first year (ovulation induction, IUI or IVF/ICSI). Results: In the study period, 3654 first appointments were carried out, of which 1464 women had a TSH result and didn’t receive any treatment in the following year. There were 48 spontaneous pregnancies (3.3%) in the first year after the appointment. The variables associated with a higher rate of spontaneous pregnancy were: shorter duration of infertility (p<0.001), secondary infertility (p=0.001), and unexplained infertility (p=0.047). Comparing TSH groups (TSH<2.5 mIU/L, TSH 2.5-4.2 mIU/L, TSH>4.2 mIU/L) no statistically significant association was found between any of them and a higher rate of spontaneous pregnancy. In the group with unexplained infertility (n= 420), 18 women had a spontaneous pregnancy (4,3%), with no statistically significant differences within the TSH groups. Conclusion: In our sample, no statistically significant association was found between the TSH groups and spontaneous pregnancy rate, nor for the subgroup with unexplained infertility.
Introduction: The literature is controversial regarding the impact of subclinical hypothyroidism on infertility and which is the best TSH cut-off that should justify an appointment with an endocrinologist and eventual treatment. Objectives/Hypotheses: Primary objective was to evaluate if women with different TSH levels present differences in the rate of spontaneous pregnancy one year after the first appointment. As a secondary objective, we performed a subanalysis of the same outcome for couples with unexplained infertility at the first appointment. Methods: Retrospective study by reviewing the database of the first appointment at the Reproductive Medicine Unit of Santa Maria Hospital, between January 2018 and December 2022, including all couples whose female partner underwent TSH assessment after the first appointment and no treatment was performed in the subsequent first year (ovulation induction, IUI or IVF/ICSI). Results: In the study period, 3654 first appointments were carried out, of which 1464 women had a TSH result and didn’t receive any treatment in the following year. There were 48 spontaneous pregnancies (3.3%) in the first year after the appointment. The variables associated with a higher rate of spontaneous pregnancy were: shorter duration of infertility (p<0.001), secondary infertility (p=0.001), and unexplained infertility (p=0.047). Comparing TSH groups (TSH<2.5 mIU/L, TSH 2.5-4.2 mIU/L, TSH>4.2 mIU/L) no statistically significant association was found between any of them and a higher rate of spontaneous pregnancy. In the group with unexplained infertility (n= 420), 18 women had a spontaneous pregnancy (4,3%), with no statistically significant differences within the TSH groups. Conclusion: In our sample, no statistically significant association was found between the TSH groups and spontaneous pregnancy rate, nor for the subgroup with unexplained infertility.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Infertilidade Hipotiroidismo subclínico Tireotropina (TSH) Infertilidade inexplicada Gravidez espontânea Obstetrícia