University of Rijeka. Faculty of Medicine. Department of Gynaecology and Obstetrics.
Abstract
Ciljevi: Cilj istraživanja je ispitati utjecaj medicinski pomognute oplodnje na vjerojatnost začeća
i rađanje djece u bolesnica sa supkliničkim autoimunim tireoiditisom.
Ispitanice i metode: U istraživanje su uključene pacijentice (n = 275) koje su se zbog
neplodnosti liječile u tercijarnom bolničkom centru od 2009. do 2017. godine konzervativno ili
MPO postupcima. U svih pacijentica je procijenjena funkcija štitnjače na osnovi hormonskog
statusa, uz testiranje protutijela i ultrazvučni pregled. Reprodukcijski ishodi neplodnih pacijentica
s autoimunim tireoiditisom su uspoređeni s pacijenticama s urednom funkcijom štitnjače.
Metodom protočne citometrije analizirane su mononuklearne subpopulacije periferne krvi i
folikularne tekućine bolesnica liječenih metodama medicinski pomognute oplodnje.
Rezultati: U skupini pacijentica s autoimunim tireoiditisom liječenih MPO postupcima bilo je
značajno manje onih koje nisu zanijele, međutim u istoj skupini, uočili smo značajno više
spontanih pobačaja. Broj rođene djece u odnosu na broj začetih trudnoća nije se statistički
značajno razlikovao. Postotak stanica urođene imunosti (NK) bio je statistički značajno niži u
folikularnoj tekućini bolesnica s pozitivnim tireoidnim protutijelima u usporedbi s bolesnicama
bez pozitivnih protutijela.
Zaključak: Postupci medicinski pomognute oplodnje značajno pomažu u vjerojatnosti začeća u
pacijentica sa supkliničkim autoimunim tireoiditisom, ali ne i u vjerojatnosti rađanja djeteta.
Rizik za spontani pobačaj povećan je u istih pacijentica neovisno o tome da li su liječene
konzervativno ili medicinski pomognutom oplodnjom.The aim: The objective of the study is to investigate whether in vitro fertilization (IVF)
procedures in patients with autoimmune thyroid disorders increase the likelihood of conception
and delivery.
Patients and methods: The study included 275 patients who had been treated for infertility at
the Clinical Hospital Center Rijeka between 2009 and 2017, either conservatively or with IVF.
In all the participants thyroid function was assessed by measuring serum concentrations of
thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3),
while thyroid autoimmunity was assessed by measuring thyroid peroxidase antibodies (TPOAt)
and thyroglobulin antibodies (TgAt) in the serum samples, as well as by thyroid ultrasound
examinations. The reproductive outcomes were compared between the infertile patients and the
patients with normal hormone levels, negative thyroid antibody tests and normal ultrasound
findings. The flow cytometry analysis was used to investigate the blood and follicular fluid
mononuclear cells in patients treated with IVF.
Results: In the group of patients with autoimmune thyroid disorders treated with IVF,
significantly less women conceived and significantly more women experienced spontaneous
abortions compared to the women with normal thyroid tests. The ratio of the number of births
to the number of conceptions did not significantly differ between the two groups. There was a
significantly lower proportion of natural killer cells in the follicular fluid of the patients with
positive thyroid autoantibodies compared to patients with no thyroid autoantibodies.
Conclusion: IVF procedures significantly increase probability of conception in patients with
subclinical autoimmune thyroid disorder, but not probability of delivery. Despite euthyroid
status as a result of levothyroxine replacement, the risk of spontaneous abortions was increased
in patients with autoimmune thyroid disorders, regardless of the type of infertility treatment
(conservative or IVF)
