Thyroid function during controlled ovarian hyperstimulation as part of in vitro fertilization

Objective To determine the exact nature and timing of alterations in thyroid function throughout controlled ovarian hyperstimulation (COH). Design Prospective cohort study. Setting University fertility clinic. Patient(s) Fifty-seven women undergoing COH as part of planned in vitro fertilization. Int...

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Bibliographic Details
Published in:Fertility and sterility 2012-03, Vol.97 (3), p.585-591
Main Authors: Gracia, Clarisa R., M.D., M.S.C.E, Morse, Christopher B., B.A, Chan, Grace, M.D, Schilling, Samantha, M.D, Prewitt, Maureen, R.N, Sammel, Mary D., Sc.D, Mandel, Susan J., M.D., M.P.H
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Biomarkers - blood
Birth control
blood serum
cohort studies
Endocrinopathies
estradiol
Estradiol - blood
Female
Fertility Agents, Female - administration & dosage
Fertilization in Vitro
Gynecology. Andrology. Obstetrics
human chorionic gonadotropin
Humans
hypothyroidism
Hypothyroidism - blood
Hypothyroidism - complications
in vitro fertilization
infertility
Infertility - blood
Infertility - complications
Infertility - therapy
Internal Medicine
in vitro fertilization
Linear Models
Medical sciences
Middle Aged
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Obstetrics and Gynecology
ovarian hyperstimulation
Ovulation - drug effects
Ovulation Induction
patients
Philadelphia
Pregnancy
Pregnancy Rate
Prospective Studies
screening
Sterility. Assisted procreation
Thyroid function
Thyroid Gland - drug effects
Thyroid Gland - metabolism
thyroid hormones
Thyroid Hormones - blood
Thyroid. Thyroid axis (diseases)
thyrotropin
Thyrotropin - blood
Thyroxine - blood
Thyroxine-Binding Globulin - metabolism
Time Factors
Triiodothyronine - blood
women
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Summary:Objective To determine the exact nature and timing of alterations in thyroid function throughout controlled ovarian hyperstimulation (COH). Design Prospective cohort study. Setting University fertility clinic. Patient(s) Fifty-seven women undergoing COH as part of planned in vitro fertilization. Intervention(s) None. Main Outcome Measure(s) Timing and magnitude of change in serum thyroid hormones, including TSH, total and free T4 , E2 , and thyroxine-binding globulin (TBG), measured at six time points from before stimulation to 2 weeks after serum pregnancy test. Result(s) Geometric mean serum TSH increased during stimulation, peaking 1 week after hCG administration compared with baseline (2.44 vs. 1.42 mIU/L), as did free T4 (1.52 vs. 1.38 ng/dL) and TBG (32.86 vs. 21.52 μg/mL). Estradiol levels increased, peaking at hCG administration (1743.21 vs. 71.37 pg/mL). Of 50 women with baseline TSH ≤2.5 mIU/L, 22 (44.0%) had a subsequent rise in TSH to >2.5 during or after COH. The pattern of change over time in TSH concentrations was significantly influenced by baseline hypothyroidism and whether pregnancy was achieved. Conclusion(s) COH led to significant elevations in TSH, often above pregnancy appropriate targets. These findings were particularly evident in women with preexisting hypothyroidism and may have important clinical implications for screening and thyroid hormone supplementation.
ISSN:0015-0282
1556-5653
DOI:10.1016/j.fertnstert.2011.12.023