基础甲状腺功能与IVF-ET妊娠结局的相关性研究

摘要

目的 研究基础甲状腺功能三项(TSH、FT3、FT4水平)与体外受精-胚胎移植妊娠结局之间的关系. 方法 以2014年9月至2015年5月在南京大学医学院附属鼓楼医院生殖医学中心行长方案体外受精/卵胞浆内单精子注射-胚胎移植术(IVF/ICSI-ET)并行新鲜胚胎移植的不孕症患者作为研究对象.于IVF前月经第2~4天空腹留血,检测基础甲状腺功能三项:促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4).纳入甲状腺功能三项均正常的患者486例,分析基础甲状腺功能与IVF/ICSI妊娠结局的关系. 结果 (1)486例患者中临床妊娠305例,活产249例,早期自然流产23例;(2)临床妊娠组与未妊娠组比较,TSH、FT3、FT4水平均无统计学差异(P>0.05),临床妊娠组女方年龄小[(29.4±3.9) vs. (30.7±4.3)岁,P=0.001)]、子宫内膜厚[(11.0±2.2) mm vs. (9.9±1.9) mm,P<0.001)];(3)活产组与早期自然流产组相比,基础TSH、FT3、FT4差异均无统计学意义(P>0.05);(4)基础TSH≥2.5 mIU/L的患者与TSH<2.5 mIU/L者的临床妊娠率、活产率、早期自然流产率和新生儿出生体重均无统计学差异(P>0.05). 结论 基础甲状腺功能三项如在正常范围不影响IVF结局,IVF前TSH≥2.5 mIU/L但<4.2 mIU/L时不增加早期自然流产率,也不影响新生儿出生体重.%Objective:To study the relationship between basic thyroid function and pregnancy outcome in IVF-ET.Methods:A total of 486 women with normal basic thyroid function who underwent the initial IVF/ICSI-ET treatment by using the long GnRH agonist protocol were included in our hospital from September 2014 to May 2015.The levels of thyroid stimulating hormone (TSH),free triiodothyronine (FT3) and free tetraiodothyronine (FT4) in fasting blood in menstruation 2nd to 4th day before IVF were measured.The relationship between basic thyroid function and IVF/ICSI pregnancy outcome were analyzed.Results:There were 305 clinical pregnancies,249 live births,and 23 early spontaneous abortions in 486 patients.There were no significant differences in serum TSH,FT3,FT4 levels between the clinical pregnant group and the non-pregnant group (P>0.05).The women were younger in the clinical pregnancy group (29.4±3.9 vs.30.7±4.3 years,P=0.001),and the endometrial thickness was thicker (11.0±2.2 vs.9.9±1.9 mm,P<0.001).And there were no significant differences in the TSH,FT3 and FT4 levels between the live birth group and spontaneous abortion group (P>0.05).Furthermore,there were no significant differences in clinical pregnancy rate,live birth rate,spontaneous abortion rate and neonatal birth weight between basic TSH≥2.5 mIU/L group and TSH<2.5 mIU/L group (P>0.05).Conclusions:The basic serum levels of TSH,FT3,FT4 in the normal range does not affect IVF/ICSI pregnancy outcome,while TSH≥2.5 mIU/L but<4.2 mIU/L does not increase spontaneous abortion rate or affect neonatal birth weight.