Thyroid ultrasonic changes relate to implantation failure in euthyroid women with thyroid autoimmunity undergoing in vitro fertilization/intracytoplasmic sperm injection

Abstract

Objective

To determine whether ultrasonic manifestations of Hashimoto’s thyroiditis (HT) related to embryo qualities or pregnancy outcomes in women with thyroid autoimmunity (TAI) undergoing in vitro fertilization/intracytoplasmic sperm injection.

Methods

Our study was a retrospective cohort study. A total of 589 euthyroid women enrolled from January 2017 to December 2019. 214 TAI women and 375 control women were allocated in each group according to serum levels of thyroid peroxidase antibodies (TPOAb) and/or anti-thyroglobulin antibodies (TgAb). Basal serum hormone levels and thyroid ultrasound were assessed, embryo qualities, pregnancy outcomes were collected from medical records. Diagnosis of thyroid ultrasound was used for subanalysis. Logistic regression was used to evaluate outcomes of embryo development and pregnancy.

Results

Implantation rate was significantly lower in euthyroid women with TAI compared with control group (TAI group: 65.5% vs. Control group: 73.0%, adjusted OR (95% CI): 0.65 (0.44, 0.97), p = 0.04). We further stratified TAI group into two groups: one group with HT features under ultrasound and another group with normal thyroid ultrasound. After regression analysis, TAI women with HT morphological changes had a lower chance of implantation compared with control group (TAI group with HT: 64.1% vs. Control group: 73.0%, adjusted OR (95% CI): 0.63 (0.41, 0.99), p = 0.04), while there was no significant difference on implantation rate between TAI women with normal thyroid ultrasound and control group. Other outcomes, such as embryo qualities and pregnancy rate, were comparable between TAI and control groups.

Conclusions

A higher risk of implantation failure was seen among euthyroid women with TAI, especially women with HT morphological changes under ultrasound. The underlying mechanisms of implantation failure among euthyroid HT patients need further research.

Keywords:

• Implantation
• embryo quality
• pregnancy outcome
• thyroid autoimmunity
• in vitro fertilization/intracytoplasmic sperm injection

Acknowledgment

The authors thank all the staffs involved in the process of data measurements and collection.

Authors contribution

Zengxiang Ma and Yingxin Zhang designed the study. Jiahui Wang and Wei Zhou wrote the manuscript, made tables and figures. Jincheng Li, Shuo Zhang, and Tong Wu performed data collection and data analysis. Zhiyi Song and Chenxi Li supervised the manuscript. All authors have read and agreed to the final manuscript.

Disclosure statement

No conflict of interest was reported by the authors.

Data availability statement

The data of this study is available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the National Science Foundation of Shandong Province (ZR2021QH320 and ZR2022MH087).