Reproductive Endocrinology Thyroid and Metabolic Function

Impact of Endocrine Disorders on IVF Outcomes: Results from a Large, Single-Centre, Prospective Study

Herman T, Csehely S, Orosz M, Bhattoa HP, Deli T, Torok P, Lagana AS, Chiantera V, Jakab A

Published June 2023 Reproductive Sciences (Thousand Oaks, Calif.), 30(6), 1878-1890
DOI 10.1007/s43032-022-01137-0 PMID 36477597 PMC PMC10229480

RRM Academy Synopsis

Endocrine disorders were linked to lower IVF pregnancy rates

Pregnancy rates with IVF were lower in women with endocrine disorders, a prospective cohort study of 231 women at one center found. The rate was about 3 out of 10 with a treated disorder and about 6 out of 10 without one.

Key Findings

  • Endocrine disorders were found in 161 of 231 women (69.7%) having IVF: thyroid disorders 32.5%, diminished ovarian reserve 23.8%, insulin resistance 22.5%, and polyendocrine metabolic ovarian syndrome (PMOS / PCOS) 15.2%.
  • The pregnancy rate was 34.16% in the endocrine group against 61.43% in controls (p = 0.003) and remained lower after age correction (p = 0.0151), with laboratory parameters corrected before IVF.
  • Women with endocrine disorders had fewer eggs retrieved, 5.42 on average against 7.5 in controls (p = 0.0001), with no significant difference in the number of IVF cycles performed.
  • Compared with 61.43% in controls, pregnancy rates were 21.82% with diminished ovarian reserve (p < 0.001), 29.41% with Hashimoto's thyroiditis (p = 0.001) and 29.03% with high prolactin (p = 0.005).
  • In the 35 women with PMOS / PCOS, pregnancy rates were 40.0% against 61.43% in controls (p = 0.061); in women under 35 the age-corrected difference was significant (p = 0.0027).

Interpretation

The prospective cohort study compared women with and without endocrine disorders. A cohort design shows association and cannot establish cause. The endocrine group was older. After age correction, the differences stayed significant for diminished ovarian reserve, Hashimoto's thyroiditis and high prolactin. The authors note that consecutive enrollment may bring selection and treatment bias. They also note that the hypothyroidism group was small. The study took place at one center, and only women having IVF took part. The study did not report how the pregnancies progressed or ended, so longer-term effects of treated endocrine disease on those pregnancies are unknown.

RRM Context

Thyroid disease, high prolactin and insulin resistance can each be found by testing. Conditions like these are among the causes of infertility that restorative reproductive medicine looks for in both partners. IVF bypasses the reproductive system without resolving why conception fails.

Abstract

Endocrine disorders negatively influence the ovarian function, and increasing incidence of endocrine diseases with age may have further negative effects on pregnancy rate. Prospective cohort study of 231 consecutively enrolled patients underwent IVF treatment. In patients with known endocrine disorders, the laboratory parameters were corrected before IVF treatment. One hundred sixty one patients (69.7%) had at least one known and treated endocrine disorder (study group), and 70 patients were endocrine negative (control group). Endocrine disorders diagnosed were thyroid disorders (32.5%), diminished ovarian reserve (23.8%), insulin resistance (22.5%), PCOS (15.2%), hyperprolactinaemia (13.4%), obesity (12.1%), hypogonadotropic hypogonadism (0.8%) and congenital adrenal hyperplasia (0.2%). Before the IVF treatment, systematic endocrine laboratory examinations were performed in all patients. Higher age, BMI and FSH were found in the study group, while AMH level was lower. There were no differences in LH, E2, prolactin, TSH, FT3, FT4, TT, DHEAS, androstendione, 17-OHP and SHBG level between the study and control groups. The study group had higher baseline glucose, baseline insulin, 120-min glucose and 120-min insulin level after oral glucose tolerance test. With no difference in the IVF cycles performed, pregnancy rate was lower in the study group (61.43% vs. 34.16%; p = 0.003), and this difference (p = 0.0151) remained in age-corrected rates, as well. The analyses were also performed in individual endocrinology groups. The prevalence of endocrine disorders is high in females participating in IVF programs, and they are often accompanying each other. Even after proper correction, the presence of the endocrine disorder negatively influences the pregnancy rate in IVF treatment.

Topics

By this author

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Reproductive Endocrinology › Thyroid and Metabolic Function › Insulin and Metabolism · Assisted Reproduction › Outcomes and Effectiveness › Outcomes by Diagnosis · Diagnostics › Hormone Testing › Serum Panels
Tunde Herman, Szilvia Csehely, Monika Orosz, Harjit Pal Bhattoa, Tamas Deli, Peter Torok, Antonio Simone Lagana, Vito Chiantera, Atilla Jakab
T Herman, S Csehely, M Orosz, H Bhattoa, T Deli, Pete Torok, P Torok, A Lagana, V Chiantera, A Jakab
PMID 36477597 36477597 DOI 10.1007/s43032-022-01137-0 10.1007/s43032-022-01137-0 Herman et al. 2023, Herman 2023