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Endocrine Abstracts (2022) 84 PS3-13-118 | DOI: 10.1530/endoabs.84.PS3-13-118

ETA2022 Poster Presentations Pregnancy & Iodine (9 abstracts)

Which is the best pre-conceptional TSH cut-off in women submitted to assisted reproductive technology?

Guia Vannucchi 1 , Irene Campi 2 , Serena Cagnina 3 , Danila Covelli 4 , Mario Mignini Renzini 5 , Luca Persani 6 & Laura Fugazzola 7

1Irccs Istituto Auxologico Italiano; University of Milan, Endocrinology Department, Milan, Italy; 2Istituto Auxologico Italiano, Irccs, Milan, Italy; 3Division of Endocrinology, Diabetology, Metabolism; University of Turin, Italy; 4Asst Bergamo Est, Italy; 5Istituti Clinici Zucchi, Monza, Italy; 6Istituto Auxologico Italiano Irccs, University of Milan, Milan, Italy, Division of Endocrine and Metabolic Diseases, Department of Pathophysiology and Transplantation, Italy; 7University of Milan, Milan, Italy, Endocrine Unit, Fondazione Policlinico Irccs, Milan, Italy, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano Irccs, Milan, Italy

TSH is involved in the immunomodulation of early pregnancy stages. Thyroid guidelines have indicated 2.5 mU/l as the best TSH level below which women undergoing assisted reproductive technology (ART) need to be maintained, though this treshold is still controversial. Aims of the present study were to evaluate if pre-conceptional TSH is associated with an increased risk of miscarriage, to identify a TSH cut-off significantly associated with risk of miscarriage and to assess the impact of TSH levels on primary and surrogate outcomes. A series of 1484 infertile women (mean± age 36.7±4.1 years, mean± SD BMI 22.7±4) submitted to IVF in a single center from 2004 and 2014 was retrospectively studied. The majority of patients (60.8%) submitted to ART cycles had a primary infertility, while the remaining cases had a secondary infertility. Primary outcomes were biochemical pregnancy, clinical pregnancy, miscarriage and delivery. Surrogate outcomes were the number of oocytes, the number of embryos and the transfer of embryos. Embryo transfer was performed in 86% of cycles. A biochemical pregnancy was recorded in 369/1274 (29%) patients and 146 of them (39.5%) experienced a pregnancy loss. Moreover, among these 146 women, 52 (36%) were clinically pregnant and had a miscarriage in the first trimester, while in 94 patients (64%) a biochemical pregnancy without clinical evolution was documented. No significant differences in mean TSH levels were observed between women with different times of miscarriage. ROC curve analysis showed that a TSH of 3 mU/l is significantly associated with miscarriage (P = 0.001), while a TSH of 2.3 mU/l is associated with a higher chance to have a biochemical pregnancy. These two TSH thresholds (2.3 or 3 mU/l) were also studied in relation to surrogate outcomes: we observed a weak association between TSH≤2.3 mU/l with the number of retrieved oocytes (P = 0.04) while no significant correlation was found with the number of either embryos obtained or transferred (P = NS). In conclusion, lower pre-conceptional TSH levels appears to favor the embryo implantation and to reduce the risk of early pregnancy loss in women undergoing ART. TSH screening prior to IVF procedures and L-T4 treatment are strongly recommended in order to optimize TSH levels before ovarian stimulation.

Volume 84

44th Annual Meeting of the European Thyroid Association (ETA) 2022

Brussels, Belgium
10 Sep 2022 - 13 Sep 2022

European Thyroid Association 

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