2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction

Kris Poppe, Peter Bisschop, Laura Fugazzola, Gesthimani Minziori, David Unuane, Andrea Weghofer

Research output: Contribution to journalArticleAcademicpeer-review

76 Citations (Scopus)

Abstract

Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be a solution. Prior to an ART treatment, ovarian stimulation is performed, leadingto high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating levothyroxine (LT4) supplements before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of TAI. Women with hypothyroidism treated with LT4 prior to ART should have a serum TSH level <2.5 mIU/L. Subfertile women with hyperthyroidism planning an ART procedure should be informed of the increased risk of maternal and foetal complications, and euthyroidism should be restored and maintained for several months prior to an ART treatment. Fertilisation rates and embryo quality may be impaired in women with TSH>4.0 mIU/L and improved with LT4 therapy. In meta-analyses that mainly included women with TSH levels >4.0 mIU/L, LT4 treatment increased live birth rates, but that was not the case in 2 recent interventional studies in euthyroid women with TAI. The importance of the increased use of intracytoplasmic sperm injection as a type of ART on pregnancy outcomes in women with TAI deserves more investigation. For all of the above reasons, women of subfertile couples should be screened routinely for the presence of thyroid disorders.
Original languageEnglish
Pages (from-to)281-295
Number of pages15
JournalEuropean thyroid journal
Volume9
Issue number6
Early online date2021
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Assisted reproductive technology
  • In vitro fertilization
  • Intracytoplasmic sperm injection
  • Radioactive iodine
  • Subclinical hypothyroidism/ hyperthyroidism
  • Subfertility
  • Thyroid autoimmunity
  • Thyroid cancer

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