Human Reproduction, Vol. 18, No. 4, 707-714,
April 2003
© 2003 European Society of Human Reproduction and Embryology
Thyroxine treatment modified in infertile women according to thyroxine-releasing hormone testing: 5 year follow-up of 283 women referred after exclusion of absolute causes of infertility
1 Department of Medicine III, Division of Endocrinology and Metabolism and 2 Department of Gynecology, University of Vienna, Vienna, Austria
3 To whom correspondence should be addressed at: Department of Medicine III, Division of Endocrinology & Metabolism, University of Vienna, AKH, Waehringer Guertel 18–20, 1090 Wien, Austria. e-mail: wolfgang.raber{at}gmx.at
BACKGROUND: Mild hypothyroidism may contribute to disturbed reproductive function. We hypothesized that frequent thyroxine-releasing hormone (TRH) testing to fine-tune thyroxine (T4) therapy instituted upon every TRH-induced thyroid-stimulating hormone (TSH) rise above the mean of a healthy population (i.e. 15 mIU/l) would improve fecundity compared with historical data. METHODS: In a cohort of 283 infertile women followed over 5 years, we assessed (i) pregnancy, abortion and delivery rates, (ii) thyroid function over time in women who conceived compared with those who did not, and (iii) various thyroid parameters with respect to fertility. RESULTS: Overall conception rate of 37% was higher (P < 0.05) than previously reported and independent of thyroid function prior to T4 therapy, thyroxine dose or elevated thyroid autoantibodies. Never achieving basal TSH <2.5 IU/l or TRH-stimulated TSH <20 mIU/l with T4 therapy resulted in lower conception rates (P < 0.05). Median time to conception was 6 months, but 18 months in women who declined TRH testing (P < 0.02). Overall abortion rate was 9%. Only first trimester miscarriages occurred. CONCLUSIONS: Based on the presented protocol, high pregnancy and parturition rates were observed. Whether this is due to early T4 therapy remains to be determined. Abortions appeared to be associated with higher TSH but not with elevated thyroid antibodies.
Key words: cohort study/infertility/mild hypothyroidism/thyroxine therapy/TRH test
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