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Hum. Reprod. Advance Access published online on May 5, 2005
Human Reproduction, doi:10.1093/humrep/deh843
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received December 17, 2004
Revised February 8, 2005
Accepted February 15, 2005

Article

Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study

Roberto Negro 1*, Tiziana Mangieri 2, Lamberto Coppola 2, Giovanni Presicce 2, Eugenio Caroli Casavola 2, Riccardo Gismondi 2, Giancarlo Locorotondo 2, Paolo Caroli 2, Antonio Pezzarossa 3, Davide Dazzi 3, and Haslinda Hassan 4

1 Department of Internal Medicine, Division of Physiopathology of Human Reproduction, Casa di Cura ‘Salus’, Brindisi, Italy
2 Department of Obstetrics and Gynecology, Division of Physiopathology of Human Reproduction, Casa di Cura ‘Salus’, Brindisi, Italy
3 Department of Internal Medicine, District Hospital, Fidenza, Italy and
4 Endocrine Unit, RIPAS Hospital, Bandar Seri Begawan, Brunei

* To whom correspondence should be addressed.
Roberto Negro, E-mail: robnegro{at}tiscali.it


  Abstract

BACKGROUND: Infertile women positive for thyroid antibodies suffer from a poor pregnancy/delivery outcome, although conflicting data have been published. Our objective was to investigate if levothyroxine (LT4) exerts any effect on pregnancy and/or delivery rates in thyroid peroxidase antibody (TPOAb)-positive (+) women undergoing assisted reproductive technologies. METHODS: Patients undergoing treatment were screened for TPOAb, thyroid-stimulating hormone (TSH) and free thyroxine (FT4). A total of 72 (15%) out of the 484 euthyroid women selected were TPOAb (+). These 72 patients were randomly divided into two groups: group A (n=36) underwent LT4 treatment, group B (n=36) placebo. Group C consisted of 412 women (85%) who were TPOAb negative (-). All patients received controlled ovarian stimulation. The endpoints of treatment were pregnancy rate, miscarriage rate and delivery rate. RESULTS: No differences in pregnancy rate were observed between the three groups. Miscarriage rate was higher in TPOAb (+) in comparison to TPOAb (-) [relative risk: 2.01 (95% CI = 1.13-3.56), P=0.028]. CONCLUSIONS: The pregnancy rate is not affected either by presence of TPOAb or treatment with LT4. However, TPOAb (+) women show a poorer delivery rate compared to TPOAb (-). LT4 treatment in TPOAb (+) does not affect the delivery rate.

Keywords: assisted reproductive technologies; autoimmunity; levothyroxine; thyroid.
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