1Infertility Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran;
2Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran;
3Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
چکیده
Background: Autoimmune diseases are a main cause of primary ovarian insufficiency. This study was designed to elucidate the relationship between ovarian reserve and anti-thyroid peroxidase antibodies in women of different ages. Methods: 98 women in a cross-sectional study was conducted at the infertility Center of Shiraz University of Medical Sciences, Hazrate Zeinab Hospital, from September 2018 to March 2019. Women with infertility and thyroid-stimulating hormone (TSH) > 3mIU/L were included in the study with convenience sampling. Data were collected by a form containing demographic characteristics, thyroid hormones, and ovarian reserve data. Participants were categorized based on the negative or positive anti-thyroid peroxidase (anti-TPO) antibodies. According to a pilot sample, and possible dropout of 20%, the sample size was determined to be 49 cases in each group. The results were compared between groups using SPSS, version 22. All statistical comparisons were performed using the t-test, and the data are presented as the mean±SD. P-values less than 0.05 were considered significant. Results: 49 women were analyzed in each group. There was no significant difference between the groups in the mean age (P=0.42), body mass index (BMI) (P=0.34), duration of infertility (P=0.99), mean prolactin (P=0.66), TSH (P=0.17), thyroxine (T4) (P=0.87) and follicle-stimulating hormone (FSH) levels (P=0.14). Ovarian reserve characteristics: antral follicular count (AFC) and anti-Müllerian hormone (AMH) levels in anti-TPO positive group were 10.61±7.29 and 1.98±2.38, respectively, and AFC and AMH in anti- TPO negative group were 16.46±6.38 and 2.94±2.22, respectively. There were significant differences between the two groups on AFC (P <0.001) and AMH (P=0.04). Conclusion: Patients with autoimmune thyroiditis were at higher risk for decreased ovarian reserve. They should consider their lower reproductive life span during their childbearing years.
Chen CW, Huang YL, Tzeng CR, et al. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies. Thyroid. 2017;27:1194-200.
Jankowska K. Premature ovarian failure. Menopause Review. 2017;16:51-6.
Podfigurna-Stopa A, Czyzyk A, Grymowicz M, et al. Premature ovarian insufficiency: the context of long-term effects. Journal of Endocrinological Investigation. 2016;39:983-90.
Sharif K, Watad A, Bridgewood C, et al. Insights into the autoimmune aspect of premature ovarian insufficiency. Best Practice & Research Clinical Endocrinology & Metabolism. 2019;33(6).
Ayesha, Jha V, Goswami D. Premature Ovarian Failure: An Association with Autoimmune Diseases. Journal of Clinical and Diagnostic Research. 2016;10:QC10-2.
Torrealday S, Kodaman P, Pal L. Premature Ovarian Insufficiency - an update on recent advances in understanding and management. F1000Research. 2017;6:2069.
Polyzos NP, Sakkas E, Vaiarelli A, et al. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Human Reproduction (Oxford, England). 2015;30:1690-6.
Tuten A, Hatipoglu E, Oncul M, et al. Evaluation of ovarian reserve in Hashimoto’s thyroiditis. Gynecological Endocrinology. 2014;30:708-11.
Saglam F, Onal ED, Ersoy R, et al. Anti-Mullerian hormone as a marker of premature ovarian aging in autoimmune thyroid disease. Gynecological Endocrinology. 2015;31:165-8.
Kuroda M, Kuroda K, Segawa T, et al. Levothyroxine supplementation improves serum anti-Mullerian hormone levels in infertile patients with Hashimoto’s thyroiditis. The Journal of Obstetrics and Gynaecology Research. 2018;44:739-46.
Amouzegar A, Mehran L, Takyar M, et al. Tehran Thyroid Study (TTS). International Journal of Endocrinology and Metabolism. 2018;16:e84727.
Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clinical Biochemistry. 2018;62:2-10.
Arora S, Sinha K, Kolte S, Mandal A. Endocrinal and autoimmune linkage: Evidences from a controlled study of subjects with polycystic ovarian syndrome. Journal of Human Reproductive Sciences. 2016;9:18-22.
Pirgon O, Sivrice C, Demirtas H, Dundar B. Assessment of ovarian reserve in euthyroid adolescents with Hashimoto thyroiditis. Gynecological Endocrinology. 2016;32:306-10.
Ozalp Akin E, Aycan Z. Evaluation of the Ovarian Reserve in Adolescents with Hashimoto’s Thyroiditis Using Serum Anti-Mullerian Hormone Levels. Journal of Clinical Research in Pediatric Endocrinology. 2018;10:331-5.
Bahri S, Ramezani Tehrani F, Amouzgar A, et al. Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up. BMC Endocrine Disorders. 2019;19:47.
Jamil Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Disease Markers. 2016;2016:5246217.
Kazemijaliseh H, Ramezani Tehrani F, Behboudi-Gandevani S, et al. The Prevalence and Causes of Primary Infertility in Iran: A Population-Based Study. Global Journal of Health Science. 2015;7:226-32.