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Üreme Döneminde Kadınlarda TSH Düzeyinin Yumurta Rezervine Etkisi

Year 2020, Volume: 22 Issue: 3, 370 - 376, 31.12.2020
https://doi.org/10.24938/kutfd.809017

Abstract

Amaç: Üreme çağındaki kadınlarda en sık görülen endokrinolojik bozukluklardan biri tiroid hastalıklarıdır. Serum Anti-Mullerian hormon düzeyinin yumurtalık düzeyini belirlemede iyi bir gösterge olduğu bilinmektedir. Bu çalışmada, serum tiroid uyarıcı hormon düzeyinin Anti-Mullerian hormon üzerindeki etkisini araştırdık.
Gereç ve Yöntemler: Endokrinoloji kliniğine fertilite değerlendirmesi için konsülte edilen 20-45 yaş arası 198 hastanın verileri kaydedildi ve geriye dönük olarak incelendi. Tüm hastalar TSH sonuçlarına göre 3 kategoriye ayrıldı; 1) ≤2.5 mIU / L, 2) 2.51-4.99 mIU / L, 3) ≥5 mIU / L. Tüm bu gruplar arasında serum Anti-Mullerian hormon, laboratuvar sonuçları ve demografik özellikler karşılaştırıldı. Ayrıca, Anti-Mullerian hormon ile tiroid uyarıcı hormon arasındaki korelasyon ilişkisi analiz edildi.
Bulgular: Hastaların ortalama yaşı 29.4 (±6.4) idi. Yaş (p=0.384), vücut kitle indeksi (p=0.407), follikül stimüle edici hormon (p=0.178), luteinizan hormon (p=0.407), östradiol (p=0.424) ve Anti-Mullerian hormon (p=0.814) gibi değişkenler gruplar arasında farklı değildi. Serum Anti-Mullerian hormon seviyesi ile serum tiroid uyarıcı hormon seviyesi veya vücut kitle indeksi sonuçları arasında korelasyon ilişkisi yoktu. Anti-Mullerian hormon ve luteinizan hormon (r=0.258, p=0.001) arasında istatistiksel olarak anlamlı düzeyde pozitif korelasyon bulunurken, Anti-Mullerian hormon ile follikül stimüle edici hormon (r=-0.207, p=0.007) ve estradiol (r=-0.198, p=0.010) arasında negatif korelasyon tespit edildi.
Sonuç: Sonuç olarak, hafif tiroid uyarıcı hormon değişiklikleri yumurtalık rezervinin değerlendirilmesinde kullanılan Anti-Mullerian hormon üzerinde etkili görünmemekle birlikte, yumurtalık rezervinin tiroid hormon replasman tedavisi ile olumlu yönde değiştiğini göstermek için daha kapsamlı çalışmalara ihtiyaç vardır.

References

  • 1. Krassas GE, Pontikides N, Kaltsas T, Papadopoulou P, Paunkovic J, Paunkovic N et al. Disturbances of menstruation in hypothyroidism. Clin Endocrinol (Oxf). 1999;50(5):655-9.
  • 2. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004;18(2):153-65.
  • 3. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55.
  • 4. Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995;43(1):55-68.
  • 5. Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips, Mahaffey KR et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid. 2007;17(12):1211-23.
  • 6. Yoshioka W, Amino N, Ide A, Kang S, Kudo T, Nishihara E et al. Thyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility. Endocr J. 2015;62(1):87-92.
  • 7. Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012;2(1):17-9.
  • 8. Monteleone P, Parrini D, Faviana P, Carletti E, Casarosa E, Uccelli A et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol. 2011;66(2):108-14.
  • 9. Hendriks DJ, Mol BWJ, Bancsi LFJMM, Velde ERT, Broekmans FJM. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. Fertil Steril. 2005;83(2):291-301.
  • 10. Maheshwari A, Fowler P, Bhattacharya S. Assessment of ovarian reserve--should we perform tests of ovarian reserve routinely? Hum Reprod. 2006;21(11):2729-35.
  • 11. Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2015;103(3):e9-e17.
  • 12. Visser JA, De Jong FH, Laven JSE, Themmen APN. Anti-Mullerian hormone: a new marker for ovarian function. Reproduction. 2006;131(1):1-9.
  • 13. Broer SL, Broekmans FJM, Laven JSE, Fauser BCJM. Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications. Hum Reprod Update. 2014;20(5):688-701.
  • 14. Knauff EAH, Eijkemans MJC, Lambalk CB, Kate-Booij MJ, Hoek A, Catharina C et al. Anti-Mullerian hormone, inhibin B, and antral follicle count in young women with ovarian failure. J Clin Endocrinol Metab. 2009;94(3):786-92.
  • 15. Broekmans FJ, Visser JA, Laven JSE, Broer SL, Themmen APN, Fauser BC et al. Anti-Mullerian hormone and ovarian dysfunction. Trends Endocrinol Metab. 2008;19(9):340-7.
  • 16. Seifer DB, MacLaughlin DT, Christian BP, Feng B, SheldenSeifer RM. Early follicular serum mullerian-inhibiting substance levels are associated with ovarian response during assisted reproductive technology cycles. Fertil Steril. 2002;77(3):468-71.
  • 17. Hansen KR, Hodnett GM, Knowlton N, Craig LB. Correlation of ovarian reserve tests with histologically determined primordial follicle number. Fertil Steril. 2011;95(1):170-5.
  • 18. Van Houten E, Themmen APN, Visser JA. Anti-Mullerian hormone (AMH): regulator and marker of ovarian function. Ann Endocrinol (Paris). 2010;71(3):191-7.
  • 19. Kucukler FK, Gorkem U, Simsek Y, Kocabas R, Guler S. Evaluation of ovarian reserve in women with overt or subclinical hypothyroidism. Arch Med Sci. 2018;14(3):521-6.
  • 20. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod. 2015;30(7):1690-6.
  • 21. Bahri S, Tehrani FR, Amouzgar A, Rahmati M, Tohidi M, Vasheghani M et al. Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up. BMC Endocr Disord. 2019;19(1):p47.
  • 22. Chen CW, Huang YL, Tzeng CR, Huang RL, Chen CH. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies. Thyroid. 2017;27(9):1194-200.
  • 23. Pirgon O, Sivrice C, Demirtas H, Dundar B. Assessment of ovarian reserve in euthyroid adolescents with Hashimoto thyroiditis. Gynecol Endocrinol. 2016;32(4):306-10.
  • 24. Erol O, Parlak M, Ellidağ HY, Parlak AE, Derbent AU, Erol EE et al. Serum anti-Mullerian hormone levels in euthyroid adolescent girls with Hashimoto's thyroiditis: relationship to antioxidant status. Eur J Obstet Gynecol Reprod Biol. 2016;203:204-9.
  • 25. Tuten A, Hatipoglu E, Oncul M, Imamoglu M, Acikgoz AS, Yilmaz N et al. Evaluation of ovarian reserve in Hashimoto's thyroiditis. Gynecol Endocrinol. 2014;30(10):708-11.
  • 26. Kuroda K, Uchida T, Nagai S, Ozaki R, Yamaguchi T, Sato Y et al. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Mullerian hormone in infertile women of reproductive age. J Assist Reprod Genet. 2015;32(2):243-7.
  • 27. Weghofer A, Barad DH, Darmon S, Kushnir VA, GleicherWeghofer N et al. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reprod Biol Endocrinol. 2016;14(1):26.
  • 28. Busnelli A, Somigliana E, Benaglia L, Sarais V, Ragni G, Fedele L. Thyroid axis dysregulation during in vitro fertilization in hypothyroid-treated patients. Thyroid. 2014;24(11):1650-5.
  • 29. Ferraretti AP, La Marca A, Fauser BCJM, Tarlatzis B, Nargund G, Gianaroli L et al. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26(7):1616-24.
  • 30. Gupta M, Yadav R, Mahey R, Agrawal A, Upadhyay A, Malhotra N, Bhatla N. Correlation of body mass index (BMI), anti-mullerian hormone (AMH), and insulin resistance among different polycystic ovary syndrome (PCOS) phenotypes - a cross-sectional study. Gynecological Endocrinology. 2019;35(11):970-3.

THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD

Year 2020, Volume: 22 Issue: 3, 370 - 376, 31.12.2020
https://doi.org/10.24938/kutfd.809017

Abstract

Objective: One of the most common endocrinological disorders in women of reproductive age is thyroid diseases. It is known that serum Anti-Mullerian hormone level is a good indicator in determining the ovarian reserve. In this study, we investigated the effect of serum thyroid-stimulating hormone level on Anti-Mullerian hormone.
Material and Methods: The data of 198 patients aged between 20-45 years, who were consulted to the endocrinology clinic for fertility evaluation, were recorded and analyzed retrospectively. All patients were divided into 3 categories according to their thyroid-stimulating hormone level results; 1) ≤2.5 mIU/L, 2) 2.51-4.99 mIU/L, 3) ≥5 mIU/L. Serum Anti-Mullerian hormone, laboratory results and demographic characteristics were compared between all of the groups. In addition, the correlation between Anti-Mullerian hormone and thyroid-stimulating hormone was analyzed.
Results: The mean age of the patients was 29.4 (±6.4). Variables such as age (p=0.384), BMI (p=0.407), FSH (p=0.178), LH (p=0.407), estradiol (p=0.424), and Anti-Mullerian hormone (p=0.814) were not different between the groups. There was no correlation between Anti-Mullerian hormone level and serum thyroid-stimulating hormone level or body mass index results. While a statistically significant positive correlation was found between Anti-Mullerian hormone and luteinizing hormone (r=0.258, p=0.001), a negative correlation was found between Anti-Mullerian hormone and follicle stimulating hormone (r=-0.207, p=0.007) and estradiol (r=-0.198, p=0.010).
Conclusion: In conclusion, while mild thyroid-stimulating hormone changes do not appear to be effective on Anti-Mullerian hormone used in the assessment of ovarian reserve, more comprehensive studies are needed to show that ovarian reserve changes positively with thyroid hormone replacement therapy.

References

  • 1. Krassas GE, Pontikides N, Kaltsas T, Papadopoulou P, Paunkovic J, Paunkovic N et al. Disturbances of menstruation in hypothyroidism. Clin Endocrinol (Oxf). 1999;50(5):655-9.
  • 2. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004;18(2):153-65.
  • 3. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55.
  • 4. Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995;43(1):55-68.
  • 5. Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips, Mahaffey KR et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid. 2007;17(12):1211-23.
  • 6. Yoshioka W, Amino N, Ide A, Kang S, Kudo T, Nishihara E et al. Thyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility. Endocr J. 2015;62(1):87-92.
  • 7. Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012;2(1):17-9.
  • 8. Monteleone P, Parrini D, Faviana P, Carletti E, Casarosa E, Uccelli A et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol. 2011;66(2):108-14.
  • 9. Hendriks DJ, Mol BWJ, Bancsi LFJMM, Velde ERT, Broekmans FJM. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. Fertil Steril. 2005;83(2):291-301.
  • 10. Maheshwari A, Fowler P, Bhattacharya S. Assessment of ovarian reserve--should we perform tests of ovarian reserve routinely? Hum Reprod. 2006;21(11):2729-35.
  • 11. Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2015;103(3):e9-e17.
  • 12. Visser JA, De Jong FH, Laven JSE, Themmen APN. Anti-Mullerian hormone: a new marker for ovarian function. Reproduction. 2006;131(1):1-9.
  • 13. Broer SL, Broekmans FJM, Laven JSE, Fauser BCJM. Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications. Hum Reprod Update. 2014;20(5):688-701.
  • 14. Knauff EAH, Eijkemans MJC, Lambalk CB, Kate-Booij MJ, Hoek A, Catharina C et al. Anti-Mullerian hormone, inhibin B, and antral follicle count in young women with ovarian failure. J Clin Endocrinol Metab. 2009;94(3):786-92.
  • 15. Broekmans FJ, Visser JA, Laven JSE, Broer SL, Themmen APN, Fauser BC et al. Anti-Mullerian hormone and ovarian dysfunction. Trends Endocrinol Metab. 2008;19(9):340-7.
  • 16. Seifer DB, MacLaughlin DT, Christian BP, Feng B, SheldenSeifer RM. Early follicular serum mullerian-inhibiting substance levels are associated with ovarian response during assisted reproductive technology cycles. Fertil Steril. 2002;77(3):468-71.
  • 17. Hansen KR, Hodnett GM, Knowlton N, Craig LB. Correlation of ovarian reserve tests with histologically determined primordial follicle number. Fertil Steril. 2011;95(1):170-5.
  • 18. Van Houten E, Themmen APN, Visser JA. Anti-Mullerian hormone (AMH): regulator and marker of ovarian function. Ann Endocrinol (Paris). 2010;71(3):191-7.
  • 19. Kucukler FK, Gorkem U, Simsek Y, Kocabas R, Guler S. Evaluation of ovarian reserve in women with overt or subclinical hypothyroidism. Arch Med Sci. 2018;14(3):521-6.
  • 20. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod. 2015;30(7):1690-6.
  • 21. Bahri S, Tehrani FR, Amouzgar A, Rahmati M, Tohidi M, Vasheghani M et al. Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up. BMC Endocr Disord. 2019;19(1):p47.
  • 22. Chen CW, Huang YL, Tzeng CR, Huang RL, Chen CH. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies. Thyroid. 2017;27(9):1194-200.
  • 23. Pirgon O, Sivrice C, Demirtas H, Dundar B. Assessment of ovarian reserve in euthyroid adolescents with Hashimoto thyroiditis. Gynecol Endocrinol. 2016;32(4):306-10.
  • 24. Erol O, Parlak M, Ellidağ HY, Parlak AE, Derbent AU, Erol EE et al. Serum anti-Mullerian hormone levels in euthyroid adolescent girls with Hashimoto's thyroiditis: relationship to antioxidant status. Eur J Obstet Gynecol Reprod Biol. 2016;203:204-9.
  • 25. Tuten A, Hatipoglu E, Oncul M, Imamoglu M, Acikgoz AS, Yilmaz N et al. Evaluation of ovarian reserve in Hashimoto's thyroiditis. Gynecol Endocrinol. 2014;30(10):708-11.
  • 26. Kuroda K, Uchida T, Nagai S, Ozaki R, Yamaguchi T, Sato Y et al. Elevated serum thyroid-stimulating hormone is associated with decreased anti-Mullerian hormone in infertile women of reproductive age. J Assist Reprod Genet. 2015;32(2):243-7.
  • 27. Weghofer A, Barad DH, Darmon S, Kushnir VA, GleicherWeghofer N et al. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reprod Biol Endocrinol. 2016;14(1):26.
  • 28. Busnelli A, Somigliana E, Benaglia L, Sarais V, Ragni G, Fedele L. Thyroid axis dysregulation during in vitro fertilization in hypothyroid-treated patients. Thyroid. 2014;24(11):1650-5.
  • 29. Ferraretti AP, La Marca A, Fauser BCJM, Tarlatzis B, Nargund G, Gianaroli L et al. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26(7):1616-24.
  • 30. Gupta M, Yadav R, Mahey R, Agrawal A, Upadhyay A, Malhotra N, Bhatla N. Correlation of body mass index (BMI), anti-mullerian hormone (AMH), and insulin resistance among different polycystic ovary syndrome (PCOS) phenotypes - a cross-sectional study. Gynecological Endocrinology. 2019;35(11):970-3.
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Taner Demirci 0000-0002-9579-4530

Mahmut Apaydın 0000-0002-7533-7084

Publication Date December 31, 2020
Submission Date October 11, 2020
Published in Issue Year 2020 Volume: 22 Issue: 3

Cite

APA Demirci, T., & Apaydın, M. (2020). THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 22(3), 370-376. https://doi.org/10.24938/kutfd.809017
AMA Demirci T, Apaydın M. THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD. Kırıkkale Uni Med J. December 2020;22(3):370-376. doi:10.24938/kutfd.809017
Chicago Demirci, Taner, and Mahmut Apaydın. “THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22, no. 3 (December 2020): 370-76. https://doi.org/10.24938/kutfd.809017.
EndNote Demirci T, Apaydın M (December 1, 2020) THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22 3 370–376.
IEEE T. Demirci and M. Apaydın, “THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD”, Kırıkkale Uni Med J, vol. 22, no. 3, pp. 370–376, 2020, doi: 10.24938/kutfd.809017.
ISNAD Demirci, Taner - Apaydın, Mahmut. “THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22/3 (December 2020), 370-376. https://doi.org/10.24938/kutfd.809017.
JAMA Demirci T, Apaydın M. THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD. Kırıkkale Uni Med J. 2020;22:370–376.
MLA Demirci, Taner and Mahmut Apaydın. “THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 22, no. 3, 2020, pp. 370-6, doi:10.24938/kutfd.809017.
Vancouver Demirci T, Apaydın M. THE EFFECT OF TSH LEVEL ON OVARIAN RESERVE IN WOMEN IN THE REPRODUCTIVE PERIOD. Kırıkkale Uni Med J. 2020;22(3):370-6.

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