Üreme Döneminde Kadınlarda TSH Düzeyinin Yumurta Rezervine Etkisi

Öz

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.

Anahtar Kelimeler

• Anti-Mullerian Hormon
• TSH
• yumurtalık rezervi

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

Öz

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.

Anahtar Kelimeler

• Anti-Mullerian Hormone
• TSH
• ovarian reserve

Kaynakça

1. 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. 2. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004;18(2):153-65.
3. 3. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55.
4. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.