The relationship between Thyroid Stimulating Hormone - Anti Mullerian Hormone in women infertility

Öz

Objective: Hypothyroidism may be a risk for infertility, the relationship between increased Thyroid Stimulating Hormone (TSH) and ovarian reserve is discussed. Anti-Mullarian Hormone (AMH) is a good predictor of ovarian reserve. We investigated the relationship between TSH and AMH levels in infertile women and the effect of TSH on fertility. Methods: Age, weight, height, additional diseases and treatment history of patients aged 19-40 years who were admitted to Mersin City Hospital Gynecology and Obstetrics Clinic between 01.01.2018 and 01.03.2019 were obtained from hospital records. Women data with similar demographic characteristics who were healthy, had at least one birth, applies to the same center for control on the same date were taken from records. Patients with polycystic ovary, hirsutism, primary amenorrhea, menopausal conditions, endometriosis, known thyroid disease and treatment, cancer, obese, cachectic were not included. Serum AMH and TSH levels were recorded. Results: The mean serum AMH and TSH levels of infertile (160) and fertile (34) women were compared. Mean AMH level in infertil women was 3.01±1.56 and 1.65±1.70ng/ml in fertilizers (p=0.00002). TSH levels in infertil women were higher (2.91±1.26μIU/mL) than fertilizers (1.76±0.72μIU/mL) and it was different at the statistical border (p=0.05). AMH-age (r=-0.34, p=0.01) and AMH-TSH levels were inversely correlated in infertil women (r=-0.20, p=0.0001). In fertilizers AMH levels were decreased with age (r=-0.40, p=0.01), but there was no correlation between AMH-TSH levels (r=-0.17,p=0,31). Conclusion: Our study suggests negative relation between AMH-TSH levels in infertile women and TSH elevation should not be overlooked in the etiology of infertility.

Anahtar Kelimeler

• Thyroid Stimulating hormone,Anti-Mullarian hormone,infertility

Kadın infertilitesinde Tiroid Stimülan Hormon - Anti Müllerian hormon ilişkisi

Öz

Amaç Hipotiroidizmin infertilitede risk faktörü olabileceği, artmış Tiroid Stimulan Hormon (TSH) düzeyinin over rezerviyle ilişkisi tartışılmaktadır. Anti Müllerian Hormon (AMH) over rezervini belirlemede iyi bir belirteçtir. İnfertil kadınlarda serum ortalama TSH ile AMH düzeyleri arasındaki ilişkiyi ve TSH'ın fertiliteye etkisini araştırdık. Yöntem: Mersin Şehir Hastanesi Kadın Hastalıkları Doğum polikliniğine 01.01.2018-1.03.2019 arasında başvuran, infertilite tanılı, 19-40 yaş kadınların yaş, kilo, boy, ek hastalık, tedavi öyküleri ve kontrol amacıyla başvuran sağlıklı, en az bir doğum yapmış, benzer demografik özelliklere sahip kadınların verileri hastane kayıtlarından alındı. Polikistik Over, hirsutism, amenore, menapozal durumlar, endometriozis, bilinen tiroid bezi hastalığı olanlar ve tedavi alanlar, kanser tanılılar, obezler, kaşektikler çalışmadan çıkarıldı. Başvuruda serum AMH ve TSH düzeyleri bakılmışların değerleri kaydedildi. Bulgular: İnfertil (160) ve fertil (34) kadına ait ortalama serum AMH ve TSH düzeyleri karşılaştırıldı. İnfertillerde AMH düzeyi 1.65±1.70 fertillerde 3.01±1.56 ng/ml olup, istatistiksel farklıydı (p=0.00002). İnfertillerdeki TSH düzeyi (2.20±1.26 μIU/mL) fertillerden (1.76±0.72 μIU/mL) yüksek olup istatistiksel sınırda farklıydı (p=0.05). İnfertillerde AMH-yaş (r=-0.34, p=0.01) ve AMH-TSH düzeyleri ters korele bulundu (r=-0.20, p=0,0001). Fertillerde serum AMH düzeyi yaş ile azalırken (r=-0.40, p=0.01), AMH-TSH düzeyleri arasında korelasyon izlenmedi (r=-0.17, p=0.31). Sonuç: Çalışmamız infertillerde AMH ve TSH düzeyleri arasındaki negatif ilişkiyi ve infertilite etiyolojisinde TSH yüksekliğinin gözden kaçırılmaması gerektiğini düşündürmektedir.

Anahtar Kelimeler

• Tiroid Stimülan Hormon,Anti Müllerian Hormon,infertilite

Kaynakça

1. Kaynaklar1. Poppe K and Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab. 2004;18:153–165.2. Krassas GE, Pontikides N, Kaltsas T, Papadopoulou P, Paunkovic J, Paunkovic N, Duntas LH. Disturbances of menstruation in hypothyroidism. Clin Endocrinol (Oxf). 1999;50:655–659.3. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31:702–755.4. Abalovich M1, Mitelberg L, Allami C, Gutierrez S, Alcaraz G, Otero P, Levalle O. Subclinical hypothyroidism and thyroid autoimmunity in women with infertility. Gynecol Endocrinol. 2007;23:279–283.5. Eldar-Geva T, Shoham M, Rosler A, Margalioth EJ, Livne K, Meirow D. Subclinical hypothyroidism in infertile women: the importance of continuous monitoring and the role of the thyrotropin-releasing hormone stimulation test. Gynecol Endocrinol. 2007;23:332–337.6. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:2543–2565.7. van den Boogaard E1, Vissenberg R, Land JA, van Wely M, van der Post JA, Goddijn M, Bisschop PH. Significance of (sub) clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2011;17:605–619. 8. Gerhard I, Becker T, Eggert-Kruse W, Klinga K, Runnebaum B. Thyroid and ovarian-function in infertile women. Hum Reprod. 1991;6:338–345.9. Gerhard I, Eggert-Kruse W, Merzoug K, Klinga K, Runnebaum B.. Thyrotropin-Releasing-Hormone (TRH) and Metoclopramide Testing in Infertile women. Gynecol Endocrinol. 1991;5:15–32.10. Michalakis KG, Mesen TB, Brayboy LM, Yu B, Richter KS, Levy M, Widra E, Segars JH. Subclinical elevations of thyroid stimulating hormone and assisted reproductive technology outcomes. Fertil Steril. 2011;95:2634–2637.11. Peñarrubia J1, Fábregues F, Manau D, Creus M, Casals G, Casamitjana R, Carmona F, Vanrell JA, Balasch J. Basal and stimulation day 5 anti-Mullerian hormone serum concentrations as predictors of ovarian response and pregnancy in assisted reproductive technology cycles stimulated with gonadotropin-releasing hormone agonist--gonadotropin treatment. Hum Reprod. 2005;20(4):915-922.12. Hutson J, Ikawa H, Donahoe PK. The ontogeny of Mullerian inhibiting substance in the gonads of the chicken. J Pediatr Surg 1981;16:822–827.13. Haççe Yeniçeri, İbrahim F. Ürünsak, Mete Sucu, Cihan Çetin, Mehmet Özsürmeli, Ghanim Khatib. The role of anti-mullerian hormone for determining the ovarian reserve of IVF patients - Cukurova Medical journal 2017;42:19-26.14. de Vet A1, Laven JS, de Jong FH, Themmen AP, Fauser BC. Antimüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril 2002;77(2):357–362.15. Teixeria J, Maheswaran S, Donahoe PK. Müllerian inhibiting substance: an instructive developmental hormone with diagnostic and possible therapeutic applications. Endocrinol Rev. 2001;22:657-674.16. Meczekalski B, Czyzyk A, Kunicki M, Podfigurna-Stopa A, Plociennik L, Jakiel G, Maciejewska-Jeske M, Lukaszuk K Fertility in women of late reproductive age:the role of serum antimüllerian hormone (AMH) levels in its assessment. J Endocrinol Invest. 2016; 39(11):1259-1265.17. Weenen C, Laven JS, Von Bergh AR, Cranfield M, Groome NP, Visser JA, Kramer P, Fauser BC, Themmen AP. Anti-mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod. 2004; 10:77–83.18. van Rooij IA1, Broekmans FJ, te Velde ER, Fauser BC, Bancsi LF, de Jong FH, Themmen AP. Serum anti-Müllerian hormone levels: a novel measure of ovarian reserve. Hum Reprod. 2002; 17(12):3065–3071.19. Oktem O and Oktay K. The Ovary: Anatomy And Function Throughout Human Life Ann N Y Acad Sci 2008;1127:1-9.20. A Weghofer, DH Barad, S Darmon, Kushnir VA, Gleicher N. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reprod Biol Endocrinol. 2016 10;14(1):26.21. Kuroda K, Uchida T, Nagai S, Ozaki R, Yamaguchi T, Sato Y, Brosens JJ, Takeda S. 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):243-247.22. 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;24:1650–1655.23. 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: 1690–1696.24. Jones DD, May KE, Geraci SA. Subclinical thyroid disease. Am J Med. 2010;123:502–504