ABSTRACT
OBJECTIVE: This study examined whether blastocysts transferred on day 5 or day 6 of embryo development, as well as positivity for anti-thyroid peroxidase antibodies, affect gestational outcomes in euthyroid women undergoing in vitro fertilisation. METHODS: Of 428 women who underwent in vitro fertilisation assessed in this retrospective cohort study, 212 (49.5%) underwent embryo transfer on day 5 of blastulation and 216 (50.5%) on day 6. Dichotomization based on anti-thyroid peroxidase antibodies status was also performed, with 370 (86.4%) women testing negative and 58 (13.6%) testing positive. Clinical and hormonal data and rates of clinical pregnancy, miscarriage, and live births were compared between the groups. RESULTS: When evaluating gestational outcomes based on the day of blastulation, a statistically significant difference was observed in clinical pregnancy rates [51.4% (day 5) vs. 40.7% (day 6); p=0.033]. However, there was no significant difference in the relative frequencies of miscarriages (p=1.000), live births (p=1.000), or preterm births (p=1.000). Using Cramer's V test, a weak association was found between the day of blastulation and clinical pregnancy outcomes (V2=10.7%; p=0.027). There were no statistically significant differences between the anti-thyroid peroxidase antibodies-negative and -positive groups in terms of clinical pregnancy rates (p=0.396), miscarriages (p=0.129), and live births (p=0.129). CONCLUSIONS: Higher rates of clinical pregnancy were observed in women who underwent embryo transfers performed on day 5 compared to those on day 6. However, no effect was observed with gestational outcomes. Further, anti-thyroid peroxidase antibody positivity did not have a statistically significant impact on gestational outcomes.
ABSTRACT
Background: The influence of thyroid-stimulating hormone (TSH) on gestational outcomes have been studied and checked whether differing TSH levels are relevant on human reproduction outcomes. International guidelines recommend TSH values <2.5 mIU/L in women trying to conceive, since values above this level are related to a higher frequency of adverse reproductive outcomes. This study aimed to evaluate whether TSH values correlate with different gestational outcomes in euthyroid infertile women without autoimmune thyroid disease. Methods: A retrospective cohort study was conducted involving 256 women who underwent in vitro fertilization (IVF) treatment. The participants were divided into two groups: TSH 0.5-2.49 mIU/L (n=211) and TSH 2.5-4.5 mIU/L (n=45). The clinical data, hormonal profiles and reproductive outcomes were compared between groups. Additionally, a systematic review with meta-analysis following the PRISMA protocol was carried out in PubMed/MEDLINE, EMBASE, and SciELO, with no time or language restrictions, for articles comparing TSH groups named "low TSH" (<2,5 mIU/L) and "high TSH" (≥2.5 mIU/L). A meta-analysis of proportions was performed with pooled estimates expressed as relative risk (RR) of events and a random effects model. Results: Age, BMI, free thyroxine levels (FT4) hormonal profile and IVF outcomes were not different between groups, neither gestational outcomes (p=0.982). Also, no difference was observed when the TSH and FT4 levels were compared between patients with positive or negative gestational outcomes (p=0.27 and p=0.376). Regarding the systematic review with meta-analysis, 17 studies from 2006 to 2022 were included, and added by this original retrospective research comprising 13.247 women undergoing IVF. When comparing the proportions of clinical pregnancy between the TSH groups, no significant difference was found (RR 0.93, 95% CI 0.80-1.08), with high between studies heterogeneity (I²: 87%; τ2: 0.0544; p<0.01). The number of deliveries was not significantly different between groups, despite a trend towards higher frequency in the high-TSH group (RR 0.96, 95% CI 0.90-1.02). Conclusion: Variation in TSH levels within the normal range was not associated with pregnancy and delivery rates in women, without autoimmune thyroid disease, who underwent IVF treatment. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD 42022306967.
Subject(s)
Infertility, Female , Thyroid Diseases , Pregnancy , Humans , Female , Infertility, Female/complications , Thyroxine/therapeutic use , Retrospective Studies , Data Analysis , Thyrotropin , Pregnancy Outcome , Thyroid Diseases/complicationsABSTRACT
Problema: Ao utilizar as práticas integrativas e complementares (PICs), em seu processo de trabalho, o profissional de saúde tem outras ferramentas que podem ajudar a responder e explicar de forma rápida e menos iatrogênica os sintomas não explicáveis para a biomedicina. Entretanto, o ensino destas práticas nos Programas de Residência Médica em Medicina de Família e Comunidade tem sido difusa e escassa. Métodos: Trata-se de um relato de experiência de uma equipe de Saúde da Família, na periferia de uma capital do Nordeste/Brasil, que utilizou a auriculoterapia nos usuários acompanhados entre os meses de agosto a dezembro de 2016. Resultados: A oferta da auriculote-rapia traz vários aprendizados e desafios. O processo iniciado com apoio da RMFC evidenciou, o que já se observava em outros espaços, grande aceitação da população, fruto também, da demanda reprimida por outras formas de cuidado. Percebeu-se grande acolhimento de profissionais e usuários que, superando preconceitos, viram a oportunidade de ampliar sua caixa de ferramentas no cuidado ao usuário e a si mesmo. Como limites para a oferta da auriculoterapia na USF, destacamos: falta de espaços adequados, materiais insuficientes para as sessões, baixo investimento da gestão local em educação permanente para trabalhadores em PICs. Conclusão: Acredita-se que as PICs vêm contribuindo para a qualificação e ampliação do cuidado no PRMFC, sobretudo, nos serviços de Atenção Básica.
Problem: When using integrative and complementary practices (PICs), in their work process, the health professional has other tools that can help to respond and explain quickly and less iatrogenically the unexplained symptoms for biomedicine. However, the teaching of these practices in the Medical Residency Program in Family and Community Medicine has been diffuse and scarce. Methods: This is an experience report by a Family Health team, on the periphery of a capital city in the Northeast/Brazil, who used auriculotherapy in users followed between the months of August and December 2016. Results: Auriculotherapy offers several lessons and challenges. The process started with RMFC support showed, which was already observed in other places, great acceptance by the population, also a result of the repressed demand of other forms of care. A great reception was perceived by professionals and users who, overcoming prejudices, saw the opportunity to expand their toolbox in the care of the user, and themselves. As limits for the offer of auriculotherapy at USF, we highlight: lack of appropriate spaces, insufficient materials for the sessions, low investment by local management in permanent education for workers in PICs. Conclusion: It is believed that PICs have contributed to the qualification and expansion of care in the PRMFC, especially in primary care services.
Problema: Al usar las Prácticas Integrativas y Complementarias (PIC), en su proceso de trabajo, el profesional de la salud tiene otras herramientas que pueden ayudar a responder y explicar de manera rápida y menos iatrogénica los síntomas inexplicables por la biomedicina. Sin embargo, la enseñanza de estas prácticas en el Programa de Residencia Médica en Medicina Familiar y Comunitaria ha sido difusa y escasa. Método: Este es un informe de experiencia de un equipo de Salud Familiar, en la periferia de una capital en el noreste/Brasil, que usó auriculoterapia en usuarios monitoreados entre los meses de agosto y diciembre de 2016. Resultados: La oferta de auriculoterapia varias lecciones y desafíos. El proceso comenzó con el apoyo del RMFC, demostró, lo que ya se había observado en otros lugares, una gran aceptación por parte de la población, también como resultado de la demanda reprimida de otras formas de cuidado. Hubo gran acogida por parte de los profesionales y los usuários que, superando los prejuicios, vieron la oportunidad de ampliar su toolbox en el cuidado del usuario y de ellos mismos. Como límites para la oferta de auriculoterapia en USF, destacamos: falta de espacios apropiados, materiales insuficientes para las sesiones, baja inversión por parte de la administración local en educación permanente para trabajadores en PICs. Conclusión: Se cree que las PIC han contribuido a la calificación y expansión de la atención en el PRMFC, especialmente en los servicios de atención primaria.
