Impact of autoimmune thyroiditis on IVF outcomes in patients with polycystic ovary syndrome and chronic endometritis.

QUESTION: To investigate the impact of autoimmune thyroiditis (AIT) on IVF/ICSI outcomes in patients with polycystic ovary syndrome (PCOS) and chronic endometritis (CE).

DESIGN

This retrospective cohort study analyzed 444 oocyte retrieval cycles from patients with PCOS and CE who underwent IVF/ICSI treatment at Peking University Third Hospital between January 2018 and December 2020. Eligible patients were infertile women who had undergone hysteroscopic surgery with endometrial pathology available. CE was defined as CD138 positivity on endometrial biopsy, and AIT was defined as positivity for TPOAb or TGAb. Of 444 cycles, 96 were AIT-positive and 348 were AIT-negative. Baseline characteristics, controlled ovarian stimulation (COS) parameters, embryological outcomes, fresh-cycle pregnancy outcomes, and cumulative live birth rate (CLBR) were compared between groups. Multivariable logistic regression was performed to identify independent predictors of CLBR.

RESULTS

The prevalence of AIT was not significantly different between patients with and without endometritis (20.63% vs. 19.17%, P = 0.265). Among patients with PCOS and CE, baseline characteristics were comparable between the AIT and non-AIT groups, except for a slightly longer infertility duration in the AIT group. The fresh-cycle live birth rate was lower in the AIT group than in the non-AIT group (5.71% [2/35] vs. 23.66% [31/131], P = 0.021). However, CLBR did not differ significantly between groups (34.38% [33/96] vs. 41.38% [144/348], P = 0.222). In multivariate analysis, the number of high-quality embryos was independently associated with CLBR (OR = 1.138, 95% CI 1.053-1.231, P = 0.001).

CONCLUSION

AIT was not associated with the prevalence of CE or with CLBR in patients with PCOS and CE. A lower fresh-cycle live birth rate was observed in the AIT group, but this finding should be confirmed in larger studies. Increasing the number of high-quality embryos may improve CLBR in patients with PCOS and CE.