Thyroxine replacement during super-ovulation for in vitro fertilization: a potential gap in management?
Open accessAbstract
Objective Our objective is to report observed changes in thyroid-stimulating hormone (TSH) in two patients undergoing super-ovulation for IVF.Design Case report.Setting Private assisted reproduction practices.Patient(s) Two hypothyroid women taking thyroxine replacement therapy undergoing super-ovulation for IVF.Intervention(s) Laboratory records for TSH taken during ovulation induction cycles were retrieved retrospectively for six cycles and measured prospectively for one cycle each in both women.Main outcome measure(s) To document changes in thyroid status during super-ovulation.Result(s) Despite being euthyroid at the start of the super-ovulation cycle, both patients demonstrated a rise in TSH to hypothyroid levels during ovulation induction, even in the absence of ongoing pregnancy.Conclusion(s) High circulating E(2) during super-ovulation for IVF induces increased thyroxine-binding globulin binding of thyroxine. In women taking thyroxine replacement therapy, hypothyroidism develops during a super-ovulation cycle. Whether such acute biochemical hypothyroidism is a hindrance to ovum quality, fertilization, conception, or ongoing pregnancy and whether thyroxine dose adjustment during a super-ovulation cycle would improve IVF outcomes requires further study. These case studies identify a potential management gap in assisted reproduction for women taking thyroxine therapy.
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Rapid estrogen increase during in vitro fertilization is associated with increased TBG and increased TSH in treated hypothyroid women.
“Rapid estrogen increase during in vitro fertilization is associated with increased TBG (209), and increased TSH values in treated hypothyroid women (210).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [210]
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- Authors
- Stuckey, B. G. A., Yeap, D., & Turner, S. R.
- Affiliations
- The University of Western Australia (AU)
- Corresponding author
- Stuckey, Bronwyn G.A.
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2010-05
- Volume
- 93
- Issue
- 7
- Pages
- 2414.e1-2414.e3
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2046807628
- Cited by
- 37
- References
- 17
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 3 · 2016: 5 · 2015: 1 · 2014: 4 · 2013: 4 · 2012: 2
- FWCI
- 2.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Keywords
- thyroxine replacement, superovulation, in vitro fertilization, thyroid-stimulating hormone, hypothyroidism, ovulation induction, estradiol, thyroxine-binding globulin, thyroid function monitoring
- MeSH terms
- Adult, Female, Fertilization in Vitro, Health Services Needs and Demand, Humans, Hypothyroidism, Infant, Newborn, Infertility, Female, Pregnancy, Pregnancy Complications, Retrospective Studies, Superovulation, Thyroxine, Treatment Outcome, Hormone Replacement Therapy
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