EC Gynaecology

Infertility is a serious health concern affecting 15% of couples of reproductive ages worldwide and female infertility has been recognized as a global public health issue by WHO. Reports on the prevalence of infertility in women with chronic endocrine disorders are abundant but ‘subclinical’ aberrations in hormone levels affecting fertility are difficult to discern and hence often go undiagnosed, subclinical hypothyroidism (SCH) being the case in point. SCH acts as a silent perpetrator of infertility and by and large goes unnoticed owing to asymptomatic condition. Autoimmune thyroid disease (AITD) is one of the most common etiological factors responsible for hypothyroidism. A correlation between the prevalence of SCH and AITD in population, if any, will help in counseling of infertile females. This study was undertaken to estimate the prevalence of SCH in infertile females and to find out the prevalence and involvement of AITD amongst them so as to help in making decisions to decide course of treatment.

Keywords: TSH; Subclinical Hypothyroidism; Infertility; Prevalence; Autoimmune Thyroid Disease; Correlation

1. Koyyada A and Orsu P. “Role of hypothyroidism and associated pathways in pregnancy and infertility: Clinical insights”. Tzu Chi Medical Journal4 (2020): 312-317.
2. Dosiou C. “Thyroid and Fertility: Recent Advances”. Thyroid4 (2020): 479-486.
3. Surks MI., et al. “Subclinical thyroid disease: scientific review and guidelines for diagnosis and management”. The Journal of the American Medical Association2 (2004): 228-238.
4. Orouji Jokar T., et al. “Higher TSH Levels Within the Normal Range Are Associated with Unexplained Infertility”. The Journal of Clinical Endocrinology and Metabolism2 (2018): 632-639.
5. Feldthusen AD., et al. “Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity: The Danish General Suburban Population Study”. Journal of Pregnancy (2015): 132718.
6. Unnikrishnan AG and Menon UV. “Thyroid disorders in India: An epidemiological perspective”. Indian Journal of Endocrinology and Metabolism2 (2011): S78-S81.
7. Bashir H., et al. “Increased prevalence of subclinical hypothyroidism in females in mountainous valley of Kashmir”. Indian Journal of Endocrinology and Metabolism2 (2013): 276-280.
8. Hollowell JG., et al. “Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)”. The Journal of Clinical Endocrinology and Metabolism2 (2002): 489-499.
9. Poppe K., et al. “Assisted reproduction and thyroid autoimmunity: an unfortunate combination?” The Journal of Clinical Endocrinology and Metabolism 9 (2003): 4149-4152.
10. Unuane D and Velkeniers B. “Impact of thyroid disease on fertility and assisted conception”. Best Practice and Research Clinical Endocrinology and Metabolism4 (2020): 101378.
11. Sen A., et al. “Baseline and lifetime alcohol consumption and risk of differentiated thyroid carcinoma in the EPIC study”. British Journal of Cancer 113 (2015): 840-847.
12. Subclinical hypothyroidism in the infertile female population: a guideline. Practice Committee, American Society for Reproductive Medicine, 1209 Montgomery Hwy., Birmingham, Alabama (2015).
13. Alexander EK., et al. “2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum”. Thyroid3 (2017): 315-389.
14. Poppe K. “Management of Endocrine Disease: Thyroid and female infertility: more questions than answers?” European Journal of Endocrinology4 (2021): R123-R135.
15. JV Hennessey and R Espaillat. “Subclinical hypothyroidism: a historical view and shifting prevalence”. The International Journal of Clinical Practice7 (2015): 771-782.
16. Won Sang Yoo. “Hyun Kyung Chung Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape”. The Journal of Clinical Endocrinology and Metabolism 36 (2021): 500-513.
17. Park SY., et al. “Age- and gender-specific reference intervals of TSH and free T4 in an iodine-replete area: Data from Korean National Health and Nutrition Examination Survey IV (2013-2015)”. PLoS One 2 (2018): e0190738.
18. Wang Z., et al. “Quantitative Analysis of the Benefits and Risk of Thyroid Nodule Evaluation in Patients ≥70 Years Old”. Thyroid 4 (2018): 465-471.
19. Li P., et al. “Effect of mildly elevated thyroid-stimulating hormone during the first trimester on adverse pregnancy outcomes”. BMC Endocrine Disorders 18 (2018): 64.