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Title

Evaluation of Ovarian Reserve in Women with Thyroid Autoimmunity

Objective

To compare the ovarian reserve of women of reproductive age with and without thyroid autoimmunity (TAI).

Methods

We performed a retrospective analysis of medical records from an assisted reproduction clinic from February 2017 to December 2021. Women aged between 18 and 49 years with data on antithyroperoxidase and antithyroglobulin (anti-Tg) antibodies and assessment of ovarian reserve by anti-müllerian hormone (AMH) and antral follicle count (AFC) were included. Participants positive for anti-thyroperoxidase (anti-TPO) and/or anti-thyroglobulin (anti-Tg) antibodies, according to the reference range of the laboratory where the tests were performed, were considered to have TAI. Low ovarian reserve was defined based on the criteria adapted from POSEIDON (AMH < 1.2ng/mL and/or AFC < 5 follicles). AMH and AFC were compared between groups. Subanalysis based on age, types of antibodies, and thyroid function markers were performed. In addition, bivariate analysis and regression models were used.

Results

Among the 188 participants included, 63 were diagnosed with TAI, and 125 had both antibodies negative. The two groups were similar regarding the baseline characteristics. Overall, there were no differences in the median levels of AMH or AFC between the groups. However, in the subgroup analysis by age, we observed a trend towards lower median levels of AMH in women over 39 years with TAI (0.9 ng/mL vs. 1.5 ng/mL, p = 0.08). In a subanalysis according to antibodies, we found a significantly lower median AFC in the group with anti-Tg than in the group without this antibody (8.0 follicles vs. 11.5 follicles, p = 0.036). We also found a significantly higher prevalence of anti-Tg in patients with low ovarian reserve compared to those with normal reserve (60.7% vs. 39.3%, p = 0.038). A multivariate regression analysis indicated that age (p < 0.001) and the presence of other autoimmune diseases (p = 0.035) were the only variables independently associated with low ovarian reserve (Table 1)

Conclusion

Our study showed a trend towards lower AMH levels in women over 39 years of age with TAI compared to age-matched controls without TAI. In addition, we found lower AFC in women with anti-Tg, and that women with low ovarian reserve had a higher prevalence of this antibody. Thus, the ovarian reserve of women with TAI appears to be insidiously compromised over the years, with a decreased ovarian reserve in women with antithyroglobulin positive. To confirm our findings, longitudinal studies including women screened for the presence of both antibodies and with their ovarian reserve evaluated through more than one marker are needed.

Keywords

autoimmune thyroiditis, Hashimoto’s disease, ovarian reserve, premature ovarian failure, fertility preservation.

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