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J Clin Endocrinol Metab. 2018 Feb 1;103(2):632-639. doi: 10.1210/jc.2017-02120.

Higher TSH Levels Within the Normal Range Are Associated With Unexplained Infertility.

Author information

1
Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.
2
Harvard Medical School, Boston, Massachusetts.
3
Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts.

Abstract

Context:

Unexplained infertility (UI), defined as the inability to conceive after 12 months of unprotected intercourse with no diagnosed cause, affects 10% to 30% of infertile couples. An improved understanding of the mechanisms underlying UI could lead to less invasive and less costly treatment strategies. Abnormalities in thyroid function and hyperprolactinemia are well-known causes of infertility, but whether thyrotropin (TSH) and prolactin levels within the normal range are associated with UI is unknown.

Objective:

To compare TSH and prolactin levels in women with UI and women with a normal fertility evaluation except for an azoospermic or severely oligospermic male partner.

Design, Setting, and Participants:

Cross-sectional study including women evaluated at a large academic health system between 1 January 2000 and 31 December 2012 with normal TSH (levels within the normal range of the assay and ≤5 mIU/L) and normal prolactin levels (≤20 ng/mL) and either UI (n = 187) or no other cause of infertility other than an azoospermic or severely oligospermic partner (n = 52).

Main Outcome Measures:

TSH and prolactin.

Results:

Women with UI had significantly higher TSH levels than controls [UI: TSH 1.95 mIU/L, interquartile range: (1.54, 2.61); severe male factor: TSH 1.66 mIU/L, interquartile range: (1.25, 2.17); P = 0.003]. This finding remained significant after we controlled for age, body mass index, and smoking status. Nearly twice as many women with UI (26.9%) had a TSH ≥2.5 mIU/L compared with controls (13.5%; P < 0.05). Prolactin levels did not differ between the groups.

Conclusions:

Women with UI have higher TSH levels compared with a control population. More studies are necessary to determine whether treatment of high-normal TSH levels decreases time to conception in couples with UI.

PMID:
29272395
PMCID:
PMC5800836
[Available on 2019-02-01]
DOI:
10.1210/jc.2017-02120
[Indexed for MEDLINE]

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