BACKGROUND Thyroid autoimmunity (TAI) is the most frequent autoimmune condition and the first cause of thyroid dysfunction among women of reproductive age. Notably, it has been associated with adverse obstetric outcomes during all trimesters of pregnancy. Furthermore, since most studies show an increased prevalence of TAI among women attending infertility clinics, a detrimental impact of this condition on natural fertility and on the rate of success of assisted reproductive techniques has been suggested. However, to date, the results have been inconsistent. OBJECTIVE AND RATIONALE The objective of this study was to define the relation between TAI per se and the outcome of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles. SEARCH METHODS A systematic literature review and meta-analysis were conducted. A Medline search was performed to identify all the comparative studies published from January 1990 to November 2015 in the English language literature on IVF/ICSI outcome in women with and without TAI, using combinations of the medical subject heading terms 'thyroid autoimmunity', 'thyroid autoantibodies', 'IVF', 'ICSI', 'pregnancy', 'miscarriage' and 'delivery'. The primary outcome was live birth rate (LBR). Our secondary outcomes were number of oocytes retrieved (NOR), fertilisation rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and miscarriage rate (MR). We also extracted data on mean age and basal serum concentrations of thyroid stimulating hormone (TSH) and performed a meta-regression analysis to assess the effect of these two covariates on CPR and MR. OUTCOMES We selected 12 studies for the meta-analysis. Six of the included studies were prospective cohort studies, and six were retrospective cohort studies. Compared with women with negative TAI, women with positive TAI had a lower LBR (odds ratio (OR) 0.73; 95% confidence interval (CI) [0.54-0.99]; P = 0.04; 9 studies; 4396 women; I2 = 41%), a higher MR (OR 1.44; 95% CI [1.06-1.95]; P = 0.02; 12 studies; 4876 women; I2 = 35%), a similar CPR (OR 0.90; 95% CI [0.77-1.06]; P = 0.22; 12 studies; 4876 women; I2 = 7%), a similar number of oocytes (standardized mean difference [SMD] 0.10; 95% CI [-0.09 to 0.29]; P = 0.28; 5 studies; 1506 women; I2 = 47%), a similar FR (OR 1.11; 95% CI [0.97-1.27]; P = 0.13; 3 studies; 1082 women; I2 = 0%) and a similar IR (OR 0.98; 95% CI [0.73-1.32]; P = 0.91; 2 studies; 918 women; I2 = 0%). Both mean age (SMD 0.96; 95% CI [0.66-1.27]; P < 0.00001; 9 studies; 3256 women; I2 = 85%) and serum TSH (SMD 0.24; 95% CI [0.15-0.34]; P < 0.00001; 6 studies; 2098 women; I2 = 59%) were higher in women with TAI. However, neither of these two covariates were significantly associated with CPR or MR. WIDER IMPLICATIONS TAI does not impact on IVF/ICSI outcome in terms of NOR and likelihood of fertilisation, implantation and clinical pregnancy. On the contrary, the presence of thyroid autoantibodies may have a detrimental effect on the course of a pregnancy, determining an increased risk of miscarriage and a decreased chance of live birth. However, given the possible modifying effects of age and serum TSH, further evidence is warranted prior to drawing inferences on causality.

中文翻译：

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甲状腺自身免疫对IVF / ICSI结果的影响：系统评价和荟萃分析。

背景技术甲状腺自身免疫性疾病（TAI）是最常见的自身免疫性疾病，也是育龄妇女甲状腺功能障碍的首要原因。值得注意的是，它与妊娠的所有三个月期间的不良产科结局有关。此外，由于大多数研究表明，在不孕诊所就诊的女性中TAI的患病率增加，因此已经提出了这种状况对自然生育和辅助生殖技术成功率的不利影响。但是，迄今为止，结果一直不一致。目的和理由本研究的目的是确定TAI本身与体外受精（IVF）/胞浆内精子注射（ICSI）周期的结果之间的关系。搜索方法进行了系统的文献综述和荟萃分析。进行了Medline搜索，以找出1990年1月至2015年11月在英语文献中发表的有关有无TAI和无TAI的女性IVF / ICSI结局的所有比较研究，并使用医学主题词“甲状腺自身免疫”，“甲状腺”自身抗体”，“ IVF”，“ ICSI”，“怀孕”，“流产”和“分娩”。主要结果是活产率（LBR）。我们的次要结果是取回的卵母细胞数（NOR），受精率（FR），植入率（IR），临床妊娠率（CPR）和流产率（MR）。我们还提取了甲状腺刺激激素（TSH）的平均年龄和基础血清浓度的数据，并进行了荟萃回归分析，以评估这两个协变量对CPR和MR的影响。结果我们选择了12项研究进行荟萃分析。纳入的研究中有六项是前瞻性队列研究，六项是回顾性队列研究。与TAI阴性的女性相比，TAI阳性的女性的LBR较低（优势比（OR）为0.73； 95％的置信区间（CI）[0.54-0.99]； P = 0.04； 9个研究； 4396名女性； I2 = 41％） ），较高的MR（OR 1.44； 95％CI [1.06-1.95]； P = 0.02； 12个研究； 4876名女性； I2 = 35％），相似的CPR（OR 0.90； 95％CI [0.77-1.06]； P = 0.22； 12个研究； 4876名女性； I2 = 7％），卵母细胞数量相似（标准平均差异[SMD] 0.10； 95％CI [-0.09至0.29]； P = 0.28； 5个研究； 1506名女性； P = 0.28）。 I2 = 47％），相似的FR（OR 1.11; 95％CI [0.97-1.27]; P = 0.13; 3个研究; 1082位女性; I2 = 0％）和相似的IR（OR 0.98; 95％CI [0.73] -1.32]； P = 0.91； 2个研究； 918名女性； I2 = 0％）。均均年龄（SMD 0.96; 95％CI [0.66-1.27]; P <0.00001；9项研究；3256名女性；I2 = 85％）和血清TSH（SMD 0.24; 95％CI [0.15-0.34]; P <0.00001; 6个研究; 2098名女性; I2 = 59％）在TAI女性中较高。但是，这两个协变量均未与CPR或MR显着相关。更广泛的意义TAI不会影响NOR和受精，着床和临床妊娠的可能性，对IVF / ICSI结局没有影响。相反，甲状腺自身抗体的存在可能对妊娠过程产生不利影响，从而决定增加流产的风险和降低活产的机会。但是，考虑到年龄和血清TSH的可能改变作用，在推断因果关系之前需要进一步的证据。95％CI [0.15-0.34]; P <0.00001；6项研究；2098名女性；TAI患者中I2 = 59％）更高。但是，这两个协变量均未与CPR或MR显着相关。更广泛的意义TAI不会影响NOR和受精，着床和临床妊娠的可能性，对IVF / ICSI结局没有影响。相反，甲状腺自身抗体的存在可能对妊娠过程产生不利影响，从而决定增加流产的风险和降低活产的机会。但是，考虑到年龄和血清TSH的可能改变作用，在推断因果关系之前需要进一步的证据。95％CI [0.15-0.34]; P <0.00001；6项研究；2098名女性；TAI患者中I2 = 59％）更高。但是，这两个协变量均未与CPR或MR显着相关。更广泛的意义TAI不会影响NOR和受精，着床和临床妊娠的可能性，对IVF / ICSI结局没有影响。相反，甲状腺自身抗体的存在可能对妊娠过程产生不利影响，从而决定增加流产的风险和降低活产的机会。但是，考虑到年龄和血清TSH的可能改变作用，在推断因果关系之前需要进一步的证据。更广泛的意义TAI不会影响NOR和受精，着床和临床妊娠的可能性，对IVF / ICSI结局没有影响。相反，甲状腺自身抗体的存在可能对妊娠过程产生不利影响，从而决定增加流产的风险和降低活产的机会。但是，考虑到年龄和血清TSH的可能改变作用，在推断因果关系之前需要进一步的证据。更广泛的意义TAI不会影响NOR和受精，着床和临床妊娠的可能性，对IVF / ICSI结局没有影响。相反，甲状腺自身抗体的存在可能对妊娠过程产生不利影响，从而决定增加流产的风险和降低活产的机会。但是，考虑到年龄和血清TSH的可能改变作用，在推断因果关系之前需要进一步的证据。