Med Bull Sisli Etfal Hosp. 2021; 55(3): 419-425 | DOI: 10.14744/SEMB.2020.87259

The Effect of Prednisolone Treatment on Pregnancy Rates in in vitro Fertilization Patients with Positive Thyroid Autoantibodies

Sefik Gokce¹, Dilsad Herkiloglu¹, Savas Ozdemir², Seyfettin Ozvural³, Onur Karabacak^4
1Department of Obstetrics and Gynecology, Yeni Yuzyil University Private Gaziosmanpasa Hospital, Istanbul, Turkey
²Department of Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
³Department of Obstetrics and Gynecology, Private Hizmet Hospital, Istanbul, Turkey
⁴Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey

Objective: This study aims to investigate the effect of prednisolone treatment on the pregnancy rates of in vitro fertilization (IVF) patients with positive thyroid autoantibodies.
Methods: This study was conducted in the IVF unit of Gazi University Faculty of Medicine. It included 158 patients who underwent intracytoplasmic sperm injection using the long-term protocol of a gonadotropin-releasing hormone (GnRH) agonist that was positive for thyroid autoantibodies. Each test’s reference value was used as a positive measure of anti-thyroid peroxidase and anti-TG antibodies. On the day of oocyte intake, 44 of 158 patients were started on prednisolone, and the other 114 patients were followed up without medication.
Results: In the control group, pregnancy did not occur in 67.5% of the patients; it was determined that 21.1% were pregnant, 5.3% had biochemical pregnancies, 4.4% had twin pregnancies, 0.9% had triplet pregnancies, and 0.9% had ectopic pregnancies. In the extended prednisolone group, pregnancy did not occur in 56.8% of the patients; it was determined that 36.4% of them were pregnant, 4.5% had twin pregnancies, and 2.3% had biochemical pregnancies. An increase in pregnancy rate was observed in the extended prednisolone group, while a statistically significant difference was found between the groups in terms of the mean values of prednisolone according to pregnancy status (p<0.05). It was thus determined that the rate of conception increased in the extended prednisolone group compared to the controls.
Conclusion: There is a strong relationship between the presence of thyroid autoantibodies and poor IVF results. The coadministration of prednisolone can improve the clinical pregnancy rate in women affected by thyroid autoimmunity.

Keywords: Antithyroid autoantibodies, in vitro fertilization, prednisolone, pregnancy.

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Tiroid Otoantikoru Pozitif Olan Ýnvitro Fertilizasyon Hastalarýnda Prednizolon Tedavisinin Gebelik Hýzýna Etkisi

Sefik Gokce¹, Dilsad Herkiloglu¹, Savas Ozdemir², Seyfettin Ozvural³, Onur Karabacak^4
1Yeni Yüzil Üniversitesi Özel Gaziosmanpaþa Hastanesi, Kadýn Hastalýklarý ve Doðum Bölümü, Ýstanbul
²Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi Bölümü, Ýstanbul
³Özel Hizmet Hastanesi Kadýn Hastalýklarý ve Doðum Bölümü, Ýstanbul
⁴Gazi Üniversitesi Týp Fakültesi, Kadýn Hastalýklarý ve Doðum Anabilim Dalý, Ankara

Amaç: Bu çalýþmada tiroid otoantikoru pozitif olan invitro fertilizasyon hastalarýnda prednizolon tedavisinin gebelik hýzýna etkisinin incelenmesi amaçlanmýþtýr.
Gereç ve Yöntemler: Bu çalýþma, Gazi Üniversitesi Týp Fakültesi Kadýn Hastalýklarý ve Doðum Bölümü Tüp Bebek Ünitesi Bölümünden, Ekim 2010 ile Eylül 2011 arasýnda tiroid otoantikoru pozitif olan gonadotropin salgýlatýcý hormon (GnRH) agonisti uzun protokolü kullanýlarak gerçekleþtirilen intrasitoplazmik sperm enjeksiyonu (ICSI) yapýlmýþ 158 hastayý içeren retrospektif bir çalýþmadýr. Anti-TPO ve anti-TG antikorlarýnýn pozitiflik ölçütü olarak her tetkikin kendi referans deðeri kullanýldý. 158 hastanýn 44’üne oositin alýndýðý gün prednol baþlandý ve diðer 114 hasta ilaçsýz takip edildi.
Bulgular: Araþtýrmaya katýlan kontrol grubunun %67,5’inin gebe kalmadýðý, %21,1’inin gebe kaldýðý, %5,3’ünün biyokimyasal gebelik, %4,4’ünün ikiz gebelik, %0,9’unun üçüz gebelik, %0,9’unun ise ektopik gebelik yaþadýðý belirlenmiþtir. Prednol verilip uzatýlan grupta ise, %56,8’inde gebelik gerçekleþmediði, %36,4’ününde gebelik gerçekleþtiði, %4,5’inde ikiz gebelik gerçekleþtiði, %2,3’ünde biyokimyasal gebelik gerçekleþtiði belirlenmiþtir. Prednol verilerek uzatýlan grupta gebelik oranýnda artýþ olduðu gözlenmiþtir.
Çalýþma grubunun gebelik durumuna göre prednol ortalama deðerleri arasýnda istatistiksel anlamlý bir farklýlýk olduðu belirlenmiþtir (p<0,05). Kontrol grubuna göre prednol verilmesi uzatýlan grupta gebe kalma oranýnýn yükseldiði belirlenmiþtir.
Sonuç: Tiroid otoantikorlarýnýn varlýðý ile zayýf IVF sonucu arasýnda güçlü bir iliþki vardýr. Prednisolon birlikte tedavisi, tiroid otoimmünitesinden etkilenen kadýnlarda, klinik gebelik oranýný iyileþtirebilir. (SETB-2020-05-079)

Anahtar Kelimeler: Prednizolone, Gebelik, Antitroid otoantikorlarý, Ýnvitro fertilizasyon

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