THYROID DYSFUNCTION IN WOMEN OF REPRODUCTIVE AGE: LABORATORY PROTOCOL FOR INFERTILITY EVALUATION

A.A Akande1, I.A. Isah2, I.S. Aliyu3, A.G Adesiyun4

  1. Department of Chemical Pathology and Immunology, College of Health Sciences, University of Ilorin, Nigeria.
  2. Department of Chemical Pathology and Immunology, College of Medicine, Kaduna State University, Nigeria.
  3. Department of Chemical Pathology, Ahmadu Bello University, Zaria, Nigeria
  4. Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria

Abstract

Background: Infertility in developing counties worldwide is associated with many social, financial, and medical challenges. With a prevalenceé rate of between 10 – 14 % and biochemical etiology of about 80% of the cases among Nigerian women, laboratory diagnosis has gradually assumed an important role in improved diagnosis.

Objective: The aim was to evaluate the prevalence of thyroid dysfunction in infertility and need to evaluate.

Method: This was a descriptive cross-sectional case study of one hundred and twenty-five (125) women selected by stratified random sampling method into two groups of primary and secondary infertility. A total of 125 healthy fertile women served as the control group. Serum freeT3 (fT3), feeT4 (fT4), and TSH were analyzed using commercial ELISA kits. Data were analyzed using SPSS version 20.0 and the p-value of <0.05 was considered statistically significant.

Result: Twenty participants (16%) were observed to have associated thyroid dysfunction with infertility. The commonest thyroid dysfunction was over hypothyroidism (9.6%) and subclinical hypothyroidism (4.0%) respectively and this was found to be commoner in secondary infertility (21.8%).

Conclusion: Thyroid function evaluation (especially serum TSH) should be included as a routine assessment in infertility protocol, especially in secondary infertility

Keywords: Thyroid dysfunction, Reproductive age, Laboratory evaluation, Infertility

Correspondence:

Prof A.A Akande
Department of Chemical Pathology
and Immunology,
College of Health Sciences,
University of Ilorin,
Nigeria
E-mail: yinkaakande@yahoo.com,
aabdullrasaq@unilorin.edu.ng

Date of Acceptance: 30th Dec., 2022

Introduction

Infertility affects 10-15% of couples at reproductive age1 and it is of the common conditions associated with a lot of psychosocial, medical, and financial challenges with attendant consequences such as stigma, deprivation, neglect, violence, marital problems, and mental health issues.2,3

The most common causes of a couple’s inability to conceive are associated with partner factors in males (30%), females (30%), and both (20%), and maybe unknown in other cases.4The causes of infertility in the female are however related to both the physical and biochemical challenges relating to the function of gonads and these biochemical challenges are caused by hormonal absence, insensitivity, and inaction in the pituitary-gonad axis with resultant failure of ovulation accounting for as many as half (16%) of the causes in female infertility.5

The ovaries are in continuous interaction with the sex hormones and the interplay may account for infertility in several ways. Hypergonadotropic hypogonadism is the most common biochemical pattern in both primary and secondary infertility, while hypogonadotropic hypogonadism is more associated with secondary infertility but hyperprolactinemia is less common in both types of infertility.6

However, the other pituitary hormones such as the thyroid and prolactin hormones can interact with the ovaries in women of reproductive age resulting in a direct effect on ovarian function, autoimmunity mechanism as well as alterations of the sex hormone binding protein levels.7Although menstrual irregularities are common in hyperthyroidism, subclinical hypothyroidism is associated with anovulation, amenorrhea, and adverse pregnancy outcome in some cases.8,9

Laboratory biochemical assessment of both pituitary and sex hormones potentially contribute to the diagnosis of infertility in over 50-75% of couples being investigated.6 Treatment of hypothyroidism in women is an important part of any effort to correct infertility and it is therefore imperative to put into consideration the serum TSH assessment when requesting an infertility test. It is recommended that only when this ruled out that other interventions to treat infertility is needed.10