{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:27:11Z","timestamp":1789414031024,"version":"build-2803163510"},"reference-count":29,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gynecol Obstet Invest"],"published-print":{"date-parts":[[2021]]},"abstract":"<b><i>Objectives:<\/i><\/b> The aim of this study was to analyze the fertility outcome in intracytoplasmic sperm injection (ICSI)-treated women across normal range thyroid-stimulating hormone (TSH) levels. Published results are inconclusive about optimal TSH levels and fertility. <b><i>Design:<\/i><\/b> This is a retrospective cohort study in 752 ICSI-treated women with predominantly severe male factor subfertility, starting treatment between the first of January 2008 and the first of March 2012 with a follow-up until 2014. <b><i>Participants\/Materials, Setting, Methods:<\/i><\/b> Women aged 22\u201345 years with TSH 0.3\u20134.5 mIU\/L without thyroid hormone substitution were included in Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands, an iodine-sufficient area. Demographic and baseline characteristics were compared between groups of patients based on TSH, using one-way ANOVA, Kruskal-Wallis ANOVA, and \u03c7<sup>2<\/sup> test. The patient was the unit of analysis: all cumulative cycles per patient were analyzed up to and including the first ongoing pregnancy. The primary outcome was a cumulative live birth rate. Clinical pregnancy rate, pregnancy loss, and ongoing pregnancy rate were secondary outcomes. The \u03c7<sup>2<\/sup> test and logistic regression were used to compare interquartile groups while adjusting for confounders. Logistic regression was used with the natural logarithm of TSH as a continuous predictor. Primary and secondary subfertile women were analyzed separately. <b><i>Results:<\/i><\/b> Analysis of the total cohort (<i>n<\/i> = 752) showed no difference in fertility outcomes across the normal TSH range. The cumulative live birth rate for the 4 groups of primary subfertile women (<i>n<\/i> = 455) was 76% in the upper TSH quartile compared to 56%, 60%, and 59% in the lower TSH quartiles. <b><i>Limitations:<\/i><\/b> Levels of thyroxine and presence of thyroid autoimmunity were not measured in this retrospective cohort study. <b><i>Conclusions:<\/i><\/b> The observation that a higher live birth rate was found in primary subfertile ICSI-treated women with high but allegedly normal TSH levels contributes to the hypothesis that in certain subfertile women in addition to a male factor, female factors such as subtle hypothyroidism and\/or thyroid autoimmunity may play a role in keeping them from conception, which can be overcome by the process of ICSI. <\/jats:p>","DOI":"10.1159\/000518083","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T21:00:54Z","timestamp":1630011654000},"page":"398-407","source":"Crossref","is-referenced-by-count":5,"title":["More 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