15 papers reviewed
Thyroid & Fertility
2024 · guideline · 1 of 15
Subclinical hypothyroidism in the infertile female population: a guideline (2024)
ASRM Practice Committee · Fertility and Sterility
ASRM guideline recommending TSH measurement in infertile women. Greatest benefit of levothyroxine seen when TSH >4.0 mIU/L. Pre-conception LT4 did not improve live births in TSH 2.5-4.0 mIU/L range.
Read the paper ↗2021 · systematic review / meta-analysis · 2 of 15
Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis
Rao M et al. · BMC Endocrine Disorders
LT4 treatment associated with decreased risk of pregnancy loss and neonatal death across 7 RCTs and 6 observational studies (7,342 individuals). Most benefit in TSH >4.0 mIU/L subgroup.
Read the paper ↗2018 · meta-analysis · 3 of 15
Effect of levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism and thyroid autoimmunity undergoing IVF/ICSI: an updated meta-analysis of randomized controlled trials
Rao M et al. · Reproductive Biology and Endocrinology
In 4 RCTs with 787 infertile couples undergoing IVF/ICSI, LT4 supplementation significantly decreased miscarriage rate. No significant effect on clinical pregnancy or live birth rates.
Read the paper ↗2019 · Cochrane review · 4 of 15
Thyroxine replacement for subfertile women with euthyroid autoimmune thyroid disease or subclinical hypothyroidism
Akhtar MA et al. · Cochrane Database of Systematic Reviews
Cochrane review examining LT4 for subfertile women with thyroid autoimmunity or subclinical hypothyroidism. Evidence insufficient to determine effects on live birth but suggests potential miscarriage reduction.
Read the paper ↗2024 · systematic review / meta-analysis · 5 of 15
Effects of Levothyroxine Treatment on Fertility and Pregnancy Outcomes in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Sankoda A et al. · Thyroid
Comprehensive meta-analysis of RCTs examining LT4 effects on fertility outcomes in subclinical hypothyroidism. Suggests benefits primarily for miscarriage reduction; mixed results for conception rates.
Read the paper ↗2018 · meta-analysis · 6 of 15
Meta-analysis of ART outcomes in women with different preconception TSH levels
Zhao T et al. · Reproductive Biology and Endocrinology
No ART outcome differences at TSH cut-off of 2.5 mIU/L, but significant miscarriage rate difference at 3.5-5 mIU/L cut-off. U-shaped association between TSH and adverse outcomes suggests narrow optimal range.
Read the paper ↗2023 · systematic review / meta-analysis · 7 of 15
Effect of autoimmune thyroid disease on pregnancy outcomes: a systematic review and meta-analysis
Various · Journal of Clinical Medicine
TPO antibody positivity associated with significantly elevated miscarriage risk (OR 3.90 in one analysis of 12,126 women). Thyroid autoimmunity negatively impacts multiple pregnancy outcomes.
Read the paper ↗2024 · meta-analysis · 8 of 15
Effect of anti-thyroid antibodies on recurrent miscarriage: a meta-analysis
Song Y et al. · Journal of Obstetrics and Gynecology Research
Analysis of 28 studies: significant association between anti-TPO/anti-TG antibodies and recurrent miscarriage (OR 2.02; 95% CI 1.63-2.51).
Read the paper ↗2020 · meta-analysis · 9 of 15
Effect of antithyroid antibodies on women with recurrent miscarriage: a meta-analysis
Xie J et al. · American Journal of Reproductive Immunology
TPO-Ab significantly associated with recurrent miscarriage (OR 1.85; 95% CI 1.38-2.49). Women with antithyroid antibodies had higher risk (OR 2.36; 95% CI 1.71-3.25).
Read the paper ↗2025 · systematic review / meta-analysis · 10 of 15
Levothyroxine in euthyroid pregnant women with thyroid peroxidase antibody: a systematic review and meta-analysis of randomized controlled trials
Various · BMC Pregnancy and Childbirth
LT4 reduced miscarriage in euthyroid TPOAb+ pregnant women (pooled OR 0.52, 95% CI 0.34-0.80). Supports treatment consideration in TPOAb-positive women.
Read the paper ↗2019 · RCT · 11 of 15
Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the SERENA study
Negro R et al. · Endocrine
Selenium supplementation significantly reduced thyroid autoantibodies after pregnancy and prevented antibody rebound. Pregnancy rate 60% in selenium group vs 16.6% placebo. Zero miscarriages in selenium vs 2 in placebo.
Read the paper ↗2022 · systematic review · 12 of 15
Selenium supplementation in pregnancy: maternal and newborn outcomes
Various · Nutrients
Selenium supplementation reduced incidence of thyroid dysfunction and permanent hypothyroidism postpartum by reducing TPO and Tg antibody titres across 4 studies.
Read the paper ↗2019 · RCT · 13 of 15
Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception (TABLET RCT)
Dhillon-Smith RK et al. · New England Journal of Medicine
In euthyroid TPOAb+ women with history of miscarriage/infertility, pre-conception LT4 did not result in higher live birth rates vs placebo. Important null finding for routine treatment.
Read the paper ↗2022 · RCT (phase 3) · 14 of 15
Levothyroxine in euthyroid thyroid peroxidase antibody positive women with recurrent pregnancy loss (T4LIFE trial)
Vissenberg R et al. · The Lancet Diabetes & Endocrinology
LT4 did not result in higher live birth rates in euthyroid TPOAb+ women with RPL. Does not support routine use of LT4 in euthyroid women with RPL and positive TPO antibodies.
Read the paper ↗2021 · cohort · 15 of 15
Positive impact of levothyroxine treatment on pregnancy outcome in euthyroid women with thyroid autoimmunity affected by recurrent miscarriage
Various · Journal of Clinical Medicine
LT4 treatment reduced miscarriages (12% vs 30%) and improved conception capacity (57% vs 29%) in euthyroid women with thyroid autoimmunity and recurrent miscarriage.
Read the paper ↗A paper's presence documents the evidence reviewed; it does not mean Filia endorses every intervention or conclusion.