K.A. Green

Gynecologic health and disease in relation to the microbiome of the female reproductive tract

It is well established that the vagina is colonized by bacteria that serve important roles in homeostasis. Imbalances in the proportion of bacteria may lead to a predisposition to infection or reproductive complications. Molecular-based approaches demonstrated a greater degree of microbial diversity both within and between women than previously recognized. The vaginal microbiome may fluctuate during various states of health, such as during the menstrual cycle or after menopause, and there may be differences in the vaginal microbiome between women of different ethnicities. Furthermore, the specific composition of the vaginal microbiome may influence the predisposition to dysbiosis and the transmission of sexually transmitted infections. An understanding of the diversity of the vaginal microbial environment during states of health is essential for the identification of risk factors for disease and the development of appropriate treatment.

A TSH Less Than 2.5 mIU/L in the Pre-Conception Period Does Not Improve Oocyte Quality in Donor IVF [14G]

INTRODUCTION: Hypothyroidism in pregnancy is associated with miscarriage, preterm delivery, low birth weight, and irreversible cognitive deficits. The American Thyroid Association recommends a pre-conception TSH less than 2.5 mIU/L be maintained to decrease these risks. It has yet to be determined if the benefit of this recommendation is limited to optimizing the gestational environment or if it extends to the oocyte. This analysis seeks to determine if a TSH less than 2.5 mIU/L impacts oocyte quality. METHODS: Euthyroid oocyte donors at a single center from 2002–2014 were included. Patients were divided into 2 groups: group A (TSH less than 2.5 mIU/L) or group B (TSH between 2.5 and 4.5 mIU/L). The number of oocytes retrieved, zygotes formed, and blastocysts formed was compared between groups. Analysis was performed using a students t test. RESULTS: 493 patients had a TSH less than 2.5 mIU/L, and 83 patients had a TSH between 2.5 and 4.5 mIU/L. The mean age of patients was not different between groups (26.7±3.7 vs 26.8±4.0 years, P=.7084). The difference in the number of oocytes retrieved (15.7±7.7 vs 16.3±7.6, P=.5092), zygotes formed (14.2±7.2 vs 14.0±6.8, P=.8249), or blastocysts formed was not statistically significant (5.4±4.1 vs 5.0±4.4, P=.4258). CONCLUSION: Hypothyroidism in pregnancy is associated with significant morbidity. While a TSH less than 2.5 mIU/L in the pre-conception period is recommended, this level does not appear to impact oocyte quality. Clinicians should maintain a TSH less than 2.5 mIU/L knowing its protective effect is likely due to optimization of the gestational environment.