Thyroid autoimmunity and assisted reproductive technologies: modern controversies

Background. Thyroid autoimmunity (TAI) affects approximately 13–19% of those experiencing infertility and is often associated with unexplained infertility, recurrent miscarriage, polycystic ovary syndrome, lower antral follicular count, reduced ovarian reserve and embryo quality. Objective of the review: to consolidate and interpret recent studies investigating the role of TAI in ART success. Materials and methods. Following several key principles of the PRISMA guidelines the following databases were searched for the last 5 years: MEDLINE (PubMed), Embase, Scopus, Lilacs, Web of Science, Clinical Trials, and SciELO. Analysis of literary data. While some evidence links TAI with impaired reproductive outcomes, such as reduced fertilization and implantation rates and increased miscarriage, other studies propose that intracytoplasmic sperm injection may alleviate these issues by avoiding immune interference during fertilization. TAI-positive women tend to develop hypothyroidism during ovarian stimulation with human chorionic gonadotropin trigger, which may further compromise pregnancy outcomes. Data supporting the same risk under alternative stimulation protocols are currently not well established. Lastly, transitional hyperthyroidism in cases of postpartum thyroiditis, presents an added challenge for women initiating ART soon after miscarriage. Conclusions. Early identification of TAI in women undergoing ART is crucial. Screening programs and personalized treatment strategies play a key role in improving fertility outcomes. Existing data highlights potential areas for further study. These involve the influence of postpartum thyroiditis on ART results, as well as the role of alternative ovulation triggers in TAI-positive patients in order to get better obstetric outcomes. In addition, upcoming research should concentrate on optimizing diagnostic models and developing personalized treatment plans.