Ovarian Reserve and Anti-Thyroid Peroxidase Antibodies in Euthyroid Infertile Women: A Cross-Sectional Study
Abstract
Objective: This study investigated the association between Anti-TPO levels and ovarian reserve markers, including anti-Müllerian hormone (AMH) and antral follicle count (AFC), in euthyroid infertile women.
Materials and methods: In this cross-sectional analytical study, 231 euthyroid infertile women were enrolled and classified as Anti-TPO positive (n = 92) or Anti-TPO negative (n = 139). Serum levels of AMH, FSH, LH, TSH, prolactin, and Anti-TPO were measured, and AFC was assessed by transvaginal ultrasonography. Because hormonal variables were not normally distributed, logarithmic transformation was applied prior to parametric analyses. Data were analyzed using independent t-tests, Pearson correlation, and multivariate regression (α = 0.05).
Results: No significant differences were observed between groups in log-transformed AMH, AFC, FSH,
or LH levels (p > 0.05). Age was negatively associated with log-AMH. Subgroup analyses demonstrated that in Anti-TPO–positive women, higher Anti-TPO levels were associated with lower log-AMH and higher
log-FSH. Multivariate regression identified age as the only independent predictor of log-AMH levels
(β = –0.337, p < 0.001).
Conclusion: Ovarian reserve decline appears primarily age-related; however, thyroid autoimmunity may have a potential modulatory role in ovarian function. Consideration of thyroid autoantibody status may be clinically relevant in infertility evaluation.
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3. Arce JC, La Marca A, Mirner Klein B, Nyboe Andersen A, Fleming R. Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients. Fertil Steril. 2013;99(6):1644-53.
4. Chen C-W, Huang Y-L, Tzeng C-R, Huang R-L, Chen C-H. Idiopathic low ovarian reserve is associated with more frequent positive thyroid peroxidase antibodies. Thyroid. 2017;27(9):1194-200.
5. Liu J, Qin Y, Liu H, Liu Y, Yang Y, Ning Y, et al. Global, regional, and national burden of female infertility and trends from 1990 to 2021 with projections to 2050 based on the GBD 2021 analysis. Sci Rep. 2025;15(1):17559.
6. Ding C, Shi Y, Li J, Li M, Hu L, Rao J, et al. Association of weight-adjusted-waist index with
all-cause and cardiovascular mortality in China: A prospective cohort study. Nutr Metab Cardiovasc Dis. 2022;32(5):1210-1217.
7. Saei Ghare Naz M, Ozgoli G, Sayehmiri K. Prevalence of Infertility In Iran: A Systematic Review And Meta-Analysis. Urol J. 2020;17(4):338-345.
8. Korevaar TIM, Mínguez-Alarcón L, Messerlian C, de Poortere RA, Williams PL, Broeren MA, Hauser R, Souter IC. Association of Thyroid Function and Autoimmunity with Ovarian Reserve in Women Seeking Infertility Care. Thyroid. 2018;28(10):1349-1358.
9. Sun Y, Fang Y, Xu M, Liu Y. Relationship between thyroid antibody levels and ovarian reserve function in infertile chinese women with normal thyroid-stimulating hormone. J Ovarian Res. 2023;16(1):100.
10. McLachlan SM, Rapoport B. The molecular biology of thyroid peroxidase: cloning, expression and role as autoantigen in autoimmune thyroid disease. Endocr Rev. 1992;13(2):192-206.
11. Freire BA, Paula ID, Paula F, Kallenberg CG, Limburg PC, Queluz TT. Absence of cross-reactivity to myeloperoxidase of anti-thyroid microsomal antibodies in patients with autoimmune thyroid diseases. Am J Med Sci. 2001;321(2):109-12.
12. Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab. 1990;71(3):661-9.
13. Huang Y, Xie B, Li J, Hang F, Hu Q, Jin Y, Qin R, Yu J, Luo J, Liao M, Qin A. Prevalence of thyroid autoantibody positivity in women with infertility: a systematic review and meta-analysis. BMC Womens Health. 2024;24(1):630.
14. Hasegawa Y, Kitahara Y, Osuka S, Tsukui Y, Kobayashi M, Iwase A. Effect of hypothyroidism and thyroid autoimmunity on the ovarian reserve: A systematic review and meta-analysis. Reprod Med Biol. 2021;21(1):e12427.
15. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum reprod. 2015;30(7):1690-6.
16. Gu C, Yue C, Li L, Li J, Wu C, He Y. Thyroid peroxidase antibodies do not impair the ovarian reserve in euthyroid women: a cross-sectional study. Endocr Connect. 2025;14(8):e250151.
17. Amani-Beni R, Darouei B, Ghadimi Nooran S, Karimi Shervedani A, Kakavand N, Amini-Salehi E, et al. Thyroid function tests and serum anti-Müllerian hormone in various populations, is there any association? A systematic review and meta-analysis. Arch Gynecol Obstet. 2025;311(6):1489-1509.
18. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55.
19. Notaro ALG, Lira Neto FT, Bedoschi GM, Silva MJD, Nunes MC, Monteiro CCP, et al. Evaluation of ovarian reserve in women with thyroid autoimmunity. JBRA Assist Reprod. 2024;28(3):442-449.
20. Bucci I, Giuliani C, Di Dalmazi G, Formoso G, Napolitano G. Thyroid Autoimmunity in Female Infertility and Assisted Reproductive Technology Outcome. Front Endocrinol (Lausanne). 2022;13:768363.
21. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod. 2015;30(7):1690-6.
22. Safarian GK, Niauri DA, Kogan IY, Bespalova ON, Dzhemlikhanova LK, Lesik EA, et al. Impact of antithyroperoxidase antibodies (Anti-TPO) on ovarian reserve and early embryo development in assisted reproductive technology cycles. Int J Mol Sci. 2023;24(5):47-55.
23. Bahri S, Tehrani FR, Amouzgar A, Rahmati M, Tohidi M, Vasheghani M, et al. Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up. BMC Endocr Disord. 2019;19(1):47.
24. Wei SX, Wang L, Liu YB, Fan QL, Fan Y, Qiao K. TPOAb positivity can impact ovarian reserve, embryo quality, and IVF/ICSI outcomes in euthyroid infertile women. Gynecol Endocrinol. 2023;39(1):2266504.
25. Qin Z, Qiu Y, Lin J, Yang Y, Hao L, He L. Analysis of the influencing factors for adverse reproductive outcomes in patients with positive TPOAb and the establishment of a nomogram prediction model. Scientific reports. 2025;15(1):19637.
26. Cai YY, Lin N, Zhong LP, Duan HJ, Dong YH, Wu Z, et al. Serum and follicular fluid thyroid hormone levels and assisted reproductive technology outcomes. Reprod Biol Endocrinol. 2019;17(1):90.
27. Dumont A, Robin G, Catteau-Jonard S, Dewailly D. Role of Anti-Müllerian Hormone in pathophysiology, diagnosis and treatment of Polycystic Ovary Syndrome: a review. Reprod Biol Endocrinol. 2015;13:137.
28. Weghofer A, Barad DH, Darmon S, Kushnir VA, Gleicher N. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reproductive biology and endocrinology: RB&E. 2016;14(1):26.
29. Almog B, Shehata F, Suissa S, Holzer H, Shalom-Paz E, La Marca A, et al. Age-related normograms of serum antimüllerian hormone levels in a population of infertile women: a multicenter study. Fertil steril. 2011;95(7):59-63.
30. Anjum S, Zahra F, Yousuf SM. Ovarian reserve parameters and response to controlled ovarian stimulation in infertile patients. Pak J Med Sci. 2019;35(4):958-65.
31. Thum MY, Kalu E, Abdalla H. Elevated basal FSH and embryo quality: lessons from extended culture embryos: raised FSH and blastocyst quality. J Assist Reprod Genet. 2009;26(6):313-8.
2. Iwase A, Osuka S, Goto M, Murase T, Nakamura T, Takikawa S, Kikkawa F. Clinical application of serum anti-Müllerian hormone as an ovarian reserve marker: A review of recent studies. J Obstet Gynaecol Res. 2018;44(6):998-1006.
3. Arce JC, La Marca A, Mirner Klein B, Nyboe Andersen A, Fleming R. Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients. Fertil Steril. 2013;99(6):1644-53.
4. Chen C-W, Huang Y-L, Tzeng C-R, Huang R-L, Chen C-H. Idiopathic low ovarian reserve is associated with more frequent positive thyroid peroxidase antibodies. Thyroid. 2017;27(9):1194-200.
5. Liu J, Qin Y, Liu H, Liu Y, Yang Y, Ning Y, et al. Global, regional, and national burden of female infertility and trends from 1990 to 2021 with projections to 2050 based on the GBD 2021 analysis. Sci Rep. 2025;15(1):17559.
6. Ding C, Shi Y, Li J, Li M, Hu L, Rao J, et al. Association of weight-adjusted-waist index with
all-cause and cardiovascular mortality in China: A prospective cohort study. Nutr Metab Cardiovasc Dis. 2022;32(5):1210-1217.
7. Saei Ghare Naz M, Ozgoli G, Sayehmiri K. Prevalence of Infertility In Iran: A Systematic Review And Meta-Analysis. Urol J. 2020;17(4):338-345.
8. Korevaar TIM, Mínguez-Alarcón L, Messerlian C, de Poortere RA, Williams PL, Broeren MA, Hauser R, Souter IC. Association of Thyroid Function and Autoimmunity with Ovarian Reserve in Women Seeking Infertility Care. Thyroid. 2018;28(10):1349-1358.
9. Sun Y, Fang Y, Xu M, Liu Y. Relationship between thyroid antibody levels and ovarian reserve function in infertile chinese women with normal thyroid-stimulating hormone. J Ovarian Res. 2023;16(1):100.
10. McLachlan SM, Rapoport B. The molecular biology of thyroid peroxidase: cloning, expression and role as autoantigen in autoimmune thyroid disease. Endocr Rev. 1992;13(2):192-206.
11. Freire BA, Paula ID, Paula F, Kallenberg CG, Limburg PC, Queluz TT. Absence of cross-reactivity to myeloperoxidase of anti-thyroid microsomal antibodies in patients with autoimmune thyroid diseases. Am J Med Sci. 2001;321(2):109-12.
12. Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab. 1990;71(3):661-9.
13. Huang Y, Xie B, Li J, Hang F, Hu Q, Jin Y, Qin R, Yu J, Luo J, Liao M, Qin A. Prevalence of thyroid autoantibody positivity in women with infertility: a systematic review and meta-analysis. BMC Womens Health. 2024;24(1):630.
14. Hasegawa Y, Kitahara Y, Osuka S, Tsukui Y, Kobayashi M, Iwase A. Effect of hypothyroidism and thyroid autoimmunity on the ovarian reserve: A systematic review and meta-analysis. Reprod Med Biol. 2021;21(1):e12427.
15. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum reprod. 2015;30(7):1690-6.
16. Gu C, Yue C, Li L, Li J, Wu C, He Y. Thyroid peroxidase antibodies do not impair the ovarian reserve in euthyroid women: a cross-sectional study. Endocr Connect. 2025;14(8):e250151.
17. Amani-Beni R, Darouei B, Ghadimi Nooran S, Karimi Shervedani A, Kakavand N, Amini-Salehi E, et al. Thyroid function tests and serum anti-Müllerian hormone in various populations, is there any association? A systematic review and meta-analysis. Arch Gynecol Obstet. 2025;311(6):1489-1509.
18. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55.
19. Notaro ALG, Lira Neto FT, Bedoschi GM, Silva MJD, Nunes MC, Monteiro CCP, et al. Evaluation of ovarian reserve in women with thyroid autoimmunity. JBRA Assist Reprod. 2024;28(3):442-449.
20. Bucci I, Giuliani C, Di Dalmazi G, Formoso G, Napolitano G. Thyroid Autoimmunity in Female Infertility and Assisted Reproductive Technology Outcome. Front Endocrinol (Lausanne). 2022;13:768363.
21. Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod. 2015;30(7):1690-6.
22. Safarian GK, Niauri DA, Kogan IY, Bespalova ON, Dzhemlikhanova LK, Lesik EA, et al. Impact of antithyroperoxidase antibodies (Anti-TPO) on ovarian reserve and early embryo development in assisted reproductive technology cycles. Int J Mol Sci. 2023;24(5):47-55.
23. Bahri S, Tehrani FR, Amouzgar A, Rahmati M, Tohidi M, Vasheghani M, et al. Overtime trend of thyroid hormones and thyroid autoimmunity and ovarian reserve: a longitudinal population study with a 12-year follow up. BMC Endocr Disord. 2019;19(1):47.
24. Wei SX, Wang L, Liu YB, Fan QL, Fan Y, Qiao K. TPOAb positivity can impact ovarian reserve, embryo quality, and IVF/ICSI outcomes in euthyroid infertile women. Gynecol Endocrinol. 2023;39(1):2266504.
25. Qin Z, Qiu Y, Lin J, Yang Y, Hao L, He L. Analysis of the influencing factors for adverse reproductive outcomes in patients with positive TPOAb and the establishment of a nomogram prediction model. Scientific reports. 2025;15(1):19637.
26. Cai YY, Lin N, Zhong LP, Duan HJ, Dong YH, Wu Z, et al. Serum and follicular fluid thyroid hormone levels and assisted reproductive technology outcomes. Reprod Biol Endocrinol. 2019;17(1):90.
27. Dumont A, Robin G, Catteau-Jonard S, Dewailly D. Role of Anti-Müllerian Hormone in pathophysiology, diagnosis and treatment of Polycystic Ovary Syndrome: a review. Reprod Biol Endocrinol. 2015;13:137.
28. Weghofer A, Barad DH, Darmon S, Kushnir VA, Gleicher N. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reproductive biology and endocrinology: RB&E. 2016;14(1):26.
29. Almog B, Shehata F, Suissa S, Holzer H, Shalom-Paz E, La Marca A, et al. Age-related normograms of serum antimüllerian hormone levels in a population of infertile women: a multicenter study. Fertil steril. 2011;95(7):59-63.
30. Anjum S, Zahra F, Yousuf SM. Ovarian reserve parameters and response to controlled ovarian stimulation in infertile patients. Pak J Med Sci. 2019;35(4):958-65.
31. Thum MY, Kalu E, Abdalla H. Elevated basal FSH and embryo quality: lessons from extended culture embryos: raised FSH and blastocyst quality. J Assist Reprod Genet. 2009;26(6):313-8.
| Files | ||
| Issue | Vol 20, No 1 (March 2026) | |
| Section | Original Articles | |
| Keywords | ||
| Infertility Thyroid Disorders Anti-Thyroid Antibodies Ovarian Reserve Anti-Müllerian Hormone | ||
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How to Cite
1.
Mirzarahimi T, Mikaeili Aghah E, Tabrizian S, Kamran A. Ovarian Reserve and Anti-Thyroid Peroxidase Antibodies in Euthyroid Infertile Women: A Cross-Sectional Study. J Family Reprod Health. 2026;20(1):71-77.
