Contemporary view and clinical implications of thyroid autoimmunity interactions in female fertility, reproduction and pregnancy

Volodymyr Artyomenko; Vasylyna Gutsol; Dmytro Zhelezov; Olena Kucherenko; Diana Parubina; Victoria Kugel; Oleksii Ishchuk; Simona Raluca Iacoban

Volodymyr Artyomenko Department of Obstetrics and Gynecology, Odesa National Medical University, Odesa, Ukraine
Vasylyna Gutsol Department of Reproduction, Master‘s Program Biotechnology of Human Assisted Reproduction, University of Valencia, Valencia, Spain
Dmytro Zhelezov Department of Pathological Pregnancy, Odesa City Maternity Hospital No. 5, Odesa, Ukraine
Olena Kucherenko Department of Pathological Pregnancy, Odesa Regional Maternity Hospital, Odesa, Ukraine
Diana Parubina Department of Obstetrics and Gynecology, Odesa National Medical University, Odesa, Ukraine
Victoria Kugel Department of Pathological Pregnancy, Odesa City Maternity Hospital No. 5, Odesa, Ukraine
Oleksii Ishchuk Department of General Medicine, Sanok Specialist Hospital, Autonomous Public Healthcare Centre, Sanok, Poland
Simona Raluca Iacoban Department of Obstetrics and Gynecology, Suceava County Hospital, Suceava, Romania

Keywords: thyroid autoimmunity, subclinical hypothyroidism, female infertility, thyroid peroxidase antibodies (TPOAb), reduced ovarian reserve, unexplained infertility, postpartum thyroiditis, thyroid dysfunction in pregnancy

Abstract

Thyroid autoimmunity (TAI) is known to influence female reproductive function and has been identified in 13–19% of infertile women, particularly in those with recurrent miscarriage, polycystic ovary syndrome (PCOS), diminished ovarian reserve, reduced embryo quality, or unexplained infertility. This review examines the relationship between TAI, including subclinical and overt hypothyroidism, as well as postpartum thyroiditis (PT), and female reproductive health, emphasizing the role of TAI in female subfertility. This narrative literature review draws on key medical databases to analyze recent and available evidence-based studies exploring the influence of TAI on ovarian function, fertility and pregnancy. TAI, even in its asymptomatic or subclinical forms, may impair fertility through direct ovarian mechanisms and immune-mediated pathways. Thyroid antibodies are associated with unexplained infertility and idiopathic low ovarian reserve that might be linked to one another. PT presents an additional challenge when pregnancy is followed by thyroid dysfunction, particularly in TPOAb-positive women. TAI should be considered in the diagnostic evaluation of subfertile women, especially those with unexplained subfertility or pregnancy loss/termination. Monitoring and individualized LT-4 therapy may improve reproductive outcomes and reduce pregnancy complications. Further research is needed to clarify the immune mechanisms linking TAI and reproductive failure.