Pooled prevalence of hypothyroidism among Indian females with infertility: A systematic review & meta-analysis.

Pushpanjali R Ojha, Amit Kumar, Rakesh Kumar

Journal: The Indian journal of medical research 2024;159(6):627-636

PMID: 39382471

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Plain Language Summary

Hypothyroidism is a common endocrine disorder that can significantly impact reproductive health, particularly in women experiencing infertility. In India, where infertility rates are rising, understanding the prevalence of hypothyroidism among affected females is crucial for effective diagnosis and management. The primary aim of this study was to systematically review and analyse the prevalence of hypothyroidism among Indian females diagnosed with infertility, providing insights into the potential role of thyroid dysfunction in reproductive health. This research is a systematic review and meta-analysis, synthesising data from multiple observational studies that reported on the prevalence of hypothyroidism in Indian women with infertility. Results showed: - hypothyroidism was present in a significant proportion of infertile Indian women with pooled proportion of 28% - a non-significant increase in the frequency of hypothyroidism with advancing publication year of articles. Authors concluded that the studies from India reported significant proportion of hypothyroidism in women with infertility. Thus, the thyroid stimulating hormone test may be considered in the screening test of women visiting a health care facility for infertility treatment.

Abstract

Background & objectives Studies suggest hypothyroidism is responsible for female infertility. This review aimed to determine the pooled prevalence of hypothyroidism in Indian infertile women so that hypothyroidism screening can be initiated, and policies are designed for prevalence reduction. Methods Electronic databases including PubMed, Google Scholar and Cochrane library were searched to obtain the relevant articles. Studies that reported the proportion of hypothyroidism in Indian infertile women were selected. Systematic procedures for study selection and data extraction were followed. Each study was evaluated for quality using the Joanna Briggs institute (JBI) critical appraisal checklist. To pool the effect sizes, a random effects model was utilized. Funnel plot and Egger's test were used to assess publication bias. To quantify heterogeneity among studies, I2 statistics were utilized. Subgroup and meta-regression analyses were used to further investigate the heterogeneity of pooled estimates. The sensitivity analysis done whereby each study was excluded in order to examine the influence of that study in the pooled estimate. A P-value of 0.05 or less was considered statistically significant. Results Out of 198 articles, a total of 20 studies involving 2396 cases met the inclusion criteria. The pooled prevalence of hypothyroidism in women with infertility was 28 per cent [95% confidence interval (CI): 20% to 36%] which was highest in Telangana at 62 per cent (n=1; 95% CI 48% to 74%) and lowest in Karnataka at 14 per cent (n=2; 95% CI: 10% to 18%). Interpretation & conclusions Infertile women have high proportion of hypothyroidism, suggesting that screening programmes during diagnostic workup for infertility may provide optimal care. The result of this meta-analysis will help design guidelines and earmark highest prevalence regions to initiate preventive and diagnostic measures for prevalence reduction in future.

Address: Department of Pathology, Trauma and Central Emergency Laboratory, Rajendra Institute of Medical Sciences, Jharkhand, India.; Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Jharkhand, India.; Department of Emergency Medicine, Bijapur Lingayat District Educational Association (Deemed to be University), Karnataka, India.

DOI: 10.25259/IJMR_987_23