Protocol for Submission of Thesis for the Award of

Degree of Diplomate of National Board

(OBSTETRICS AND GYNECOLOGY)
SESSION 2016–2019

“ CORRELATION BETWEEN THYROID DYSFUNCTION AND

SERUM AMH LEVELS IN INFERTILE WOMEN ”

Department of Obstetrics and Gynecology,

Kamineni Hospital, LB Nagar, Hyderabad

Dr.T.PRATHYUSHA

PROFORMA
1 NAME Dr.T.PRATHYUSHA
2 DATE &YEAR OF March-2013
GRADUATION
3 COLLEGE/UNIVERSITY KAMINENI HOSPITAL,
LB NAGAR,HYDERABAD,TELANGANA
4 COURSE OF ADMISSION DNB OBSTRETRICS AND GYNECOLOGY

5 DATE OF JOINING 21/03/2016

6 PRESENT STATUS 1st YEAR DNB RESIDENT (PRIMARY)

7 DEPARMENT IN WHICH OBSTETRICS AND GYNECOLOGY

SUBJECT OF THESIS
FALLS
8 TITLE CORRELATION OF THYROID DYSFUNCTION
AND SERUM AMH LEVELS IN INFERTILE
WOMEN

9 BRIEF RESUM OF WORK ENCLOSED

PROPOSED

SIGNATURE OF CANDIDATE

10 CHIEF GUIDE Dr. HARIPRIYA MD(OBG)

KAMINENI HOSPITAL, LB
NAGAR,HYDERABAD

SIGNATURE:

11 CO-GUIDE 1)Dr.VASUNDHARA DNB(OBG),DGO

KAMINENI HOSPITAL, LB NAGAR
HYDERABAD

SIGNATURE:

2)Dr.VIJAYA LAKSHMI MD(BIO-CHEMISTRY)

 KAMINENI HOSPITAL,LB
NAGAR,HYDERABAD

SIGNATURE:

12 HEAD OF THE DR.VASUNDHARA DNB(OBG),DGO.

DEPARTMENT DEPARTMENT OF OBSTETRICS AND
GYNECOLOGY
KAMINENI HOSPITAL,LB
NAGAR,HYDERABAD

SIGNATURE:

To
The Registar,
National Board Of Education, New
Delhi.
SUBJECT: Protocol of thesis of Dr.Prathyusha,undergoing postgraduate training in
our department at Kamineni Hospital,LB Nagar,Hyderabad.
Reference:DNB Provisional registration number : 125-46113-161-209035

Sir,
Please find the enclosed thesis protocol of Dr.Prathyusha
TITLE: Correlation of thyroid dysfunction and serum AMH levels in infertile women
Under the guidance of
CHIEF GUIDE
Dr.HARIPRIYA MD(OBG)
ASSISTANT PROFESSOR,
KAMINENI HOSPITAL, LB NAGAR,HYDERABAD
CO-GUIDES
1. Dr.VASUNDHARA
DNB(OBG).DGO
HEAD OF DEPARTMENT(OBG)
KAMINENI HOSPITAL, LB NAGAR,HYDERABAD
2.Dr.VIJAYA LAKSHMI MD(BIO-CHEMISTRY)
KAMINENI HOSPITAL, LB NAGAR,HYDERABAD.

The thesis and ethical committee of our hospital has accepted this topic and
protocol.Please acknowledge receipt of the same.

Yours sincerely
Dr.T.Prathyusha

THESIS TITLE
CORRELATION OF THYROID DYSFUNCTION AND SERUM
ANTI-MULLERIAN HORMONE LEVELS IN INFERTILE WOMEN

GUIDE
1)Dr.HARIPRIYA
MD(OBG)
Kamineni Hospital LB Nagar

CO-GUIDE
1)Dr.VASUNDHARA
DGO DNB(OBG)
Kamineni Hospital,LB Nagar
2)Dr.VIJAYA LAKSHMI
MD(BIOCHEMISTRY)
Kamineni Hospital,LB Nagar

HYPOTHESIS
Women with thyroid dysfunction may have decreased ovarian reserve

INTRODUCTION
Infertility is a disease of the reproductive system defined by the failure to achieve
clinical pregnancy after 12 or more months of regular unprotected sexual
intercourse{1}.
Infertility is a world wide problem affecting 8-12%couples{2,3}. In India the
prevalence~3.9-16.8%{4}

Thyroid dysfunction is the most common endocrine disorder in women of

reproductive age. Overt and subclinical hypothyroidism may cause menstrual
irregularities and anovulation {5}, and thus associated with female infertility {6}.
This may be explained by elevated levels of prolactin in hypothyroidism,which inhibit
ovulation{7}. Hypothyroidism is also associated with an increased risk of polycystic
ovarian disease (PCOS), a condition that causes cysts on the ovaries and inhibits
pregnancy.

Anti-Mullerian hormone(AMH) is a dimeric glycoprotein belonging to the

transforming growth factor-beta (TGF-B). It is produced by the granulosa cells of
preantral and small antral follicles. AMH levels decline with age from adult hood
toward menopause reflecting the size of the ovarian follicle pool{8}.Thus AMH is a
suitable biomarker of ovarian reserve{9}.
Ovarian function may be affected by impaired
thyroid function, although this association has not been elucidated, average TSH
levels in infertile women were reportedly higher than those in normal fertile women
{10,11}.
While some studies have shown association between between thyroid dysfunction and
AMH levels,few studies concluded no significant correlation. In this study, we will
evaluate the relationship between thyroid function and AMH levels by comparing
them in infertile patients of our urban centre.

REVIEW OF LITERATURE

1) Keiji Kuroda & Toyoyoshi Uchida & Saki Nagai & Rie Ozaki & Takashi
Yamaguchi & Yuichi Sato & Jan J. Brosens & Satoru Takeda- concluded,an inverse
relationship between serum TSH levels, which were within the normal range, and
AMH levels in infertile women of reproductive age

2) Omar Dawood Al-Azzawi, Amal H. A. Al-Hadithy & Seenaa Sadeq

Amen(International Journal of science and nature)-There is no significant correlation
between AMH serum level and thyroid hormones (TSH, T3, and T3& TG) serum
level

3) Andrea Weghofer, David H. Barad, Sarah Darmon, Vitaly A. Kushnir, and Norbert

Gleicher-concluded that even after adjustment for thyroid autoimmunity and age,
TSH <3.0μIU/mL in euthyroid infertility patients is associated with significantly
better AMH than TSH ≥3.0μIU/mL. This observation suggests a direct beneficial
effect of lower TSH levels on follicular recruitment.

4.) K. Kuroda , T. Uchida, S. Nagai, R. Ozaki, T. Yamaguchi, N. Kato

Y. Sato, S. Takeda-concluded that AMH levels correlated inversely with TSH
concentration in infertile reproductive age group.

5)Nikolaos P. Polyzos Evangelos Sakkas, Alberto Vaiarelli1, Kris Poppe, Michel

Camus1, and Herman Tournaye- concluded that thyroid disorders and TAI are highly
unlikely to be associated with low ovarian reserve
AIM OF THE THESIS
Study of correlation between thyroid dysfunction and serum AMH levels in women
presenting with infertility.

OBJECTIVES

1)To the study the clinical profile of patient with infertility

2)To study the prevalence of thyroid dysfunction among women presenting with
infertility

3)To determine AMH levels among women presenting with infertility.

4)To study relationship between thyroid dysfunction and AMH levels in infertile
women if any.

 TYPE OF STUDY-OBSERVATIONAL CASE CONTROL

STYUDY

 SAMPLE SIZE- 100

 PLACE OF STUDY-KAMINENI HOSPITAL,FERTILITY

CLINIC,LB NAGAR

 STUDY PERIOD-2 YEARS

INCLUSION CRITERIA
• Women presenting with primary and secondary infertility
 • age group of 25-45yrs

EXCLUSION CRITERIA

-H/O thyroid surgery

- K/C/O hypo or hyperthyroidism receiving treatment
-H/O Ovarian surgery

MATERIALS & METHODS

• Women presenting with primary and secondary infertility to Gynaecology
Fertility clinic,at
Kamineni hospital in the age group of 25-45yrs would be enrolled after
obtaining an informed consent.
• S.T3,T4,TSH,TPO antibody levels (along with the routine workup) and serum
AMH levels would be determined.
• Control group- Age matched controls with euthyroid status presenting with
infertility.

ANALYSIS

Correlation between thyroid hormone levels/TPO antibody levels and AMH levels
would be determined by appropriate statistical methods.

REFERENCES
1. WHO-ICMART glossary

2.Sciarra J. Infertility: an international health problem. Int J Gynaecol

Obstet. 1994;46:155–63
 3. Looking back, looking forward: a profile of sexual and reproductive health in
India. New Delhi: Population Council; 2004. Population Council. Infertility; pp. 67–
72

4. Infecundity, infertility, and childlessness in developing countries. DHS

Comparative Reports No 9. Calverton, Maryland, USA: ORC Macro and the World
Health Organization; 2004. World Health Organization.
5. Krassas GE, Pontikides N, Kaltsas T, Papadopoulou P, Paunkovic J, Paunkovic N,
Duntas LH. Disturbances of menstruation in hypothyroidism. Clin Endocrinol
(Oxf) 1999;50:655–659. doi: 10.1046/j.1365-2265.1999.00719.x. 
6. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin
Endocrinol Metab.2004;18:153–165. doi: 10.1016/j.beem.2004.03.004.
 
7. Krassas GE, Poppe K, Glinoer D (2010) Thyroid function and human reproductive
health. Endocr.Rev. 2010 31:702-755.

8.Themmen, A.P. (2005) Anti-Mullerian hormone: its role in follicular growth initiation

and survival and as an ovarian reserve marker. J. Nati Cancer Inst. Monogr. 34:18-21.

9.Hansen KR, Hodnett GM, et al. Correlation of ovarian reserve tests with
histologically determined primordial follicle number. Fertil Steril. 2011;95:170–5.
doi: 10.1016/j.fertnstert.2010.04.006.

10. Gerhard I, Becker T, et al. Thyroid and ovarian-function in infertile women. Hum

Reprod. 1991;6:338–45.

11. Gerhard I, Eggertkruse W, et al. Thyrotropin-Releasing-Hormone (TRH) and

Metoclopramide Testing in Infertile women. Gynecol Endocrinol. 1991;5:15–32. doi:
10.3109/09513599109049938. 

STUDY PROFORMA
• S. No.
• NAME
• AGE DOB :
• ADDRESS
• OCCUPATION
• UHID
• MARRIED LIFE
• PARITY
Nulliparous/ Parous
• YEARS OF INFERTILITY
• MENSTRUAL HISTORY
• PAST MEDICAL HISTORY
• H/O THYROID DISEASE
• FERTILITY TREATMENT
• PAST SURGICAL HISTORY
• DRUG/RADIATION HISTORY
• OCP use – Yes/ No
• PERSONAL HISTORY
Smoking- Never/ Ex-smoker/ Chronic
Any other Addiction
• FAMILY HISTORY
History of Ovarian/ Breast Cancer in the family

PHYSICAL EXAMINATION
• HEIGHT
• WEIGHT
• BMI
• HIRSUTISM
• GALACTORRHOEA
• ANY OTHERS
• GYNAECOLOGICAL EXAMINATION

INVESTIGATIONS

• T3
• T4
• TSH
• Anti TPO antibodies
• SERUM FSH
• SERUM AMH LEVELS
• SONOGRAPHY D2 –D3 AFC