Impact of Thyroid Dysfunction on Post-Surgical Fertility Outcomes in Women Undergoing Pelvic Surgery: A Prospective Study

Abstract

Background: Thyroid dysfunction has been implicated in female infertility. However, its impact on fertility outcomes following pelvic surgery remains underexplored.

Objective: To evaluate the effect of thyroid dysfunction on fertility outcomes in women undergoing pelvic surgery.

Methods: This prospective study was conducted at Peshawar General Hospital, Pakistan. The time period of the study ranges from March 2024 to October 2025. Targeted populations constitute women aged 18–40 years. The women who were scheduled for elective pelvic surgery and desiring future fertility were included. Preoperative thyroid function (TSH, fT4) and anti-thyroid peroxidase antibodies (anti-TPO) were measured. Participants were classified as euthyroid or having thyroid dysfunction (overt/subclinical hypo- or hyperthyroidism). A Follow-up was carried out on the intervals of 6 weeks, 3, 6, and 12 months. This follow-up was done post-surgery and recorded fertility outcomes. Logistic regression and Cox proportional hazards models were used for statistical analysis using SPSS-26.

Results: A total of 829 women completed the follow-u and 212 (25.6%) had thyroid dysfunction. Women with thyroid dysfunction had lower 12-month conception rates (42.5% vs 57.7%, RR 0.73, 95% CI 0.61–0.87, p < 0.001), longer time-to-pregnancy (median 8 vs 6 months, p < 0.001), higher miscarriage rates (14.2% vs 8.1%, p = 0.018), lower live birth rates (33.0% vs 50.1%, p < 0.001), and greater ART use (12.7% vs 6.3%, p = 0.005). Multivariable analysis confirmed thyroid dysfunction as an independent predictor of reduced conception (adjusted OR 0.59, 95% CI 0.45–0.76, p < 0.001) and lower conception hazard (adjusted HR 0.68, 95% CI 0.54–0.85, p = 0.001).

Conclusion: Preoperative thyroid dysfunction significantly amplify the post-surgical fertility outcomes in women undergoing pelvic surgery.