Fertility, Pregnancy and Thyroid DiseaseFrom Mary Shomon,
Your Guide to Thyroid Disease.
Undiagnosed and untreated thyroid disease can be a cause for infertility. If you have not already been tested for a thyroid problem, there are several things you should do.
1. First, be sure you have a TSH (thyroid stimulating hormone) test, along with the full panel of thyroid levels, including Free Thyroxine (Free T4).
TSH level is a key issue. You may have had a TSH thyroid test already run and been told that you're "normal." Don't accept "normal." Insist on getting the exact number, and the normal range for your lab. Labs in North American typically use a "normal" range of somewhere around 0.5 to 5.5 TSH (with over 5.5 being considered hypothyroid, or underactive, and under .5 being hyperthyroid, or overactive.). Note, however, that there is an ongoing controversy among endocrinologists, and growing numbers of experts believe that the normal range needs to be revised, to 0.3 to 3.0.
My endocrinologist at the time (a 40-something woman who had more than 15 years treating women with thyroid problems and thyroid-related infertility) believed FIRMLY that most women do not normalize unless TSH is between 1 and 2 (considered low by some doctors) and that a woman with evidence of thyroid disease can't get and/or maintain a pregnancy at a TSH higher than 1-2. (Note: I didn't get pregnant at 4, a level considered totally NORMAL, but got pregnant quickly at a TSH of 1.2 and had my first baby in December of 1997.)
So you might want to find out what your TSH level was, and if it's "high-normal" and your doctor is not willing to treat you, I'd advise finding an endocrinologist who has a good success rate working with thyroid-related infertility.
2. Second, insist on having thyroid antibodies tested when you have your TSH test.
There's a value in having antibodies tested or looking at antibody values in someone experiencing infertility or suffering recurrent miscarriage, particularly if TSH levels have already been checked, and are mid or high-normal. Antibodies usually indicate a thyroid that is in the process of autoimmune failure. Not failed yet, and often not enough to register in thyroid tests, but in the process of failing. This may be enough to affect fertility or ability to maintain a pregnancy.
There is evidence that antibodies level can affect fertility and the viability of early pregnancy. Some endocrinologists believe that the presence of thyroid antibodies alone is enough to warrent treatment with small amounts of thyroid hormone, especially in a woman trying to get pregnant. You may with to consult with an endo that has this philosophy.
3. Finally, consider looking into some of the innovative treatments that deal with antibodies.
A study reported in The American Journal of Reproductive Immunology found a link link between female infertility and subtle immunologic problems. According to the study co-author, Geoffrey Sher, M.D., a significant increase in IVF birthrates was observed in women who tested positive for antiphospholipid antibodies (APAs), and also in women who tested positive for antithyroid antibodies (ATAs) when low doses of heparin (an anti blood clotting agent) and aspirin and/or intravenous immunoglobulin G (IVIG) were administered.
In a related research study, Dr. Sher and co-workers found that the IVF failure also occurs in women who produce antibodies (ATAs) to their thyroid glands, regardless of whether or not there are clinical symptoms or signs of reduced thyroid hormone activity (hypothyroidism). Many women, especially those who have a family history thyroid disease, will manifest with ATAs.
"The presence of ATAs is associated with a variety of manifestations of poor reproductive performance," said Dr. Sher. "These range from infertility, through early miscarriage to prematurity, intrauterine growth retardation, other serious complications of late pregnancy, and even fetal death." These complications he said, often occur when there is no clinical suggestion of hypothyroidism.
- Managing Thyroid Disease in Pregnancy: 2007 Guidelines
- Thyroid Hormone Breakthrough, by Mary Shomon, -- chapters on fertility and pregnancy with thyroid disease
Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age," "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia." Click here for more information on Mary Shomon.