Thyroid Disease and Infertility
A Special Report by Mary Shomon, About.com Guide, Thyroid Disease Website
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. At many labs in North America, "normal" range is somewhere around .5 to 5.5 (with over 5.5 being considered hypothyroid, or underactive, and under .5 being hyperthyroid, or overactive. My endocrinologist (a 40-something woman with more than 15 years treating women with thyroid problems and thyroid-related infertility) believes 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 in one month at 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.
If your doctor does not believe that the lower TSH level might be optimal, you can print out a copy of a recent British Medical Journal article that indicates that the way the normal ranges have been devised may in fact mean that people with a TSH level over 2 actually represent a population that is likelier to already have developing thyroid problems.
Also, in the August 1998 issue of Obstetrics and Gynecology, Italian researchers reported that they found women in their study who eventually miscarried had significantly lower blood levels of human chorionic gonadotropin (hCG) and free thyroxine (Free T4, a measure of thyroid hormone in the bloodstream) at baseline. Women who miscarried also had high levels of TSH and gamma globulins at baseline, compared with those who did not miscarry.
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, and 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 are endocrinologists who believe that the presence of thyroid antibodies alone is enough to warrant treatment with small amounts of thyroid hormone. You may with to consult with an endo that has this philosophy.
Dr. Elizabeth Vliet, an MD who runs Her Place, a women's health clinic at All Saints Hospital in Fort Worth, and author of Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore, does not believe that TSH tests are the almightly indicator of a woman's thyroid health. Dr. Vliet says that symptoms, along with elevated thyroid antibodies and normal TSH, may be a reason for treatment with thyroid hormone. Here's a quote:
"The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but two are women, who had a normal TSH and turned out to have significantly elevated thyroid antibodies that meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."
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 linked 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.
A Special Report by Mary Shomon, About.com Guide, Thyroid Disease Website
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. At many labs in North America, "normal" range is somewhere around .5 to 5.5 (with over 5.5 being considered hypothyroid, or underactive, and under .5 being hyperthyroid, or overactive. My endocrinologist (a 40-something woman with more than 15 years treating women with thyroid problems and thyroid-related infertility) believes 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 in one month at 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.
If your doctor does not believe that the lower TSH level might be optimal, you can print out a copy of a recent British Medical Journal article that indicates that the way the normal ranges have been devised may in fact mean that people with a TSH level over 2 actually represent a population that is likelier to already have developing thyroid problems.
Also, in the August 1998 issue of Obstetrics and Gynecology, Italian researchers reported that they found women in their study who eventually miscarried had significantly lower blood levels of human chorionic gonadotropin (hCG) and free thyroxine (Free T4, a measure of thyroid hormone in the bloodstream) at baseline. Women who miscarried also had high levels of TSH and gamma globulins at baseline, compared with those who did not miscarry.
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, and 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 are endocrinologists who believe that the presence of thyroid antibodies alone is enough to warrant treatment with small amounts of thyroid hormone. You may with to consult with an endo that has this philosophy.
Dr. Elizabeth Vliet, an MD who runs Her Place, a women's health clinic at All Saints Hospital in Fort Worth, and author of Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore, does not believe that TSH tests are the almightly indicator of a woman's thyroid health. Dr. Vliet says that symptoms, along with elevated thyroid antibodies and normal TSH, may be a reason for treatment with thyroid hormone. Here's a quote:
"The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but two are women, who had a normal TSH and turned out to have significantly elevated thyroid antibodies that meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."
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 linked 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.
