Infertility and Hypothyroid

Tracy

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Reply Infertility and Hypothyroid Posted on: Oct 13, 2010 at 10:52pm
Hi Dr. Braverman,
My Husband and I have been trying to get pregnant over a year now, with no prior history of conception. I was evaluated by an Endocrinologist for TSH of 4.0. Six months later my TSH was 3.5. I am thought to have subclinical hypothyroid and was advised to start Thyroxine. Research shows a link between infertility and hypothyroid, but does this also apply to subclinical? Furthermore, hypothyroidism can cause ovulation issues, which is a non-issue for me. Aside from ovulation, what other infertility issues can hypothyroid cause? Treatment for subclinical thyroid seems controversial. My concern is having to take thyroxine permanently for a diagnosis that may not be the cause of my infertility. Thank you.

Dr. Braverman

2005 Posts
Re: Infertility and Hypothyroid Posted on: Oct 14, 2010 at 12:43am
Hi Tracy, there are several issues here. First , in patients that are having a difficult time getting pregnant you need to optimize as much as possible. The TSH for fertility should be between 1 and 2. Although symptoms of hypothyroidism 'may' not be prevelant until the THS is much higher a TSH of 4 can contribute to your difficulties, so i do agree with the tyroxine and trying to get it lower. I have had many success stories with just getting the TSH to come down when there were no other issues, even if there were no ovulation dysfunctions.
The cuase of the hypothryoidism can sometimes give you a clue to your problems as well. If there are anti thyroid antibodies , while they themselves are not the cause of the problem, they are a sign that the immune system's tolerance to "self" is altered and this inability to tolerate 'self" can contribute to immune rejection of embryos trying to implant(I discuss some of this under the T reg cell portion on the immune caused of infertility on the website).

I would run a full thryoid antibody screen, and check the prolactin as well(sometimes elevated with high TSH). If all normal I would treat with thyoxine to bring down the TSH, most of the current literature supports this and our experience with this has also been excellent.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.