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Fertility and Thyroid Disease
Frequently Asked Questions About How to Overcome Thyroid-Related Infertility and Get Pregnant When You Have Thyroid Disease

by Mary Shomon

cover.jpg - 45036 BytesHyperthyroidism – or having an overactive thyroid gland – can pose special concerns during pregnancy. When the body delivers too much thyroid hormone, both the mother and the baby can suffer. Miscarriages, premature births, and intrauterine growth retardation can occur when the disorder goes undiagnosed or untreated. Pregnant women with hyperthyroidism can also develop high blood pressure, and are at greater risk of heart conditions.

While a thyroid condition can sometimes complicate the process of getting - or staying - pregnant, the good news is that when your disease is properly managed, most of you with thyroid conditions -- whether hypothyroid or hyperthyroid -- can have a safe, uneventful pregnancy and delivery. Taking your medications, keeping your thyroid levels -- including TSH and T4 -- under control, getting regular care with a specialist familiar with treating pregnant thyroid patients, and taking charge of your own health appears to be key to a successful outcome.

In some cases, pregnancy can actually lessen the symptoms of thyroid disease, and you may be one of the many women who enjoy a nine-month respite from some of the undesirable effects of thyroid conditions.

If I could urge women with thyroid disease who are contemplating pregnancy to do one thing, it would be to become educated about how thyroid dysfunction can affect fertility and pregnancy - and what to do about it. Read all you can, ask questions, and urge your doctors to perform the necessary blood tests to keep your levels in check.

Will my thyroid disease hamper my ability to get pregnant?

Sometimes - but certainly not always - thyroid disease can affect your fertility. According to Dr. Sheldon Rubenfeld, a practicing thyroidologist, and Founding Chairman of the Thyroid Society for Education and Research, fairly common problems caused by thyroid dysfunction are anovulation (no ovulation, or release of an egg) and menstrual irregularities. With no egg to fertilize, conception is impossible.

Thyroid dysfunction can halt ovulation by upsetting the balance of the body’s natural reproductive hormones. One way to tell if you’re ovulating is to test the level of a pituitary hormone called LH (or luteinizing hormone) by using an ovulation predictor kit. LH stimulates the ovaries to release an egg. The kit will show you if you have that surge in LH that indicates ovulation. If there is too much or too little thyroid hormone, ovulation might not occur. Remember...even though you may be menstruating regularly, you may not be ovulating - and may never know that fact until after years of infertility.

In addition, some women experience a short luteal phase. The luteal phase is the timeframe between ovulation and onset of menstruation. The luteal phase needs to be of sufficient duration -- a normal luteal phase is approximately 13 to 15 days -- to nurture a fertilized egg. A shortened luteal phase can cause what appears to be infertility, but is in fact failure to sustain a fertilized egg, with loss of the very early pregnancy at around the same time as menstruation would typically begin.

Dr. Rubenfeld said that "the mechanisms by which thyroid problems interfere with fertility are often unknown, but there is no question that other aspects of thyroid function affect fertility." For example, Dr. Rubenfeld said that hypothyroidism can cause an increase in prolactin, the hormone produced by the pituitary gland that induces and maintains the production of breast milk in a post-partum woman. Excess prolactin has a negative effect on fertility - sometimes preventing ovulation, or sometimes causing irregular or absent monthly cycles.

The increase in prolactin may be caused by an elevation of a hormone from the hypothalamus called TRH (or thyrotropin releasing hormone) that stimulates the pituitary gland to send out both prolactin and TSH.

Some women with hypothyroidism also have polycystic ovaries, or cysts on the ovaries, which hamper ovulation and can cause fertility problems as well.

This all sounds pretty grim. Should I even bother trying? What can I do to maximize my chances of getting pregnant?

Yes, you should bother trying - there are many, many success stories (I happen to be one of them, as it only took a few months to get pregnant with my daughter). You shouldn’t go into this thinking it’s going to be a long, arduous process. But attempting pregnancy with a thyroid condition may require a little preparation.

First of all, talk to your doctor about when you should attempt conception. Many doctors think TSH levels of 3, 4, or even 5 may acceptable to try to get pregnant. But research suggests otherwise. In 1994, a study in the Journal of Clinical Endocrinology and Metabolism looked at pregnant women with thyroid antibodies and TSH in the normal range. The study found that women with autoimmune thyroid disease had TSH values significantly higher, though still normal, in the first trimester than in women with healthy pregnancies used as controls.

The higher TSH level of the women with autoimmune thyroid disease? 1.6.

The normal TSH level for the control group of pregnant woman without autoimmune thyroid disease? 0.9. A TSH of .9 is a far cry from the so-called "normal" TSH levels of 3 or 4 or 5 that some doctors feel are no impediment whatsoever to getting -- or staying -- pregnant.

My endocrinologist at the time I was trying to get pregnant believed very firmly that most women with a thyroid problem should be maintained at a TSH level of between 1 and 2 in order to help them get pregnant -- and maintain the pregnancy.

Second, ascertain whether you’re ovulating. An excellent, empowering book is Toni Wechsler’s Taking Charge of Your Fertility.. You can learn how to use basal temperature and other fertility signs to chart your monthly hormonal cycle. You can also use an over-the-counter ovulation predictor kits, available for around $10 at the drugstore, to confirm ovulation. Or the more expensive ovulation predictor electronic devices can also be used.

What if I can't get pregnant, but my thyroid tests "normal?" Or what if I test positive for "antibodies?"

Some women who have fertility problems actually have underlying autoimmune thyroid problems, but they and their doctors are not aware. If you or someone you know is having difficulty getting pregnant, or is suffering recurrent miscarriage, thyroid antibodies should be tested.

Many doctors do not appear to know about this link between antibodies and infertility, yet it is published in conventional research journals. The respected journal Obstetrics & Gynecology reported that the presence of antithyroid antibodies increases the risk of miscarriage. And according to U.S. research reported in the Journal of Clinical Endocrinology and Metabolism, that risk of miscarriage can be twice as high for women who have antithyroid antibodies.

Researchers have also demonstrated that antithyroid antibodies can cause greater difficulty conceiving after in vitro fertilization, regardless of whether or not there are clinical symptoms of hypothyroidism. The researchers had greater success in achieving successful pregnancies when they gave low doses of heparin (an anti blood clotting agent) and aspirin and/or intravenous immunoglobulin G (IVIG) to women who had antithyroid antibodies.

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Keep in mind that if you are monitoring your ovulation and cycle, and have your thyroid and TSH levels regulated, and you still don't get pregnant after the requisite six months to a year, you probably should consult with a fertility specialist for additional treatment and ideas.

Read the Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success

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All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician or health practitioner before starting a new treatment program. Please see our full disclaimer.