What can happen if you have hypothyroidism?

You can think of the action of thyroid hormone as revving up your body and keeping it functioning at the proper rate. Too little and things slow down, and too much causes things to go too fast. Common symptoms of hypothyroidism include fatigue, weight gain, constipation, loss of sex drive, hair loss, dry skin, loss of periods, and miscarriages.

What causes you to get hypothyroidism?

Most commonly hypothyroidism is a result of an autoimmune process (your immune system attacks your thyroid gland with antibodies) called Hashimoto’s thyroiditis. Other causes include surgery or radiation treatments.

How do we test for hypothyroidism?

The most sensitive way to track thyroid activity is indirectly, by measuring Thyroid Stimulating Hormone (TSH), a hormone that stimulates your thyroid to produce thyroid hormone. When thyroid function is low, the brain detects this and raises the TSH to stimulate the thyroid. A higher than normal TSH suggests that your body is detecting hypothyroidism.

What is a normal TSH level?

Traditionally, TSH levels from 0.5 to 5.0 were considered normal. Above 5, we would diagnose and treat for hypothyroidism. (If the patient doesn’t actually have any symptoms, we call it “subclinical hypothyroidism”).
More recently, some researchers suggest we should treat subclinical hypothyroidism when TSH is over 2.5. There is some controversy around this. When the TSH is elevated your doctor will often ask for additional tests to look for the antibodies that would indicate that this is the autoimmune form of hypothyroidism.

How can hypothyroidism affect fertility?

For starters, hypothyroidism can lead to irregular cycles. It also affects babies because they rely on their mother’s thyroid hormone levels for the first trimester because its thyroid is not fully functional until around 20 weeks of gestation. If you are hypothyroid early in the pregnancy, your baby is as well. This is clearly a problem when you have untreated overt hypothyroidism but it is debated how much of a problem is posed by subclinical hypothyroidism. Most physicians will err on the side of treatment for subclinical hypothyroidism when you are trying to become pregnant.

How is it treated?

Hypothyroidism is treated with a synthetic form of thyroid hormone called Levothyroxine. It can take some time to make sure the dose is correct and so often a repeat blood test will be done in 4-6 weeks. It takes about that long for the TSH to adjust to the Levothyroxine or for any change in the dose of this medication. Monitoring is important to make sure you are getting enough thyroid hormone and also to make sure you are not getting too much.
Levothyroxine is a synthetic hormone with few impurities, very few side effects and produces almost no allergic reactions.

Once a patient is pregnant we will often increase dosing as pregnancy hormone interacts with TSH. We check TSH levels for all of our pregnant patients. If you are taking Levothyroxine there is no harm in reminding us that you too may need to have your dose increased.

What is “natural” thyroid hormone and should you take it?

The main hormone secreted by your thyroid gland is T4 hormone. Your body will then convert this to T3 hormone, which is the more active form of thyroid hormone. Natural thyroid hormone is desiccated thyroid gland and contains T3 and T4. It may be dangerous as the levels are difficult to predict. Most endocrinologists prefer to give synthetic T4 and let your body decide how much to convert to T3.

More questions?
Ask us here! We want to help.

You can also visit www.thyroid.ca.

The post Hypothyroidism and Fertility appeared first on Fertility.ca.

I was reading about the success rates of FSP (fallopian sperm perfusion) for unexplained infertility and how FSP may be more effective than IUI. It is suggested that couples with unexplained infertility may benefit from FSP over IUI, resulting in higher pregnancy rates.

I was just wondering what your thoughts were on FSP vs IUI and if you offer FSP treatments?”

We use a modified FSP technique much of the time.

FSP was developed in the 1990s, before ultrasound could be used widely. It addressed the concern: is it better to have the sperm highly concentrated and thus quite possibly left in the fundus of the uterus (“IUI”) or dilute the fluid 8x, put a balloon or other device to make sure nothing comes back, and thus ensure through higher pressure and volume that sperm must go up the tubes (“FSP”).

It took randomized controlled trials to see if there was a difference. The result: both techniques appear to deliver the same pregnancy rates. You can read more about this in The Cochrane review, here.

At our clinic we do a combination of IUI or a FSP variant with every insemination: we focus on ultrasound guidance and, when necessary, using a balloon catheter to keep the sperm up and inside. We’ve been doing this for about four years or so. When we started we saw a 50% boost in pregnancy rates from previous techniques. Now we find success rates are the same whether we use ultrasound or not (but M-F we use ultrasound).

In our opinion, pregnancy rates are maximized when your team is focusing on what you individually need. Its less about IUI FSP or ultrasound, more about your clinician taking care when completing the procedure.

Hope that helps!

The post What’s more effective: IUI or FSP? appeared first on Fertility.ca.