Infertility, Miscarriage and Subclinical Hypothyroidism

As a doctor helping women conceive and carry pregnancies to the point of having a healthy baby for over 35 years, I have noticed that recognizing and treating thyroid problems was essential in helping both conception and reducing miscarriage. I remember the early days in my career, when blood testing was just being developed and doctors relied on listening to a patient’s symptoms in order to make a diagnosis. In those days, if a woman had some or all of the typical symptoms of hypothyroidism, she was given a prescription for a natural thyroid medication and observed for the improvement in her symptoms and for conception to occur. Almost all women who had miscarriages were treated with thyroid medication and many eventually completed successful pregnancies. The practice of medicine in those days was much less complex and doctors treated patients symptomatically. In many cases, such treatments can be very successful. After all, “if it looks like a duck, walks like a duck and it quacks, it is a duck!”

Unfortunately in many cases today, when doctors rely only on a few blood tests to diagnose hypothyroidism, an obvious diagnosis will often be missed. There are several scientifically valid, complex technical reasons that explain why thyroid blood tests can actually be misleading in many cases. The most important one is that a person can actually be hypothyroid with the common thyroid blood tests being normal.  Nearly forty years later, treating infertile couples with the cutting edge of the In Vitro Fertilization technology, I have had a “front row” view of the vast complexities involved in the process of conception. The genetic basis for 60% of cases of miscarriage has been scientifically demonstrated, so most miscarriages are the result of chromosomal problems that occur at the moment of actual conception. However, that leaves almost 40% of miscarriages as potentially being medically preventable.

Since hypothyroidism is quite common in the female population   (up to 30% are treated for hypothyroidism in some surveys), I believe that natural thyroid  treatment could potentially save a significant number of genetically normal pregnancies, in cases in which a woman has clinical symptoms of hypothyroidism.  In my own clinical experience, both the rate of conception is improved and incidence of miscarriage is reduced when women with the typical symptoms of an under active thyroid gland, but have “normal” blood test results, are treated adequately with natural thyroid hormone supplementation. By adequate treatment, I mean that a woman is treated with gradually increasing doses of natural thyroid medication, until her symptoms improve. Although I do monitor blood tests, the levels in blood indicate that the medicine is being absorbed and gets into the circulation. It does not indicate the adequacy of the dose or whether too much medication is being taken (when a patient is on natural thyroid medication, many doctors will misinterpret blood test results and mistakenly think that the patient is hyper(overactive)thyroid. There are frequent cases of “unexplained infertility” in which all factors that could cause infertility are found to be normal, yet pregnancy does not occur naturally or with fertility treatments.

Unfortunately, many such cases are attributed to stress or to psychological factors. When questioned closely, many of these women do have symptoms that are typical of hypothyroidism. I find that in this group thyroid supplement treatment will often result in successful conception, either naturally or when combined with fertility enhancing therapy. The key to the successful diagnosis and treatment is that the physician asks the right questions to the patient in order to elicit whether the symptoms of hypothyroidism are present. It is also important that a patient feels free to discuss all her symptoms, related to fertility or not, with a physician. Thyroid treatment, once the proper dose is reached, takes 2-12 weeks to exert its effect on the cells of the body.

Certain thyroid blood tests, not routinely performed, are mandatory on all couples (both partners) having infertility issues and on any woman who has had miscarriages. These tests are called anti-thyroid antibodies (Anti-TPO and Anti-TG). When positive, these tests indicate that a person has an autoimmune condition known as Hashimoto’s thyroiditis. This is a fairly common condition, which may be genetic in origin that is not in any way dangerous to your health, but does affect the function of the thyroid gland. These tests may be positive in totally asymptomatic individuals, yet should be treated with thyroid medication if there is an infertility or miscarriage issue. All men should have thyroid tests done of there seems to be a problem with their sperm. I have seen cases in which pregnancy has occurred naturally after men were diagnosed and treated for Hashimoto’s thyroiditis. The thyroid gland is known as the master gland of the body, because thyroid hormones control the cell’s metabolism and ensures its proper biological function.

Although it is not currently known exactly how hypothyroidism contributes to infertility and miscarriage, it is well known that the detrimental effect of inadequate amounts of thyroid hormone in the cells of body can be corrected by adequate thyroid hormone treatment, which results in successful conception and delivery of a healthy baby for many couples.

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