Infertility & Miscarriage

INFERTILITY/MISCARRIAGE/PREGNANCY

IMPORTANT INFORMATION REGARDING HYPOTHYROIDISM AND FEMALE FERTILITY, MISCARRIAGE AND PREGNANCY 

Low thyroid function can effect ovulation (egg production) by causing menstrual irregularities or the absence of periods. Treatment with adequate amounts of thyroid medication can restore ovulation and permits conception.

Women having unexplained infertility (unable to conceive when all fertility tests are normal) should have a thorough evaluation for hypothyroidism, including comprehensive blood testing, BBT (basal body temperatures) measurement, and a thyroid sonogram. If symptomatic or if any of the tests are outside of the functional range, treatment with adequate amounts of thyroid medication will help many women conceive. This common clinical observation suggests that adequate amounts of thyroid hormone are needed to produce eggs of adequate quality to allow conception to occur.

20% of women with Polycystic Ovarian Syndrome (PCOS), a common condition causing infertility, will test positive for hypothyroidism. Thyroid medication must be added to make these women ovulate properly and conceive.

In some cases hypothyroidism causes an elevation of Prolactin, the milk hormone, which blocks ovulation, just as it does when a woman is breast feeding. Treatment with thyroid hormone reduces prolactin levels and permits ovulation to occur. 

Hashimoto’s thyroiditis can be associated with premature menopause. Any young woman of child-bearing age who has positive antithyroid antibodies should have her AMH level, which reflects the number of eggs remaining in the ovaries, tested. If a young woman has a reduced reserve of eggs, she should be be advised to consider starting her family as soon as possible or be offered the option of freezing and storing her eggs for future use if menopause occurs prior to the time that conception is desired.

Maternal Hypothyroidism is associated with pregnancy complications such as multiple miscarriage ( although in most cases miscarriages are caused by genetic abnormalities of the fetus which occur at the time of conception), premature delivery, preeclampsia, and stillbirth. Unfortunately, many women are not adequately screened for hypothyroidism in early pregnancy and go untreated, increasing both maternal and fetal risks for complications.

Maternal hypothyroidism is the most common cause of postpartum depression. A common time Hypothyroidism to appear acutely is during the six week period after delivery.  

In pregnancy, Hypothyroidism is conventionally defined by a maternal TSH level of greater than 2.5, which is lower than the cutoff point for non-pregnant individuals, conventionally defined as being between 3.0 and 4.5. This supports the fact that there is need for higher levels of thyroid hormone to support both the pregnancy as well as the normal growth and development of the fetus.

Maternal Hypothyroidism is known to have a negative effect on the early neurologic development of the fetus.  In the most severe cases of fetal deprivation of maternal thyroid hormones during pregnancy, the baby can be born with cretinism, a condition in which there is severe mental retardation and abnormal physical development. Studies indicate that fetal deprivation of thyroid hormones may be a factor in the  development learning disabilities and behavioral issues in young children. There may even be a link to the autism spectrum.  

Many teenagers with ADD or ADHD may actually be hypothyroid when adequately tested. Treatment with thyroid medication often eliminates the need for stimulatory medications such as Ritalin or Adderall. 

Since Hashimoto’s thyroiditis has a strong genetic component, children of parents having this condition should be periodically monitored for its development, especially in cases where there are learning or behavioral issues. 

MANY WOMEN ARE AFRAID OF TAKING ANY MEDICATIONS DURING PREGNANCY FOR FEAR OF AN ILL EFFECT ON THE BABY THAT SHE IS CARRYING. TO BE ABSOLUTELY CLEAR, THYROID HORMONE IS A NATURAL SUBSTANCE AND POSES ABSOLUTELY NO RISK TO THE MOTHER OR HER BABY. HOWEVER, THE RISK OF NOT TAKING ADEQUATE AMOUNTS OF THYROID MEDICATION DURING PREGNANCY ARE SUBSTANTIAL FOR BOTH THE MOTHER AS WELL AS  HER UNBORN CHILD. 

VIDEO: THYROID FUNCTION AND FERTILITY
BY HUGH D. MELNICK, M.D.



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