by Jeffrey Dach MD
A new study in Endocrinology, found that women with unexplained infertility had higher TSH levels than aged matched controls, indicating lower thyroid function may be responsible. Nearly twice as many women with Unexplained Infertility had TSH level above 2.5 compared to controls.(1)
My previous article, Low Thyroid, Hashimotos and Pregnancy, discussed the association between low thyroid function and poor pregnancy outcomes.
Broda Barnes and Hypothyroidism, The Unexpected Illness
Dr. Broda Barnes in his famous 1976 thyroid classic, “Hypothyroidism, the Unexpected Illness“, discusses the association between low thyroid function and infertility, menstrual irregularities, excessive menstrual bleeding, and ovarian dysfunction in general.(3) Dr Barnes treated many such low thyroid women with thyroid hormone with good results. Here is a quote from Dr Broda Barnes from 1972:
“The medical literature is full of reports going back many years that provide evidence that thyroid medication, used when indicated, is one of the most helpful measures in the treatment of infertility in both men and women. And not infrequently it may be needed by both partners in an infertile marriage.”
Hashimotos and Pregnancy
Similarly the presence of Hashimotos’ antibodies is associated with poor pregnancy outcomes. Ten to twenty per cent of reproductive age women have elevated thyroid antibodies. Dr. Roberto Negro from Italy published a study in 2006 of women who had Hashimotos with Elevated thyroid antibodies. Treatment of these women with thyroid hormone resulted in a dramatic reduction of stillbirths and preterm deliveries.(2)
Conclusion: Many cases of Unexplained Infertility and menstrual irregularities are related to low thyroid function. Administration of thyroid hormone often resolves the issue.
Jeffrey Dach MD
7450 Griffin Road suite 190
Davie, Fl 33314
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Header image: courtesy of : Dalene at Natural Fertility Info.com , see You Tube Video: Thyroid Problems and How They Affect Fertility
1) Women with Unexplained Infertility found to have lower thyroid function than Control Patients, (higher TSH values) . See: Tahereh Orouji Jokar, Lindsay T Fourman, Hang Lee, Katherine Mentzinger, Pouneh K Fazeli. Higher TSH levels within the normal range are associated with unexplained infertility. The Journal of Clinical Endocrinology & Metabolism, 2017; “Women with Unexplained Infertlity (UI) had significantly higher TSH levels than controls. Nearly twice as many women with UI (26.9%) had a TSH >2.5mIU/L compared to controls (13.5%; p<0.05).”
J Clin Endocrinol Metab. 2006 Jul;91(7):2587-91.
Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. Negro R1, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H.
Euthyroid women with autoimmune thyroid disease show impairment of thyroid function during gestation and seem to suffer from a higher rate of obstetrical complications.
OBJECTIVE:We sought to determine whether these women suffer from a higher rate of obstetrical complications and whether levothyroxine (LT(4)) treatment exerts beneficial effects.
DESIGN:This was a prospective study.
SETTING:The study was conducted in the Department of Obstetrics and Gynecology.
PATIENTS:A total of 984 pregnant women were studied from November 2002 to October 2004; 11.7% were thyroid peroxidase antibody positive (TPOAb(+)).
INTERVENTION:TPOAb(+) patients were divided into two groups: group A (n = 57) was treated with LT(4), and group B (n = 58) was not treated. The 869 TPOAb(-) patients (group C) served as a normal population control group.
MAIN OUTCOME MEASURES:Rates of obstetrical complications in treated and untreated groups were measured.
RESULTS:At baseline, TPOAb(+) had higher TSH compared with TPOAb(-); TSH remained higher in group B compared with groups A and C throughout gestation. Free T(4) values were lower in group B than groups A and C after 30 wk and after parturition. Groups A and C showed a similar miscarriage rate (3.5 and 2.4%, respectively), which was lower than group B (13.8%) [P < 0.05; relative risk (RR), 1.72; 95% confidence interval (CI), 1.13-2.25; and P < 0.01; RR = 4.95; 95% CI = 2.59-9.48, respectively]. Group B displayed a 22.4% rate of premature deliveries, which was higher than group A (7%) (P < 0.05; RR = 1.66; 95% CI = 1.18-2.34) and group C (8.2%) (P < 0.01; RR = 12.18; 95% CI = 7.93-18.7).
CONCLUSIONS:Euthyroid pregnant women who are positive for TPOAb develop impaired thyroid function, which is associated with an increased risk of miscarriage and premature deliveries. Substitutive treatment with LT(4) is able to lower the chance of miscarriage and premature delivery.
3) Barnes, Broda Otto, and Lawrence Galton. Hypothyroidism: The unsuspected illness. New York: Harper & Row, 1976.