Thyroid & Infertility

The Connection between Thyroid & Infertility

How Thyroid affect fertility?

• Hypothyroidism: It occurs when the thyroid gland does not produce enough thyroid hormones. Symptoms of hypothyroidism include fatigue, weight gain, depression, and irregular menstrual cycles. In terms of fertility, hypothyroidism can cause:
  • Irregular menstrual cycles: This can make it difficult to predict ovulation.
  • Anovulation: Absence of ovulation, leading to infertility.
  • Increased risk of miscarriage: Due to hormonal imbalances.
  • Luteal phase defect: Shortening of the second half of the menstrual cycle, affecting implantation.
• Hyperthyroidism: It occurs when the thyroid gland produces too much thyroid hormone. Symptoms include weight loss, anxiety, tremors, and irregular menstrual cycles. In terms of fertility, hyperthyroidism can cause:
  • Irregular menstrual cycles: Similar to hypothyroidism, making ovulation unpredictable.
  • Decreased ovarian reserve: Reduced number of viable eggs.
  • Increased risk of premature birth: And low birth weight in pregnancies.
• Autoimmune thyroid disorders: Autoimmune disorders such as Hashimoto’s thyroiditis (leading to hypothyroidism) and Graves’ disease (leading to hyperthyroidism) can also affect fertility. These conditions interfere with the immune system’s ability to support a healthy pregnancy.

Diagnosis of Thyroid-Related Infertility

Diagnosing thyroid-related infertility is a comprehensive process that involves multiple steps to accurately identify and understand the nature of the thyroid disorder and its impact on fertility. Here’s an overview of the key diagnostic procedures:

1. Initial consultation

The diagnostic journey begins with an initial consultation. During this visit, your healthcare provider will:

• Conduct a thorough review of your medical history.
• Discuss your symptoms and any concerns you may have.
• Ask about your menstrual cycle regularity, duration, and any noticeable changes.
• Inquire about previous pregnancies, miscarriages, and overall reproductive health.

2. Physical examination

A physical examination may be performed to look for signs of thyroid dysfunction, such as:

• Enlargement or swelling in the neck (indicative of goitre).
• Dry skin, hair loss, and changes in weight (common in thyroid disorders).
• Reflexes and heart rate abnormalities.

3. Blood tests

Blood tests are essential to measure thyroid hormone levels and other related markers. These tests typically include:

• Thyroid-Stimulating Hormone (TSH): High TSH levels suggest hypothyroidism, while low TSH levels indicate hyperthyroidism.
• Free Thyroxine (FT4) and Free Triiodothyronine (FT3): These tests measure the active thyroid hormones in your blood. Low levels indicate hypothyroidism, and high levels suggest hyperthyroidism.
• Thyroid Antibodies: Tests for thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb) help diagnose autoimmune thyroid disorders like Hashimoto’s thyroiditis and Graves’ disease.

4. Imaging tests

Imaging studies provide a visual assessment of the thyroid gland’s structure and any abnormalities. Common imaging tests include:

• • Thyroid ultrasound: Uses sound waves to create an image of the thyroid gland, helping detect nodules, cysts, and gland enlargement.
  • Radioactive Iodine Uptake test (RAIU): Measures the thyroid gland’s ability to absorb iodine, which is crucial for hormone production. This test helps differentiate between different types of hyperthyroidism.

5. Additional Diagnostic Procedures

Depending on your individual case, your healthcare provider may recommend additional tests, such as:

• • Fine-needle aspiration biopsy: In cases where nodules are detected, a biopsy may be performed to rule out thyroid cancer.
  • Basal body temperature charting: Monitoring basal body temperature can help identify ovulation patterns and any disruptions caused by thyroid dysfunction.

6. Hormonal Evaluation

Since thyroid disorders can affect overall hormonal balance, your healthcare provider may also assess other hormones involved in reproduction, such as:

• • Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH): To evaluate ovarian function.
  • Prolactin: Elevated levels can interfere with ovulation and are sometimes associated with hypothyroidism.
  • Estradiol and Progesterone: To assess ovarian and luteal phase function.

7. Comprehensive Fertility Assessment

In addition to thyroid function tests, a comprehensive fertility assessment may be performed to evaluate other factors that could affect your ability to conceive. This includes:

• • Hysterosalpingography (HSG): An X-ray test to check for blockages in the fallopian tubes.
  • Transvaginal ultrasound: To assess the ovaries, uterus, and endometrial lining.
  • Semen analysis: To evaluate the male partner’s fertility.

By combining these diagnostic approaches, healthcare providers can develop a thorough understanding of how thyroid disorders are affecting your fertility. This comprehensive evaluation is essential for creating an effective treatment plan tailored to your specific needs, ultimately improving your chances of conceiving.

Treatment of Thyroid-Related Infertility

Treating thyroid-related infertility involves addressing the underlying thyroid disorder to restore hormonal balance and improve reproductive health. The treatment plan will depend on whether you have hypothyroidism, hyperthyroidism, or an autoimmune thyroid condition. Here’s a detailed overview of the treatment options:

Hypothyroidism Treatment

Hypothyroidism is characterized by an underactive thyroid gland that produces insufficient thyroid hormones. Treatment focuses on hormone replacement and lifestyle adjustments:

• Medication
  
  • Levothyroxine: This synthetic thyroid hormone is the standard treatment for hypothyroidism. It helps restore normal hormone levels, thereby regulating metabolism and supporting normal ovulation and menstrual cycles.
  • Dosage monitoring: Regular blood tests are essential to monitor TSH levels and adjust the medication dosage to ensure optimal thyroid function.
    

• Diet and Lifestyle
  

  • Balanced diet: A diet rich in iodine, selenium, and zinc can support thyroid health. Foods such as fish, dairy, eggs, nuts, and seeds are beneficial.
  • Exercise: Regular physical activity helps maintain a healthy weight and overall well-being, which can positively impact thyroid function and fertility.

Hyperthyroidism Treatment

Hyperthyroidism occurs when the thyroid gland produces excessive thyroid hormones. Treatment aims to reduce hormone production and alleviate symptoms:

• Medication
  

  • Antithyroid drugs: Medications like methimazole and propylthiouracil (PTU) help reduce thyroid hormone production. These drugs are typically the first line of treatment for hyperthyroidism.
  • Beta-blockers: These may be prescribed to manage symptoms such as rapid heart rate and anxiety until thyroid hormone levels are under control.
    

• Radioactive Iodine Therapy
  

  • Purpose: This treatment involves taking radioactive iodine orally. The iodine is absorbed by the thyroid gland, where it gradually destroys overactive thyroid cells, reducing hormone production.
  • Monitoring: Patients need regular follow-ups to monitor thyroid function post-treatment, as this therapy can sometimes lead to hypothyroidism, requiring subsequent hormone replacement therapy.
    

• Surgery
  

  • Thyroidectomy: In cases where medication and radioactive iodine therapy are not effective or suitable, surgical removal of part or all of the thyroid gland may be necessary. Post-surgery, patients will require lifelong thyroid hormone replacement therapy.

Treatment of Autoimmune Thyroid disorders

Autoimmune thyroid conditions, such as Hashimoto’s thyroiditis and Graves’ disease, require specific treatments to manage both the thyroid disorder and its impact on fertility:

• Immunosuppressive therapy
  

  • For autoimmune conditions, immunosuppressive drugs may be used to reduce the immune system’s attack on the thyroid gland.
    

• Hormone Replacement and Regulation
  

  • Hashimoto’s Thyroiditis: Typically treated with levothyroxine to manage hypothyroidism.
  • Graves’ Disease: Managed with antithyroid medications, radioactive iodine, or surgery, similar to other hyperthyroidism treatments.

Assisted Reproductive Technologies (ART)

For couples struggling with thyroid-related infertility, Assisted Reproductive Technologies (ART) can be an effective solution when combined with thyroid management:

• In Vitro Fertilization (IVF)
  

  • IVF involves fertilizing an egg with sperm outside the body and then implanting the embryo into the uterus. Properly managing thyroid levels can enhance the success rate of IVF by creating a favourable environment for implantation and pregnancy.
    

• Ovulation Induction
  

  • Medications like clomiphene citrate or gonadotropins may be used to stimulate ovulation in women with thyroid-related anovulation (absence of ovulation).
    

• Intracytoplasmic Sperm Injection (ICSI)
  

  • In cases where male factor infertility is also present, ICSI can be used in conjunction with IVF to inject a single sperm directly into the egg.