TSH levels and starting IVF

[luthien]

Just had my most recent thyroid blood test at my GP (16th April)

Serum TSH level 3.7 miu/L [0.2 - 5.5] - no action required - stay on same medication dose

For reference

1st Dec (2020) - Serum TSH level 14.2 miu/L [0.2 - 5.5]Above high reference limit

16th Feb - Started on 50mcg of Levothyroxine - delayed due to mix up at GP and pharmacy

19th Feb - Serum TSH level 7.7 miu/L [0.2 - 5.5] Above high reference limit

19th Feb - Serum thyroid peroxidase antibody concentration 358 iu/mL [0.0 - 25.0] Above high reference limit

The GP doesn't seem bothered about my TSH level but the letter from my fertility specialist (to my GP) says it needs to be below 2.5 to start IVF, so what do I do now? I need a dose adjustment (and of course a repeat test to start IVF but the GP just says it's in the normal range.

[DianeArnold Partner Nurse Fertility Network UK]

Hi luthien. I agree with your specialist. Although your levels have been within normal range, usually beforer starting IVF etc they like it to be a bit below 2.5 Speak to your GP who may start you on a low dose of levothyroxine. Good luck. Diane

[Jane8412]

Sounds very frustrating. You would hope the GP would take on board the advice from the clinic and adjust your dose to bring your TSH down. I had an issue where the GP said my TSH was fine at 2.6 but my naturopath said ideally closer to 1 for fertility. I had the Fertility clinic test it again and it had gone up to 3.6 in less than a year. I expressed my concern but they said their clinic policy was below 4 was fine for fertility. I had a failed round in Dec and told my clinic I was uncomfortable having a TSH level so close to 4 and would like to take a low dose of Levothyroxine. The clinic ended up prescribing it to me. Now that I am pregnant they are checking my levels to ensure they remain low. Last reading was 2.04 so at least the Levothyroxine is working.

Could your fertility clinic get involved and up your dose of levothyroxine?

[luthien in reply to Jane8412]

Wow, thanks for letting me know how things worked out for you.

I shall see if I can approach the thyroid subject with my GP from the point of view of my fertility - they may respond better to that.

My fertility clinic is private so will cost a bit for a consultation, I can try through the secretary first and see if they can send a letter to my GP - that may cost as they've already sent a post consultation letter saying "I would like to see her TSH level below 2.5 then we can proceed with IVF". So that's kind of as clear as she can be!

[Jane8412 in reply to luthien]

Ah yes, definitely go back to the GP then. No way you want to be spending any more than is absolutely necessary. This process is already expensive enough! Good luck with your GP. Hopefully after a gentle nudge they are open to upping your dose.

[Cinderella5]

My clinic wanted my TSH under 2. They gave me a letter to give to my GP asking him to assist in bringing it down to suitable levels of under 2 in preparation. The NICE guideline also say it should be lower for pregnancy so perhaps you could quote that and the letter from your clinic may help?!xx

[luthien in reply to Cinderella5]

I've mentioned it to them, so hopefully they'll do something. Frustratingly it's only an e-consult sort of thing, so now I just need to wait for a reply email and then see if they'll amend my prescription / do a telephone consultation.

Lets hope they do something as I would like to start IVF soon considering I have low AMH levels (5.6), and 37, with endometriosis which I had surgery for in January (this year) specifically so I could be at my best for any fertility treatment.

[Cinderella5 in reply to luthien]

Could you email them a copy of the letter or drop a copy through the Drs letterbox for the attention of who you've been speaking to? I was very lucky that my GP was switched on that my levels needed to be lower for fertility? Like I said try quoting the NICE guidelines thing and see if they listen. Good luck.xx

[luthien in reply to Cinderella5]

The letter is on my record, so I've referred them to that, including the date and whom the consultant is so they should be able to find it.

The GP won't accept email attachments as enquiries are all managed through their online system. Good idea about dropping a copy of a letter in; I shall do that when I next go that way or if they do not seem to understand from my e-consult query.

thanks for your advice, hopefully something works.

[Marisa32]

My endocrinologist also recommends TSH levels below 2, ideally 1 for women ttc. GPs have no clue about optimal range for women trying or pregnant women. Any chance you can find an endocrinologist to sort it out for you? Thyroid really is crucial for a successful pregnancy.

[luthien in reply to Marisa32]

Thanks for the info. It's frustrating that GPs don't know about it; they say "if you're having problems TTC come see us", so I did and they weren't interested in checking any levels. I had my yearly blood tests which showed high TSH and they just said "here's some medication", no mention of how it affects TTC, I had to read up and now feel like that last two years has been a waste of time as I'm not getting any younger, two years ago my TSH was at the top end of the normal range so around 4 something which even then could have caused the problems TTC.

I've noticed up until 6 months ago I've had normal basal body temps, which increase after ovulation (CD14) for two days and then decrease until my period. Recently though over the last 6 months they peak after ovulation and stay increased until CD26, then they plummet and I have my period (my cycles are 28 days). Researching into this, it can show implantation failure, but it's not well researched so doctors don't take note, my GP wasn't bothered. Coincidentally the past 6 months look to be when my TSH levels were the highest.

My GP won't refer me to an endocrinologist, so I'll have to go private without a referral, which will cost quite a lot. I have booked in to see a private GP (that's about £90), hopefully they'll be able to see the links and get me on the right medication dose. I'm then happy to keep my thyroid treatment at the private GP.

We shall see x

[Marisa32]

Oh I see, can't believe your GP is not only ignorant but also won't refer you to a professional. That's scary actually. The first IVF clinic I walked into sent me to an endocrinologist, as they wouldn't even begin treatment until my thyroid was below 2. Hopefully this new GP will be more helpful. Assuming nothing else is wrong apart from thyroid levels, fixing them would save you a lot of heartache and money in the long run.

[Sarah_37]

I had to get my fertility clinic to send my GP a letter and then they agreed to increase my dose x

[luthien in reply to Sarah_37]

Ah that would be my next thing to do

[Hobbies89]

Hi, I am under an endocrine specialist who changes my levothyroxine levels and works directly with ivf clinic instead of GP (just copies them into letters) but I also had to have it under 2.5 to start ivf. We sadly lost a pregnancy in 2019 as my thyroid went crazy and my T4 was 59 and TSH very high. Ended up having the thyroid removed. They like it to be low and stable prior to ivf. I was told under 4 for natural pregnancy but not sure why the difference, I was told under 2.5 is a HFEA requirement. Mine is currently 0.08 but they were always more keen in making sure T4 was under 22 for me. I’ve just been through ivf and got a bfp. Good luck x

[luthien in reply to Hobbies89]

Yay, congrats!

Thanks for sharing how it's gone for you. I shall see if I can push for an endocrine specialist, last time I asked my GP she just said they don't refer unless it needs more investigation.

I shall keep pushing