TSH result six days before transfer

[Skittles11]

Hi all.

I am currently in the middle of a frozen cycle which I was eventually able to start in August after 4 months of delays for various reasons.

I have had several TSH tests over the past few months to ensure my levels were acceptable prior to starting treatment. However recent results have got me worried as I am only six days away from embryo transfer. These are my results:

30th June - 1.86 - result was fine and approved to start treatment

9th August- 2.0 (four days after starting oestrodiol)

18th August- 2.85 (fourteen days after starting oestrdiol). I had to push to get retested as clinic were convinced it would be fine but I was convinced it was increasing.

I am currently taking 50 mcg Thyroxine.

The clinic have told me to increase my dosage by 25mcg now and the doctor is happy to go ahead with the transfer without retesting beforehand. I dont know what to do though. Will the increased dose make a difference at this stage?

I dont produce many eggs per cycle due to low AMH and we certainly do not want to waste the two frozen ones we have on a sub- optimal environment.

On the other hand we have waited four long months to commence our cycle. Goodness knows if/ when my body will allow us to do it again.

Should I get bloods retaken a couple of days before transfer and make the decision then based on that result?

I appreciate any help or guidance you can give on this issue as I feel like I just don't know what to do.

Thank you x

[XOXO13]

I wouldn’t worry too much about it as you’re only slightly over the recommended 2.5 for pregnancy and that’s up for debate amongst professionals anyway. My previous consultant said new evidence suggests anything under 4 is acceptable where as my endocrinologist likes it under 2.5. Mine is elevated and after I got my BFP it elevated to over 7 so my thyroxine dose was also increased. It works quite quickly. It may be worth having it rechecked after transfer and hopefully when you get a BFP 🤞🏻☘️ Xx

[Skittles11 in reply to XOXO13]

Hi, Thank you for your response and reassurance. My previous consultant took a similar perspective based on some new evidence. However everyone else at my clinic has always classed 2.5 as the magic number. I feel lost about what to do now that my numbers are above the 2.5, but maybe the meds would work quickly and bring it back down. It just feels like a lot of guess work and hope.

[XOXO13 in reply to Skittles11]

I would trust the advice of your clinic. I just know mine is usually always on the higher side of 2.5 and I’m pregnant and it must have quickly elevated post transfer to get to 7+. So long as it’s managed with your medication and carefully watched, then I think you’d be okay to go ahead but I also understand why you wouldn’t want to chance it so trust your doctors and your own gut ☘️ Xx

[Skittles11 in reply to XOXO13]

Hi, thanks for coming back to me again. When you say yours was the higher side of 2.5, do you mean it was above 2.5 before or around your transfer time? That's good advice, at the moment my gut is telling me to get retested before transfer to see if there is any change. I'll just have to hope that the meds work quickly!

[XOXO13 in reply to Skittles11]

I can’t remember my exact numbers as they fluctuate so much. I’ve gone from 5.5 with my first transfer down to 1.8 at its lowest then back up to over 2.5. Constantly changing my dose of thyroxine! But the meds do work quickly. Just keep an eye on it 🤞🏻 Xxx

[Pnw2020]

Hi.

Just wondering if you take the thyroxine a fews hours away from your other medication as if not that might affect the absorption. I recall being told it was a fussy medication and likes to be taken alone!

[Skittles11 in reply to Pnw2020]

Thank you for this, although I do take the Thyroxine away from other medication I could definitely stand to increase the gap. I wasn't told to take it away from other meds but will take this advice for sure!

[Marisa32]

My endocrinologist recommends TSH to be between 1 and 2 pre-pregnancy. Closer to 1 is better. Not sure why they haven't increased your dose when they saw your TSH number going up. 2.85 is not ideal, so I get your worries. Can you delay transfer? It will take 2 to 4 weeks for the number to come down with higher dose. The fact alone that you had to push them to check TSH, the clinic itself wasn't even on top of this is reckless to me. Especially if you don't have tons of embryos on ice to risk it. Not sure if this is free NHS treatment but if you are paying for this type of poor service, I would be pissed.

[Skittles11 in reply to Marisa32]

Hey, thank you for your reply. I do feel a little let down by the clinic as I feel like I've had to push them to even do the repeat test. The test I had on 9th August was actually done at GP and so I wonder if that had anything to do with their laissez-faire attitude about it. We are private patients. I dunno but I am feeling quite lost and vulnerable about it. The problem is I have taken months to start this cycle because of my periods and I worry that I will have a repeat of all of that again which may delay by months again. Feeling very frustrated with it.

[gianna83]

I have Hashimoto's and i think that your levels will be fine by transfer.Why don't you ask them to increase your dosage a little bit so that it will get lower more quickly?For me,it takes about 6-7 days to lower my levels (i know because i can re-check often,testing for tsh is cheap where i live).

[Skittles11 in reply to gianna83]

Thank you for replying and for telling me of your experience with how fast the meds can work. This is useful to know. I know it will be difficult to speak to them about increasing the dose further as they'll not be there with it being a weekend but it is a good idea, wish I'd been more pushy about it on the phone yesterday!

[Squareark]

I think you will be fine to go ahead with the transfer, though I do understand the worry. A couple of things to echo what previous posters have said:

A) 2.5 is not a hard cut-off, I've definitely heard 4 get thrown around. I've looked at some research literature about TSH and pregnancy (cuz my clinic forgot to check mine and I was 8 weeks pregnant with my TSH levels at like 4), and I think the levels to worry about are like TSH at 10, which may cause birth defects. I haven't come across anything about TSH and implementation, but maybe it's because I wasn't super focused on that.

B) It takes about 1-2 weeks for the medication to come into affect, so you probably won't see a decline until later.

C) My endo has recommended that I take the medicine early in the morning, an hour before I eat/drink anything else (especially anything with milk cuz Vitamin D counteracts the drug).

D) I'm not sure which medication you are using, but the generic brand didn't work me, so I have to take the branded Synthroid.

I think you are fine to transfer, but I totally get the worry. I think if you are at all unsure and uncertain, maybe do wait for another cycle, at least that's what I would do. I've had 3 transfers, and 1 of which didn't work. I still beat myself up over things that I could have done (TCM, more progesterone, more rest etc.) for that transfer. So it's important to me to feel like I've done everything in my power, even though I know I have very little control over the outcome.

It's a really hard process and I have my fingers crossed for you! Good luck with your decision and lots of baby dust!

[Skittles11 in reply to Squareark]

Hi, thank you for taking the time to reply - there is some really useful information here. I think one of the things that has made me question what to do is that 2 months ago my TSH was 2.7 and the clinic told me to wait to get it lower before starting a cycle. Now it's 2.85 and they're saying I can go ahead...so it's mixed messages and leaves me in turmoil about what to do.

Maybe they take a different view because I've already started the drugs whereas before I hadn't.

Since my most recent result I have been taking the meds really early in the morning, hours away from anything else, thank you for the advice.

Useful to know what your endocrinologist said. Maybe I need to look into getting myself an endocrinologist as I feel nobody is really looking after that side of things, I'm having to point everything out myself and get worried in case I miss something.

Thanks again for your thoughtful reassurance and practical tips 👍

[Squareark in reply to Skittles11]

I agree, the mixed messaging is very anxiety-inducing. I'm not sure about protocol in the UK, but in the US (at least NYC where I am), I think the clinics are required (by protocol not law) to monitor your TSH levels but the doctors are actually not too concerned as long as it's within reasonable levels. I know I freaked out when my TSH reached 4 but they didn't seem bothered (which, like you, made me question their professionalism).

Definitely agreed on getting an endo, I think the initial tests they ran on me to rule out potential underlying issues (like Hashimoto's) were pretty useful. To be honest, I think my endo was even less concerned about my TSH levels for pregnancy (I was at 4.5 when I went to the fertility clinic), she didn't even bother to schedule me for follow-ups once my levels reached 2.3. To clarify, I think she was a really good doctor, but was just not concerned about my TSH and pregnancy.

Separately, I totally hear you on feeling like you have to manage your own care, I felt/still feel that way; definitely wish I could have a doctor that I trust to look after me. Although I guess the silver lining is that we learn a lot more about the process and can make more informed decisions (hopefully).

Good luck with your decision, I believe that you'll be fine either way, but definitely go with the decision that feels right to you. Rooting for you and your little embabies!

[Skittles11]

Thank you to everyone that commented on this post. I had my TSH retested and it has come down to 2.32 so we are planning to go ahead with our transfer tomorrow! Feeling very nervous and hoping beyond hope that the embryo survives the thaw 🤞

[katiehopeful81]

Hi Skittles11 how did your transfer go? Have you had your TSH re-tested since? X