TSH results for fertility treatment

[On_a_mission]

My TSH results are 3.05 mU/L. I had this test done by my NHS miscarriage Dr. The NHS considers the standard range as 0.35 - 5.50 mU/L. The Dr said we should keep an eye on it but no need to medicate for now. To give some context, this Dr has been excellent and I trust her judgment. My private fertility clinic Dr has not given me the same confidence however. Upon sharing my TSH results the fertility Dr was concerned and recommended medication. I protested and asked for some supporting evidence. They simply said it is clinic policy that it should be less than 2.5mU/L, and that different institutions can have different policies. They didn’t understand why I was upset with the conflicting advice I had been given about starting life long medication and it’s relevance to a successful pregnancy. I’m conscious that the clinic probably profits from a private prescription and that an NHS prescription probably costs the NHS. The clinic did offer me an appointment with the medical director to discuss this further. Does anyone know about TSH and fertility treatment??

[CICMAC]

Hi, I am in exact same situation! My TSH is 2.5 and private consultant I spoke to said it needs to be under 2.5 so to keep an eye on it and check regularly. My treatment is NHS and they are refusing to test it as they say it needs to be below 5 so no concerns. I am paying for private blood tests to keep an eye on it but not sure what next steps will be if above 2.5. It’s so frustrating when getting conflicting information 😩

[On_a_mission in reply to CICMAC]

I hadn’t even thought about private blood tests to monitor it! They would cost me £55 each (+ travel costs). A super quick google search tells me low dose medication might be about £40 per month.

[Pnw2020 in reply to On_a_mission]

Endocrinologists generally recommend TSH <2.5 for fertility and would treat with low dose thyroxine. I believe in a normal functioning thyroid TSH is always under 2 and usually under 1.5.See Medichecks for full thyroid check including antibodies. If you get diagnosed with an underactive thyroid you are exempt so don’t pay for medical prescriptions (IVF drugs not included).

[On_a_mission in reply to Pnw2020]

But.. wouldn’t an NHS endocrinologist use the same diagnostic range as the NHS miscarriage Dr?

[Skittles11]

This is a really hard predicament to be in. I originally measured at 3.8 for TSH via NHS test and they said that was in the normal range. When I started fertility treatment I was also told it was fine but I had read a lot that suggested under 2.5 was optimal.

I've been going through fertility treatment for over a year now and have seen more than one fertility consultant. Every single one except the one I mention above has said it needs to be under 2.5 which is hard when NHS use a different range.

The only reason the NHS started to monitor mine was because one of my private tests came back out of range even by NHS standards so they then agreed to monitor me. My clinic wrote them a letter explaining it needs to be under 2.5 for fertility reasons.

It's very frustrating as it's inconsistent with GPS saying one thing and fertility specialists saying something else. X

[On_a_mission in reply to Skittles11]

Thank you for sharing your story. It’s super frustrating different ranges are used in the NHS and private sector. I’m going to look into this more.

[Boo718]

Hi my doctor has also said under 2.5 xxx

[Pnw2020]

Search on thyroid uk forum. Loads of good advice on there. One thing to say is that they advise for thyroid function to be checked in the morning ideally no later than 9 as this is when TSH is highest so can be helpful in getting a diagnosis. You also need FT4 and FT3 tested plus antibodies . I personally saw an endocrinologist privately to get a diagnosis but did a test with Medichecks first. I had tested positive for thyroglobulin antibodies ( which NHS ) doesn’t test for but with that and a rising TSH was diagnosed with Hashimoto’s. In my case it didn’t directly affect my IVF treatment but I made sure it was stable as IVF drugs and subsequent pregnancy can raise TSH.

[On_a_mission in reply to Pnw2020]

Thank you. I was not advised to do the test first thing but did it mid morning. TSH was tested alongside all the other tests the miscarriage clinic does as standard. Unsure if a full thyroid evaluation was done. My vitamin D is low so I’m taking supplements now. Thanks for noting that fertility drugs and pregnancy can raise TSH, I suppose this supports medicating moreso!

[lauraB87]

I went to a private endocrinologist who recommends lower than 2.5. She also said that in such a low dose (which you would need) you can come off it again. It also supports through pregnancy - I’ve had a miscarriage and 3 rounds of ivf. Now have a medicated pregnancy (letrozole) and have made it to 17 weeks and all is well! Only difference is levothyroxine. I get the prescription on the nhs so the private endocrinologist doesn’t have any incentive to prescribe (she even gives me free advice over email). Good luck!

[On_a_mission in reply to lauraB87]

Thanks for noting you can come off the medication on low doses! But how did you get the prescription on the NHS if diagnosed privately - were your levels within the NHS range then? Wishing you all the best for your pregnancy!!

[lauraB87 in reply to On_a_mission]

No, my levels weren’t. The nhs were telling me repeated they were fine but they were at 4. The endocrinologist just wrote to my gp and sent a prescription and I get it through them. My gp now liaises with her if needed. This is in Scotland though but I didn’t think it would be different

[Jana483]

Where I am from they like it less than 2 and that's why I am on medication

[Jane8412]

I found this really confusing too. My clinic is part of a big teaching hospital in London and they said after extensive research the clinic had a top level of 4 for TSH. This confused me since everyone else seemed to say closer to 1 for fertility and at least under 2. After my first round failed and I went private (with the same clinic) I asked if they could prescribe me a low dose of TSH against the clinic policy. They agreed. My next round worked. It may have been a coincidence but I think I’ll ask to go back on it if/when we do our next round. I stayed on it throughout pregnancy and stopped once my son was born. The GP has monitored it since and says TSH is fine by NHS standard. So you can come off it (don’t have to stay on for life). X

[On_a_mission in reply to Jane8412]

This is really interesting, thanks for sharing.

[XOXO13]

Hello,

I’ve received this same conflicting advice in the past. My private (via NHS) fertility doctor said the new guidelines was to have a TSH below 5.5 but my endocrinologist who I’ve seen for years has always said it needs to be below 2.5 to be optimal for TTC… I trust him over my fertility doctor when it comes to my thyroid as that’s his area of expertise.

With my latest transfer, new clinic, my TSH shot up to over 7 following my BFP, they reacted quickly by increasing my medication to 100mg a day. I’ve been taken thyroxine for years as well, on a daily basis without any issues.

It’s also about your T4 & T3 levels. High TSH and low T4 for example can indicate a thyroid issue such an underactive thyroid. Your doctor may also test your TG and TPO antibodies. I have elevated TG antibodies which my fertility clinic treat with steroids, but my endocrinologist says it’s the TPO we need to watch. Worth knowing what they are too.

Anyway, if can be really confusing but it is worth getting checked. I believe most of the research supports a TSH being less than 2.5 when TTC and that’s what I’d always push for. I generally felt better in myself as well when my thyroid levels are stable - I do notice a difference when they’re fluctuating such as low mood and being more lethargic.

Best of luck to you xx

[On_a_mission in reply to XOXO13]

Thanks, I don’t think I was tested for those other things. Was your endocrinologist NHS or private? I’ve read about the symptoms of low thyroid and I probably have a few but on the other hand they are super common ailments many of which I’ve had forever.. 2.5 does seem to be the private sector norm, maybe the NHS is too lax..?

[XOXO13 in reply to On_a_mission]

My endocrinologist was always private. Most of the reading out there says optimal levels for TTC is 2.5 and I felt most comfortable with it being below that number. The T4 and T3 should all under the thyroid screening blood tests so they should have tested you for those. Maybe not the TG and TPO antibodies but definitely the T4 and T3 and without it, it doesn’t tell you much about the TSH in terms of whether it indicates a high or low functioning thyroid xx

[Tarasunny]

I was in a very similar position my TSH levels after my missed miscarriage in August were 3.86, they wanted them under 4 so I thought it was fine. Had another round of IVF in November got pregnant again was asked to have my thyroid checked at 5 weeks it was 5.5. Took till about 6 weeks to get me started on thyroxine unfortunately I found out at my 9 week scan that I had another missed miscarriage the baby stopped growing at 6w5d. I will always wonder if this was why, they say probably not but.... Did get my thyroid checked after 6 weeks on medication and it was 2 so I'm happy with that. Hopefully I'll be in a better position for next round once AF comes. Ended up having an MVA for failed medical management but only discovered it 4 weeks later.I definitely recommend getting it checked if you are worried after a BFP.

[On_a_mission in reply to Tarasunny]

Thank you for sharing your story. Now that I understand that TSH can shoot up in pregnancy, I would be worried about the length of time between identifying it and getting it down.. Maybe medication is the way to go..

[HopeOfYou]

When I started my IVF journey, my TSH was about 4.7. I was treated by the NHS and they didn't even mention that could be an issue. The first cycle failed, the second I had an ectopic surgically removed.

Then I moved to a private clinic, and they said they wanted the levels to be under 2.5. A few weeks after I started the hormone replacement some of the symptoms I had and I couldn't place, started improving. My understanding is that below 5.5 is an average : some people have a low functioning thyroid and cope well with that, others are affected even by a little lack of hormones.

I know it's taken like a medicine, but it's not exactly a medicine : the pill you get contains exactly the same chemical that your body would produce, if the thyroid worked fine.

Anyway, going on with my journey, I had a baby with my first cycle at the private clinic : I managed to transfer 2 and freeze one (first time I froze anything!) And this was from only one ovary, my first attempt I had 11 eggs collected from both but none of the embryos made it to freeze. The private fresh attempt was negative, but the FET is now a lovely 2yo girl.

To go back on the thyroid story : after giving birth, I kept checking my TSH levels, and at some point I got 25 😳 so my thyroid function was indeed compromised, and possibly giving birth made it give up. I now take 125mg levothyroxine every morning to compensate. In Italy I pay the medications something like 2 euros for a 50 pills supply, so it's weird that you have an estimate for 40£ a month. Also, actually a thyroid disorder makes you exempt from paying for medicines in the UK.

[Cinderella5]

My clinic preferred my TSH to be around 1.5. I got put on a low dose of levothyroxine and it came down nicely from 4.96. It's better to be lower for conception and my GP agreed so helped me with a prescription for meds.xx

[sj482]

Thanks all I have read this with interest - after my chemical pregnancy (start of Jan) I paid for a TSH test which showed my levels to be 2.64 - my clinic (I am an NHS patient) said that was borderline and to retest with them at the end of feb. But that it might be worth putting me on low dose of thyroxine. I randomly had blood tests with my GP at the beginning of Feb and the level with them is 3.6. Now I am just blaming myself for the chemical, even though I had no control over it! I have read that taking biotin can interfere with the testing of TSH (and falsely lower it) and so you should avoid supplements with that in prior to the test for a couple of days- my preconception multivitamin had that in and so before the GP test I stopped taking it - maybe that is the reason for the increase?!

[Skittles11 in reply to sj482]

Please don't blame yourself for the chemical pregnancy you had. It was absolutely not your fault.

Thanks for drawing attention to the biotin. I have never stopped taking my multi vitamin before TSH tests and realise now that it would be a good idea to prevent affecting the result xx

[sj482 in reply to Skittles11]

My sensible head knows that and knows even if it was that there is nothing I could have done as didn't know! But there is always that silly voice telling me off for not knowing!

[Marisa32]

Can you go to an Endocrinologist? My clinic wouldn't even do IVF on me, until my TSH was below 2. Ideally closer to 1 when ttc and during the 1st trimester. It's crucial that your hormone levels are where they need to be. The general guidelines do not apply to pregnant women and women ttc, so they should really give you medicine to bring it down. I have Hashimoto's and bringing my TSH and T4 to correct levels is what got me my 2 daughters. Don't let them brush you off, get the medicine or seek a specialist.