Thyroid and fertility/IVF

[Mlove12]

Hi all,

Just got aome thyroid results back and they have come back satisfactory but a little higher than they would ideally like for fertility. I need to forward results to my clinic to see what they say but just wonderee if anyone else had experience with this and how your clinic managed it/next steps?

Thanks x

[Camkid12]

Hi Mlove,

I've recently been diagnosed with sub-clinical hypothyroidism. So far I haven't had any success/improvement, and I'm still researching what I can do about it, but thought I'd share my experience so far.

Prior to referral to IVF clinic (Dec 2020), my TSH was tested and came back at 4.5. I was advised to get it re-checked in a months time, which I did. When I called GP surgery for results they said it was slightly raised, and to go back in 6 months. I was happy that there didn't seem to be any concern.

Skip forward 11 months and one failed IVF cycle later, I decided to go back to my GP and get it checked again; mainly out of curiosity, and because of some posts I'd read on here. TSH was 6.9 by this time. I passed results to my clinic who then told me they like it to between 2 and 4 for IVF, so they put me on 25mcg Levothyroxine.

Started the second IVF cycle in January this year and purely for my own piece of mind, I decided to get it checked again at GP - it was now at 7.1. Again, I passed this info to my clinic who then cancelled the whole cycle and put my dose up to 50mcg.

I'm now waiting for further blood tests in 2 weeks time to see if my TSH is starting to come down. It seems to be a slow process, and they can only increase dose by 25mcg each time so you don't risk being over medicated. Also - GP's don't seem to acknowledge that TSH needs to be lower for fertility purposes - this is why I was told it was satisfactory, when in reality it was not!

According to some other articles I've read, your TSH should ideally be below 2 for IVF. Also, if you have a look at the Thyroid UK website (they have a forum on Health Unlocked too), they suggest that T3, T4, antibodies and vitamins/minerals should be tested too. This is something that doesn't seem to be offered on the NHS, so I have organised private testing for next week.

Sorry for the long post - but I wish I'd known this a year ago and they wouldn't have wasted my first cycle!

You say that your test came back slightly high - I assume it was your TSH level? If so, the standard treatment just seems to be a little tablet. Nice and straightforward, it will just depend on how high the level is, and how quickly the medication works for you I guess.

Good luck with your next steps, hopefully an easy solution and you can move forward to the next stage of your journey.x 🥰

[Mlove12 in reply to Camkid12]

Hi Camkid12,

Thanks for a really insightful response.

My TSH was 4.6 so similar to your own. My clinic has said ideally for it to be 2.5 however have asked if my doctors can do another blood test which is anti TPO, im not entirely sure what this is, have you heard of it? They said if this is under 34 then my thyroid level is fine and i wont need medication, but if its higher i will need medication.

I was worried medication would take a while to kick in and take effect on levels, but would much rather everything be at the level it should before starting.

Personal question but can i ask how your periods are with your levels before medication? Mine only last one day and saw that is an effect of a higher thyroid level but dont have any of the other symptoms.

Will definitely take a look at the website you suggested.

Hope your well

[Camkid12 in reply to Mlove12]

You’re welcome, the thyroid is such a minefield and there is so much conflicting information! Everyone will be different I suppose, but I feel that the more info we can gather then the more informed we are, which can only help us.

I believe the TPO is to do with antibodies, and if you have antibodies then that suggests am autoimmune disease. The TPO enzyme helps conversion of T4 to T3, but if we have antibodies then this affects to process. My GP will only test TSH and T3, so I’ve arranged a full set of tests privately.

My periods were mostly regular before medication, generally every 30-34 days, and last 4-5 days. Don’t know what they’ll be like now due to IVF being cancelled half way through, still waiting on 1st bleed.

I was on 25mcg for 11 weeks and it made no difference at all. Been on 50mcg for the last 2-3 weeks and will find out a week on Monday if it’s working 🤞

Interestingly (and annoyingly!) I had no symptoms at all before, and since being medicated I feel really tired and my skin is dryer, also put on a little weight 🤷‍♀️ . It’s frustrating as my GP wouldn’t have bothered medicating me if I wasn’t doing IVF, but the clinic don’t seem to care about my thyroid and how I’m feeling, they just want TSH down. Can’t win!!x

[Skittles11]

Hi

The advice regarding thyroid and TSH seems so inconsistent which makes it very hard to make sense of.

My TSH was 3.8 when I first had it tested for fertility purposes and the GP said that was fine. I then discovered from an accupuncturist that this was pretty high when TTC and was told under 2.5 is best.

My doctor at my fertility clinic at that time said that 3.8 was also fine but put me on 25 mcg Thyroxine to appease me. Other doctors I had at the same clinic on subsequent cycles wanted it below 2.5 so even within the same clinic, fertility doctors were managing it differently and it was very inconsistent for me.

I monitored my own TSH through my fertility clinic by requesting regular bloods, and on one occasion it was nearly 5.0 and the antibodies were high. It was at this point I was able to get support from the GP as my results had surpassed their criteria for Thyroid. They now monitor me rather than the private clinic.

My new clinic want TSH below 1.0. So again, huge inconsistency between and within clinics.

Hopefully your clinic can offer some useful input, fingers crossed but personally, I would get your clinic to support you in getting it below 2.5 as that does seem to be the consensus overall (from what I've seen and heard anyway). X

[Mlove12 in reply to Skittles11]

Hi Skittles11,

Thank you for replying.

My clinic also agree that they would like it to be 2.5 ideally, they also said that its pretty much up to me if i want to take medication, they wouldnt cancel the treatment etc if i said no.

They also asked my doctors to check anti TPO, have you heard of this? They said if its under 34 then i wont need medication but if its over they would recommend taking medication to bring TSH level down, mine is currently 4.6.

Thanks

[ruth1988]

We met with our consultant last week to discuss starting our second round following a BFN in December. I shared my blood results with him, which I had done through my GP. My TSH level is 3.4 and the consultant said he would like it below 2.5, so he prescribed me 25mg Levothyroxine. I'm not sure how I check if it's working to be honest. Ideally I'd like to check it again before we start our next cycle, but he didn't mention any follow up.

[Pnw2020 in reply to ruth1988]

Best to check thyroid function 4-6 weeks after a dose increase. You could ask your clinic/ GP or test privately. See Medichecks or Monitor my Health. I also tested just before test day so I knew if my TSH had increased with treatment or not.

[Pnw2020]

Hi. As mentioned above I highly recommend searching for similar posts on thyroid uk forum.

I spoke with 2 endocrinologists privately who both agreed TSH should be under 2.5 for optimal fertility and T4 in the upper third. I look at blood tests results as part of my job and TSH is usually 1 something, so I over 2 could indicate a thyroid issue but at that stage you may not be symptomatic.

TSH varies throughout the day so an afternoon blood test may appear lower or only slightly over range so best to test in the morning. I tested privately with medichecks and was found to have high thyroglobulin antibodies. TPO antibodies were normal for me but if either is raised this leads to a diagnosis of Hashimoto’s. ( you are entitled to free prescriptions ). NHS will only test for TPO antibodies.

I personally didn’t start IVF until levels were consistently under 2.5 and needed several dose increases to find the right level. TSH rises in early pregnancy and you often need a dose increase as the baby needs your thyroid hormones for their own development.

I also gave up gluten and stopped took separate vitamins rather than an multi-vitamin that has iodine. I can’t say that this directly influenced my thyroid function but tends to encourage you to eat healthier.

I hope that helps and good luck x

[Jana483]

My doctor like my thyroid to be under 2