Ivf loss - due to lack of TSH/ Hypothyroidism monitoring? Any advice appreciated :)

[Timmytoop]

Hello all, very useful & supportive group this! thanks in advance for any thoughts.. My partner has hypothyroidism, and takes levothyroxine for it. She had 1st ever IVF transfer (frozen) in November, which became positive but sadly didn’t get past 4 weeks.

Out of curiosity, she asked her GP to test TSH a few days after finding out about the loss and it was 6.65- way above the levels it should be to maintain pregnancy. Originally, she had asked her GP/ fertility doctors to test TSH before transfer, but they didn’t think it was needed (Her last test was in the summer). She thinks this could've been a big error, possibly causing loss of our embryo.

She also read the progesterone and estrogen she was taking for a month can disrupt to thyroid levels?

Just wondered if anyone has experience with this?

For our next transfer, wonder if need to be able to increase the dosage immediately and / or have levels monitored better during treatment and transfer, so her levels won't be able to affect pregnancy.

We've reached out to our hospital anyway (NHS funded), to ask this.

Many thanks for any thoughts or suggestions

Tim

[JA-fnuk Partner Nurse Fertility Network UK]

Thinking of you both - sending a big hug. Now they are aware of the issue with the thyroid they should be able to factor it in to the next treatment protocol

Take care of each other

Janet- Partner

[Timmytoop in reply to JA-fnuk]

Thanks very much Janet, we hope so

[Eloquentia]

Hi! I have hypothyroidism too. My clinic wouldn't test my TSH, FSH and very importantly TPO antibodies levels before transfer but they directed me to ask my GP to do so, which worked. Levels were normal at the time. However, I had been told that it is very common for these hormones to rise during pregnancy, so I paid for private blood tests in my first trimester to see if the levels were holding on with my current dose of levothyroxine. It is the common practice in the UK to double your dose in the second trimester (without testing!) because of how common it is for the levels to rise as the blood in the body increases by 50%. They didn't tell me to go back to my original dose after birth and I started feeling poorly, so worth asking the GP for tests and help then too. Good luck!

[Timmytoop in reply to Eloquentia]

That's all really helpful, and useful! thanks so much for taking the time. pass that on to my partner. Hopefully we can arrange to have tests at the necessary times on our next go 👍

[Millbanks]

Hi Tim,

I don't have hyperthyroidism but I do have a very slightly elevated thyroid (just tested by my GP when we started TTC) and so I have always taken levothyroxine whenever I'm going through IVF treatment to keep it low.

I think mine was about 2.7 and it should be under 2.

I'm not sure this would have caused the embryo to stop growing, but it's not ideal conditions for it so best to get it under control for sure.

I've never thought to test it during treatment but we had a successful pregnancy while I was on medication for it.

x

[Timmytoop in reply to Millbanks]

Thanks so much! That's encouraging we'll definitely look to get the dose monitored a bit better

[BearPanda]

Hello! GPs are terrible at advising on thyroid levels. I have Hashimotos and I've been Levothyroxine for 6 years now (TTC 2 years). A few info which I got from my endocrinologist who I consult privately:

- TSH must be below 2.5, ideally aiming for 1.5. Featus does not have a functioning thyroid pretty much until the birth and relies on mother's production of thyroid hormones to develop so you must have a good 'buffer' as the minute it implants you start to support the developing embryo and the levels will start to rise. They cannot go over 4.5 in that period so you must have enough in your system to get you through until the pregnancy test.

- do your blood tests monthly to monitor levels. It's a hormon and it will fluctuate, like you said and this could be affected by how well it is absorbed. Always take the tablet in the morning on an empty stomach. I take it with a glass of hot lemon tea; boosts absorption.

- if your TSH is slightly off (2,5-4) do a 'buster' for one day ;take one table of the next dose up (+25mg) instead of your usual does and retest in a month

- Your thyroid tests must include T3 and T4 levels as those conversations are crucial. You must test for antibodies at least once a year.

- I do private blood tests with Randox; they are cheap and have a quick turn around. At this point I am able to monitor a lot of things myself but call my endocrinologist if in doubt

- from the day of a positive pregnancy test you must increase your dose by 25% and go for a blood test to check levels. you will be on a higher dose until you give birth, switch back to the previous dose on the day of delivery

Hope this helps!

[Timmytoop]

That is so, so helpful. Partner sends thanks too! She's realising, as you say, you do have to be your own advocate so much, as it's not always taken into account by doctors. And I think hopefully they'll prescribe 25s,so she can make little adjustments when necessary. (she's got 100mg currently). We'll raise all this with our meeting back with the doctor in a week or two. And hopefully get her levels in order, and get this all taken on board, before we go again with embryo No.2. Thanks so much again

[BearPanda in reply to Timmytoop]

Good luck to you both!!!! ☺️☺️☺️

[DLZ321]

hello! I am on levothyroxine (100mg at the moment) and it’s driving me wild 😂

My clinic did actually test this in the final bloods before starting IVF & said my levels were too high to start (at that point was around 5.6) so it was something on their radar from day 1. After adjusting my dose my level came down to 4ish - at this point they advised I could start with my first cycle with current level at the top end of normal but for transfer id have to be below 2.5 (I’m doing 3 rounds back to back before transfer so have some time to get my level down).

Out of interest, has your partners level dropped as she’s increased her dose of levothyroxine? This year I have increased from 25 to 50 to 75 to 100 and my levels have seemed to randomly fluctuate between 4 and 8. My most recent test results yesterday based on 100mg taken for 5 weeks came back at 7.56, last month after increase to 75mg it had gone down to 4.71. I take my tablet roughly at the same time every morning, an hour before food & drink so it’s really frustrating.

I’ve actually got an app with my GP today as I’m going to ask to be referred privately to endocrinologist - hopefully be able to get to the bottom of it!

[BearPanda in reply to DLZ321]

Hello! Sorry to jump on this, but I've been looked after a wonderful private endocrynologist and monitoring thyroid is way more complex than GP powers, it seems 😅 things that are worth asking your GP about is whether they checked antibodies and what is your T3/T4 conversion like? Don't let them brush this off; this must be checked following NHS guidance. You might require a different type of thyroid medication (triiodothyronine to mimic T3) if your body struggles with conversion. If you have autoimmune roots of under active thyroid there is a calculation you do to work out your done which is 1.7x your weight in kg= dose in mg. Eg. If you weigh 70kg then your dose is 70x1.7=119, round up to the nearest dose which would be 125. Also if you have autoimmune roots, you will have low stomach acid and won't be able to absorb properly, so take your medication with a cup of hot water with lemon to increase acidity (it worked really well for me and I was able to reduce my dose). Hope this helps!

[DLZ321 in reply to BearPanda]

Wow thank you so much, your message was super helpful! You’ve provided way more info than my GP has to date, and I’ve had several appointments 😄

She has no idea why my levels are fluctuating and neither do her colleagues apparently. When I mentioned about private medical cover she was very keen for me to go down that route (to avoid having to do more blood tests/wait longer) so I’m currently on Bupa having a look at different consultants! When choosing someone, can it be any endocrinologist or did you see someone who specifically deals with IVF?

Also really interesting about possibly requiring a different type of medication. Basically nice to have other options outside of ‘are you sure you’re having your tablet on an empty stomach?’ !