Cause of infertility?

[damask]

Hi all this is my first post - I would really appreciate some advice please if anyone can shed any light?

I’m 25 years old, and my husband and I have been trying to conceive for a little under 18 months, with no success so far. Back in October of last year we both underwent initial blood tests, and were told all were within the normal range. I was particularly surprised to hear that my thyroid test was ‘normal’ as I’d long suspected there might be a problem there as I have A LOT of the symptoms of hypothyroidism (fatigue/low energy levels, weakness, dry skin, weight gain, difficulty losing weight, muscle aches, bouts of depression/anxiety), but at 3.18 my GP said it was fine.

It was only earlier this month when I came across an article discussing the links between infertility and hypothyroidism that I decided to look further into it. I found information that suggested a TSH level of above 2.0 could severely inpact on the ability to conceive (and also increase the risk of miscarriage). Not only that, but I read that a short luteal phase along with irregular cycles have also been linked to hypothyroidism. My own luteal phase is 10/11 days, and my cycles can vary quite significantly between 25 days right up to 36 days, and so this seemed to resonate.

Armed with this new information, last week I went back to my GP to be met with a less than sympathetic attitude, and to be told because my levels were in the normal range there was nothing they could do. I fought against this and requested a more detailed thyroid panel, which eventually, my GP (reluctantly) agreed to.

My results for this were as follows:

TSH - 3.03 (less than last time but this was an evening test which I’ve heard can lower the result?)

Free T4 - 15.7

Free T3 - 5.4

TPOab - 242

So although my TSH, T4 and T3 levels are ‘normal’ in this latest test, I’ve got an elevated TPOab level, which, from my research, suggests Hashimoto’s - is this right?

I’m booked in to see my GP again on Tuesday and I would really appreciate any advice that you can offer so that I am armed with as much information as possible - especially should I need to fight my corner with this. Should I be expecting to be put onto treatment or be referred to an endocrinologist? Or is it possible the GP won’t do anything further at all?

Thanks so much for any help and apologies this is so long!

[damask]

I also forgot to mention - just in case this adds to my post - I am monitoring my BBT for tracking ovulation, and my temperatures are consistently below 36.5 degrees celsius, which I believe is also associated with hypothyroidism (and infertility). Thanks!

[waveylines]

Hi sorry to hear about your trouble conceiving.

Can you pop the ranges for the blood tests on as well please? They are the numbers in brackets beside your results. Labs ranges vary according to different areas. Thanks.

Looking at your blood test results according to the lab ranges in my area it look like you have high Thyroid anti-bodies (TPOab) This is an indicative of autoimmune thyroid disease. IE your body is attacking your thyroid which results in fluctuating thyroid hormones. If this is the case then a gluten free diet can help to reduce the anti bodies.

Really need the blood lab ranges popped on....thanks

And yes thyroid blood tests should be done first thing in the morning, fasting.

[moniacho]

Hi damask and welcome to the forum.

I also had similar problems conceiving, although it took less time than for you. I have been hypothyroid for 17 years and treated with Levothyroxine (although still having hypo symptoms). After few months of trying, I started tracking my temperature etc and that’s how I found that I have short luteal phase of 8 days. I was surprised to find out that you need at least 10 days for fertilised egg to travel down to uterus and implant into the uterus wall. If there is less than 10 days from ovulation to period, then even if the egg is fertilized, its just washed out during the period. I also went to my GP with that info, but they did nothing. They just told me that I have to be unsuccessful for more than a year before they can send us for some tests. Finally, I read somewhere that deficiency in B vitamins can lead to short luteal phase, and without even testing what my levels were I started taking B100 form Hollands&Barrets. I started at the beginning of my cycle (so about 20 days before ovulation) and I never got another period. I was pregnant the same month! I later found out that my B12 was below the range at the beginning of pregnancy, so it must have been even lower before I started taking the supplements.

With high TPOAb it is more than likely that your autoimmune system is attacking your thyroid. It may not be damaged enough yet to increase your TSH more, which is what doctors usually look at before they officially diagnose Hashimoto or hypothyroidism. I don’t know the ranges for your T4 and T3 results so its hard to figure out how desperately you need to be medicated. T3 is the active thyroid hormone, and if it is within the top part of the range then that would mean that the damage to your thyroid is not that extensive yet and it is still producing some hormones.

You should keep trying to convince your GP to diagnose based on antibodies. But I do understand that it may be hard if your T4 and T3 are mid-range or high in the range. But if they are, then just concentrate on your immune system to slow down the attack and on any possible vitamin and mineral deficiencies. Even if you cant convince your GP to diagnose and start medicating there is still much you can do to feel better and increase your chances to conceive…

When you do get pregnant, your growing baby will depend on circulating thyroid antibodies so you will need more of them. For me that meant dose increase, for you it may mean that your TSH will increase and they will finally start medicating you.

Please check your vitamin levels: vitB12, vitD and iron are usually low. Consider taking Bcomplex, at least for some time. Taking selenium 200ug/day for 6months is known to decrease thyroid antibodies. Diet is very important with Hashimoto, definitely try gluten free or even best gluten/diary/soy free (I know it sounds hard, I was battling myself for months before finally deciding to go gluten/dairy/soy/sugar free. It was hard the first few days, but there is so much alternatives nowadays its much easier than I thought. Its been 3 weeks and I feel good and my weight started going down). Read website/books of Dr Izabella Wentz, the thyroid pharmacist. You will find a lot of information there.

All the best on your journey. I wish you and your husband all the best. xx

[damask]

Hi waveylines and moniacho and thanks for taking the time to reply to me!

I will definitely ask for my vitamin levels to be checked as in the 4 blood tests I’ve had so far, none included any vitamin levels. Thank you also for confirming that the thyroid tests need to be done in te morning whilst fasting - my GP didn’t make me aware of this unfortunately.

With regards to the gluten free diet, I will start to do some reading on that - it does seem daunting but at this point I’m willing to try whatever I can. It might help me lose a few pounds too which is always going to be helpful!

Sorry to hear you had similar problems with conceiving moniacho - it really is something that I wouldn’t wish on my worst enemy! Fantastic that you were able to get pregnant straight away with the vit B supplements though, congratulations to you!

Apologies for not including the ranges on my results, I hadn’t realised they can differ between labs! I’ll list them below so if that sheds any more light I would be really appreciative to hear anyone’s thoughts:

TSH - 3.03 (0.40 - 4.50 mu/L)

Free T4 - 15.7 (8.00 - 21.00 pmol/L)

Free T3 - 5.4 (2.50 - 6.50 pmol/L)

TPOab - 242 (<34.00 klU/L)

Thanks again!

[Clutter]

Damask,

Ask your GP to start you on Levothyroxine because TSH >3.0 makes it difficult to conceive.

The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. When pregnancy is confirmed dose is usually increased by 25-50mcg to ensure good foetal development. NICE also recommends that hypothyroid women planning pregnancy should be referred to en-docrinology. cks.nice.org.uk/hypothyroid...

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee

13. The serum TSH reference range in pregnancy is 0·4–2·5 mU/l in the first trimester and 0·4–3·0 mU/l in the second and third trimesters or should be based on the trimester-specific reference range for the population if available. These reference ranges should be achieved where possible with appropriate doses of L-T4 preconception and most importantly in the first trimester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

onlinelibrary.wiley.com/doi...

According the ATA First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...