IVF and Fertility : hello! My husband and I have... - Thyroid UK

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IVF and Fertility

OMIVF profile image
17 Replies

hello!

My husband and I have a diagnosis of unexplained infertility, and had our first ivf cycle last month that didn’t work.

Blood tests last year showed I had subclinical hypothyroidism TSH was 6.3. I have been on levothyroxine since June 2021. Last 2 blood tests TSH has stabilised to 2.7. I have previously swung too low to 0.1 in March 2022 and that cycle I had a chemical pregnancy. So the closest I got to naturally conceiving. Most recent medichecks report attached.

All the literature suggests that TSH should be below 2.5, ideally 2. Wondering if I need to push for dosage to be slightly adjusted? My IVF clinic don’t seem that bothered! I’m currently on 75mg weekdays, and 50mg at the weekend. When I was on daily 75mg I swung too low.

Any advice greatly appreciated.

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OMIVF
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shaws profile image
shawsAdministrator

The following is a link that might be of help. Some mothers-to-be can miscarry.

thyroiduk.org/having-a-baby...

Jaydee1507 profile image
Jaydee1507Administrator

Firstly I'm sorry you are struggling with infertility. As you know thyroid levels can be very important for this.

What time of day are you having these tests for thyroid? Have you taken your medication before the tests?

SlowDragon profile image
SlowDragonAdministrator

Was test done early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Have you had vitamin D, folate, ferritin and B12 levels tested

What vitamin supplements are you currently taking

Or an ultrasound scan of thyroid

Were thyroid antibodies higher in previous tests?

Have you had coeliac blood test done yet

OMIVF profile image
OMIVF in reply toSlowDragon

Thank you for your response. Here are some answers to your questions.

Blood test was taken before 9am and before any food and last medication taken the morning before.

I currently have both Teva and accord so having to mix the brands for 50 and 25mg. I don’t have a choice when I pick up prescription and pharmacist always says it’s okay to mix. I have sometimes been on the same brand - is one better than the other?

Ferritin all okay. Haven’t had vit d or b12 done.

No scan of thyroid done.

Haven’t had coeliac blood tests done -Is this something I should request and what is the link?

previous thyroid antibodies attached from last year

Results
SlowDragon profile image
SlowDragonAdministrator in reply toOMIVF

What was ferritin result

Have you had full iron panel test for anaemia

What vitamin supplements are you currently taking

OMIVF profile image
OMIVF in reply toSlowDragon

yes full blood panel taken April 2022 and all fine. I am taking a fertility multi vitamin with folic acid and a strong cod liver oil. I was taking coq10 but have stopped that for a bit

SlowDragon profile image
SlowDragonAdministrator in reply toOMIVF

ferritin needs to be at least over 70

OMIVF profile image
OMIVF in reply toSlowDragon

It was 100 so that’s good

Results
SlowDragon profile image
SlowDragonAdministrator in reply toOMIVF

Suggest you retest ferritin soon

Ferritin was likely good because TSH was low in April

As TSH has risen, likely vitamin levels dropped

OMIVF profile image
OMIVF in reply toSlowDragon

okay so need ferritin, vit d, b12 anything else? Do you think I need to try and get TSH down further ahead of IVF? 2.7 is well within normal range

SlowDragon profile image
SlowDragonAdministrator in reply toOMIVF

FT4: 19.4 pmol/l (Range 12 - 22)

Ft4 74.00% through range

FT3: 4.6 pmol/l (Range 3.1 - 6.8)

Ft3 only 40.54% through range

helpful calculator for working out percentage through range

thyroid.dopiaza.org/

Shows poor conversion and Ft3 too low

Suggest you get FULL thyroid and vitamin testing done

Or get all four vitamins tested via GP

Ferritin should be testing early morning and fasting

Don’t eat iron rich dinner night before test

For good conversion of Ft4 to Ft3 we need optimal vitamin levels

OMIVF profile image
OMIVF in reply toSlowDragon

thanks so much for all this info! I’m not sure I understand it all, shall I get the GP to refer me to an endocrinologist?

SlowDragon profile image
SlowDragonAdministrator in reply toOMIVF

Yes probably a good idea

But first get vitamins tested

If not optimal….work on improving

Does your multivitamin contain biotin.

If it does you must stop taking it 3-5 days before any blood tests as biotin can falsely affect test results

Have you had BOTH TPO and TG thyroid antibodies tested

If both are negative have you had ultrasound scan of thyroid - £100 privately

20% of Hashimoto's patients never have raised antibodies 

healthunlocked.com/thyroidu...

 

Paul Robson on atrophied thyroid - especially if no TPO antibodies 

 paulrobinsonthyroid.com/cou...

It’s many months wait on NHS and if TSH and Ft4 within range…..often refused referral

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors …NHS and private

tukadmin@thyroiduk.org

OMIVF profile image
OMIVF in reply toSlowDragon

okay thank you! Will GP check vitamins? What else do I check apart from b12?

SlowDragon profile image
SlowDragonAdministrator in reply toOMIVF

would have thought IVF clinic/GP should have automatically tested vitamin D, folate, B12 and ferritin levels

But if they won’t…. use Medichecks or Blue horizon

all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests both thyroid antibodies or Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning.

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

SlowDragon profile image
SlowDragonAdministrator in reply toOMIVF

currently have both Teva and accord so having to mix the brands for 50 and 25mg. I don’t have a choice when I pick up prescription and pharmacist always says it’s okay to mix

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva contains mannitol as a filler, which seems to be possible cause of problems.

Teva is the only brand that makes 75mcg tablet.

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Glenmark or Aristo (100mcg only) are lactose free and mannitol free. May be difficult to track down Glenmark, not been available very long 

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Accord only make 50mcg and 100mcg tablets 

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord  doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

guidelines for GP if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test 

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

Request GP test B12, folate and vitamin D

SlowDragon profile image
SlowDragonAdministrator

Before considering TTC levels need to be stable 

verywellhealth.com/infertil...

.

Pregnancy guidelines 

thyroiduk.org/having-a-baby-2/

gp-update.co.uk/files/docs/...

See pages 7&8

btf-thyroid.org/Handlers/Do...

Also here - dose increase in levothyroxine as soon as pregnancy test confirms conception 

cuh.nhs.uk/patient-informat...

thyroidpharmacist.com/artic...

Low ferritin, low thyroid levels and miscarriage 

preventmiscarriage.com/iron...

Low iron and hypothyroid 

endocrineweb.com/news/thyro...

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