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Thyroid disorders are one of the most common disorders.
Thyroid Disorders:
- Hypothyroidism and Female Infertility
- Thyroid Autoimmunity and Fertility
- Hyperthyroidism and Female Infertility
Hypothyroidism can be easily identified by evaluating hormonal levels. A slightly elevated TSH level with normal thyroxin and free triiodothyronine levels indicate SCH whereas high TSH level along with low FT4 and FT3 levels indicate OH.
Thyroid autoimmunity is the most common autoimmune disorder in women of reproductive age. This is more common in subgroups of women with idiopathic infertility, polycystic ovarian syndrome (PCOS), Diminished Ovarian Reserve (DOI) and Premature Ovarian Insufficiency (POI).
Various proposed theories are:
• Thyroid hormone-dependent effects might disturb fertility as TAI predisposes to hypothyroidism, especially during pregnancy.
• TAI might reflect a general immune dysfunction that can affect embryo implantation
• A recent study delineated that endometrium and placenta expresses thyroid peroxidase (TPO) at gene and protein levels. This might explain why infertility and miscarriages are more frequent in patients with TAI.
Impact of Ovarian Stimulation on Thyroid Function
• Ovarian Stimulation
• Increase in oestradiol levels
• Excess of thyroxine binding globulin (TBG) production and sialylation by the liver
• Reduced clearance rate of TBG
• Increase in TBG levels
• Decrease in free thyroid hormone (TH) and thus, greater demand from thyroid gland
• Can lead to subclinical hypothyroidism in thyroid autoimmunity (TAI) women requiring levothyroxine (LT4) supplementation before pregnancy
Key Learning Points:
• Thyroid Dysfunction and TAI have often been associated with Infertility and poor reproductive outcomes.
• In overt thyroid dysfunction(when TSH values are greater than 4.0 mlU/L or upper limit reference range), levothyroxine treatment should be started promptly. The treatment should be started independent of the presence of TAI and the target is to maintain the serum TSH levels less than 2.5mlU/L.
• Women with hyperthyroidism treated with levothyroxine prior to ART should have serum TSH level less than 2.5 mlU/L.
• In women with TSH levels between 2.5 and 4 mlL/U and TAI, treatment decision should be individualized.
• Ovarian stimulation in ART leads to high oestradiol levels, which may lead to decrease in free thyroid hormones or hypothyroidism.
• Screening for thyroid dysfunction (TSH) in males of infertile couples should be limited to male subsets with ejaculatory and erectile dysfunction and/or altered semen parameters.
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