Hypothyroidism and Infertility

Hypothyroidism is the deficiency of thyroid hormones in the body which is responsible for maintaining the body metabolism. Hypothyroidism and infertility are closely related terms as a deficiency in thyroid hormones are one of the major reasons that can cause difficulty in achieving and maintaining a pregnancy. Let's understand what hypothyroidism is, how it affects reproductive health, and how to treat this condition.
hypothyroidism-and-infertility
Hypothyroidism and Infertility
Introduction

When your thyroid gland isn't making enough thyroid hormone, it can seriously affect each organ in your body; even your reproductive system. Hypothyroidism happens when the thyroid organ isn't secreting as much thyroid hormone as it should, and this in a way may cause several different symptoms and may influence all the functions in the body. In women of reproductive age, hypothyroidism is more common than you can imagine. Women with hypothyroidism may not ovulate (anovulation) or ovulate irregularly. This makes a female's periods happen less frequently (oligomenorrhea) or to stop totally (amenorrhea). And this irregularities in menstruation may make it difficult to conceive while planning a pregnancy.

Hypothyroidism can influence fertility in men also. As indicated by a research report, hypothyroidism is found less in men yet might be present. The individuals who have a condition of less active thyroid or hypothyroidism may have low sperm count and experience less libido. Also, hypothyroidism can cause weakness in both male and female.

What are thyroid hormones and why are they important?

The thyroid gland is an important organ in our body, which secretes some crucial hormones in our body collectively known as thyroid hormones. The thyroid gland is located in our throat, partially surrounding the windpipe and is shaped like a butterfly. Thyroid gland mainly releases the Thyroxine (T4) hormone and small amounts of Triiodothyronine (T3). These hormones have several functions in our body, such as:

  • Controlling the metabolism of fat, carbohydrate and protein in our body.
  • Controls body metabolism by regulating the oxygen consumption rate and heat production by the cells in our body.
  • Helping in the activity of other hormones for controlling blood pressure, heart rate and proper brain functioning.

Apart from these general functions, thyroid hormone is also responsible for the growth and development of the foetus. Thus, its deficiency can affect fertility and pregnancy in a woman.

What is hypothyroidism and what are its causes?

In easy words, when the thyroid gland is not able to produce thyroid hormones in sufficient quantities to meet the needs of body functions, the condition is called Hypothyroidism. There are several reasons for this condition developing in our body. Some of them are as follows:

  • The thyroid gland may not be able to produce enough T4 thyroid hormone because of some problem in the thyroid gland itself. An example of such a condition is the Hashimoto’s Disease in which the immune system targets the T4 hormone for destruction, thus making a deficiency of thyroid hormone in the body.
  • Some problems with the hypothalamus and pituitary glands can also cause the thyroid gland to dysfunction. In such a case, the production of both the T4 and TSH hormones may be found less in the body.
  • Iodine is an important part of both the T3 and T4 hormones (T3 has 3 iodine atoms, and T4 has 4). Deficiency of iodine in our body is also a reason behind hypothyroidism.
  • Another reason which is rare but may happen is the slow rate of conversion to T3 hormone. The T4 and TSH levels in our body may be normal, but the T3 level is very low than the normal range. This might happen because of two reasons – either the T4 hormone is not being converted to the T3 in target cells, or it is being converted into reverse T3.

Symptoms of hypothyroidism

You can identify yourself suffering from hypothyroidism if you experience the following symptoms:

symptoms-of-hypothyroidism-and-infertility
Symptoms of Hypothyroidism and Infertility
  • Weariness, exhaustion
  • Forgetfulness
  • Depression
  • Muscle pains
  • Dry/harsh skin or Eczema
  • Dry or weak hair, hair loss
  • Goitre (swollen thyroid)
  • Stomach related problems
  • Abnormal weight gain
  • Skin inflammation
  • Low body temperature
  • Slower heartbeat
  • Shortness of breath
  • Less sexual desire
  • Menstrual cycle variations
  • Trouble in getting pregnant

In case you are experiencing more than three of the given signs, it is recommended that you see a doctor and get your thyroid tested.

Hypothyroidism, pregnancy and infertility

As discussed earlier, hypothyroidism is one of the causes of infertility. Thus we can say that hypothyroidism, pregnancy and infertility are related to each other.

Pregnancy

It has been seen that thyroid hormone imbalance tend to create pregnancy issues in around 15% of the cases. Thyroid hormone is imperative for both placental and foetal growth. To meet the increased metabolic needs of the mother as well as the growing foetus, the thyroid production in the body also increases by 20 to 50%. Due to hypothyroidism, or even subclinical hypothyroidism, this increased need is not fulfilled, and hence the danger of birth problems arises such as premature delivery, miscarriage, abnormal birth weight, caesarean delivery, postnatal development issues, and many more. This risk increases in women with hypothyroidism.

Fertility and Conception

Conceiving a child is more troublesome for females suffering from hypothyroid due to related ovarian problems. Both hypo and hyperthyroidism upset regenerative balance in hormones and women with thyroid issue frequently have variations in their menstrual cycle, for example, infrequent periods or unpredictable cycles, flooding, etc. Hypothyroidism has been related with decreased FSH (Follicle Stimulating Hormone) and LH (Luteinizing hormone) levels which are required for egg and follicle development and ovarian generation of oestrogen and progesterone. Hypothyroidism has likewise been associated with the development of ovarian cysts.

Diagnosis of hypothyroidism

In case you're encountering the signs and symptoms of hypothyroidism; like exhaustion, more sensitivity to cold, dry skin, weight gain or weight loss, muscle pains, constipation and irregularities in menstrual periods (in women), then you need to get your thyroid checked.

Even before planning pregnancy, it would be advisable for you to get your thyroid tested. Couples are now holding up until they're more established before getting pregnant. With increasing age, several changes occur in a woman’s body such as low haemoglobin, brittle bones, muscle pains, lack of nutrition, etc. and thus the chances of getting hypothyroidism increases with it. The thyroid is a sensitive organ and needs special care at ages where there are a lot of changes going on in the body. Moreover, the growing age also brings other problems like low ovarian reserve, low FSH, etc. which are responsible for reduced fertility.

Hypothyroidism is one of the numerous conditions that your specialist can test for as a component of a pre-pregnancy health check-up. It is wiser to distinguish and treat medical problems before getting pregnant. If there are previous thyroid problems in your family, particularly in your parents or grandparents, it becomes even more necessary to get it tested.

A basic blood test can uncover whether your thyroid organ is functioning properly or not. The test estimates the measure of Thyroid Stimulating Hormone (TSH) in your circulatory system, and abnormally high levels mean hypothyroidism.

Treatment for hypothyroidism

There are several methods for the treatment of hypothyroidism. The medical approach is one and nutrition being the other. Before going for any method, it is advisable to go for a full body check-up to find out if there are any other issues like Diabetes and Hypertension along with Hypothyroidism and act accordingly. Also, if you are pregnant, some medications might not go well with your pregnancy, so it is best that you take expert advice.

  • Medical Approach

    The straightaway approach for treating the condition of hypothyroidism is to increase the levels of thyroid hormones in our body, which is mainly T4 with the help of drugs like levothyroxine. But this method is unable to counter the problem where T4 to T3 conversion is slow or reverse T3 is more. Hence most of the patients choose the way in which both the T3 and T4 hormone levels are targeted. In any case, a thorough check-up and consultation with a doctor are necessary.

  • The Nutrition Way

    The nutritional way of overcoming the problem of hypothyroidism involves eating anti-inflammatory, highly nutritious food; a diet that contains a lot of vegetables and fruits, fats, whole grains and a lot of healthy proteins. The following are some of the key nutrients that you need in your food. Mind you, these nutritional elements can be easily taken in the form of supplements and medicines, but it is better to try and have them in your food as much as possible.

  • Iodine: Iodine is an essential element that is needed for the production of thyroid hormone and is important for foetal and early baby blues improvement. Dietary iodine necessities are higher in pregnancy on the grounds that the need for T3 and T4 is higher, and it's not surprising for iodine levels to drop during pregnancy. Studies have demonstrated that the babies of women with a little to moderate iodine inadequacy amidst pregnancy are at an increased risk for neurodevelopmental issues. Stay safe so as not to over-supplement with iodine as it can cause or worsen hyperthyroidism and hypothyroidism. Iodine is found in refined salt, but you cannot take salt as food. Instead, eating fish, eggs, and natural dairy products is a good way to maintain your iodine level during pregnancy.

  • Zinc: Zinc is an important mineral for our body and is quite related to the proper functioning of the thyroid gland, and its deficiency can cause hypothyroidism. The suggested amount of Zinc in the diet for pregnancy is 11mg, which must be ensured. Cheese, red meat, pumpkin seeds, carrot, cucumber and watermelon peels are good sources of zinc in our food.

  • Selenium: Selenium is vital for the working of enzymes in our body engaged in thyroid function. Also, selenium has been found to reduce thyroid autoantibody levels. Selenium levels might be low in some pregnant ladies, and low selenium levels might be a contributing reason for the dysfunction of thyroid after delivery that burdens numerous ladies. The RDA for pregnancy is 60 mcg. Healthy lean meat, fish, cheese, eggs, green vegetables, butter, mushrooms and tomatoes are great sources of selenium.

  • Vitamins E, C and A: These vitamins are great for cell reinforcements, support the immune system and are also anti-inflammatory. The suggested everyday quantities for pregnancy are Vitamin E (15mg), C (85mg) and A (770mcg).

  • Apart from taking the best nutrients in your food which are mentioned above, it is also equally important to avoid certain foods like raw cruciferous vegetables (Cauliflower, cabbage, broccoli, kale, etc.), soy, flaxseeds and other inflammatory foods like alcohol, processed flour and processed fats. These foods can inhibit thyroid function and increase inflammation in our body. Apart from that, you should also avoid excess salt as it can prompt autoimmune reactions in our body, which can destroy the thyroid hormones.

Conclusion

It is advisable for women who have been attempting to get pregnant, and have experienced one or more failed pregnancy, or are unable to conceive due to thyroid issues, to get their thyroid hormones checked before planning a pregnancy. You can avoid dysfunctional thyroid by maintaining overall health by taking proper nourishments, supplements, herbs, and also by maintaining body weight by doing yoga or exercise. Thyroid levels should be maintained when you are trying for pregnancy to avoid any issues during pregnancy. Get your thyroid levels checked at regular intervals and keep it balanced if necessary all throughout your pregnancy and during breastfeeding.

Related questions on hypothyroidism & infertility:

Q) I’m hypothyroid and I was taking levothyroxine. Should I continue to take it during my pregnancy?

A) A) First of all, if you are pregnant, get a thyroid blood test done. It is recommended to continue with your levothyroxine during pregnancy. If TSH value has increased, your Doctor will increase your medicine dosage accordingly.

Q) I've been diagnosed with underactive thyroid. Can I get pregnant?

A) Yes, you can. But some women who are diagnosed with hypothyroidism may face difficulty in conceiving and there may be a risk of miscarriage too.

Q) Is it possible to develop thyroid disease after you have a baby?

A) It has been observed that around 10% of women can develop thyroid disease after they had a baby. It may be a temporary condition, but, in some cases, this could stay lifelong. If you experience the symptoms of hypothyroidism, you should contact your doctor.

References

1)https://journals.lww.com/greenjournal/Fulltext/2005/02000/Subclinical_Hypothyroidism_and_Pregnancy_Outcomes.5.aspx
2) https://europepmc.org/abstract/med/3380497
3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657979/