FACEBOOK LIVE: Advanced Thyroid Testing for Fertility

January 21, 2020

FACEBOOK LIVE: Advanced Thyroid Testing for Fertility

The following is a transcription of a Facebook Live for your convenience. Please either read the transcription below, or watch the video itself! Enjoy!

Join Dr. Harsimranjeet Singh, ND where he is chatting about the importance of Advanced Thyroid Testing and Thyroid Health for anyone undergoing Fertility Treatments.

 

Hey everyone, welcome to the live stream. So, the topic for today is thyroid health and fertility. And this is pretty cool because when it comes to fertility, we're looking at really anything that we can further delve into or further investigate or further provide treatment for especially when it comes to maximizing treatment outcomes for patients who have unfortunately had miscarriages or recurrent miscarriages. So, the thyroid world or thyroid health is probably the most I think rich in research and things that we can add in or investigate to try and help with this process. So, whether you're trying to conceive on your own, naturally, or you’re doing an IUI or if you're done IUIs and IVFs or if you’re going through your IVF. 


Now I think first off, like what we should talk about is that the first thyroid test that's really done if you're trying to conceive, will be something called TSH, that’s Thyroid Stimulating Hormone. And that's a really great place to start when we're checking for thyroid function. Particularly because it just gives us a really big overall snapshot of how the thyroid is behaving and if there's something that is majorly off or not. But when it comes to recurrent miscarriage or previous miscarriages, an important issue that we have to investigate or look at is the role of a thyroid autoimmunity, a bit more what we call advanced thyroid testing. 


So, with regards to IVF, when we look at the different disorders, we can look at the common, which is hypothyroidism. And hyperthyroidism isn't always the same as some of these other thyroid conditions that we can develop as well. With thyroid autoimmunity, I think that's like the most important thing that's overlooked, it's the presence of what's called antibodies that target thyroid peroxidase in the thyroid or thyroglobulin antibody, so two types of antibodies there. And it's very important to investigate this because about 10 to 20% of individuals that go for fertility treatments actually have positive antibodies for the thyroid. And the antibodies themself can actually damage the health of the follicles. So, when we look at the-- you know, imagine you're looking at an egg, that thick border around the egg or what we call the zona pellucida is something that can be damaged with the use of or with the presence of thyroid antibodies. 


So, it's important that we do testing for these antibodies as well. And if it is an issue, there's research showing that giving a bit of extra thyroid hormone can sometimes reduce the risk of miscarriages or other complications. Because if you are hyperthyroid or if there's even mild decrease in thyroid hormone during pregnancy or after IVF then we see that there's a significant increase in other complications such as preeclampsia during pregnancy, preterm labor, miscarriage rate goes up. So, giving a bit of thyroid hormone can mitigate that risk and help to reduce the adverse risks that are associated with the fertility treatments or associated with caring to a healthy term and having a healthy pregnancy that's hopefully not complicated or just smooth and easy to go through. 


The other thing to look at is there is a condition known as hypothyroxinemia. So, it's isolated and what that means is we see TSH levels are totally normal. So, at the fertility clinic, when you have the TSH level done, it will look like you don't have a thyroid condition, but the actual thyroid hormone or T4 is actually very low. And this can happen in about one to 2% of women of reproductive age that are trying to conceive. And for this case, usually the treatment is giving iodine, so it's an iodine deficiency that will relate to a decline in some of this thyroid hormone. So, same thing as before. If you have that then we see an increased risk of miscarriages, we see an increased risk of treatment failure, implantation or estrogen, progesterone production. And so that would be something you could pick up on an advanced thyroid test.

 

So, the benefit of doing advanced testing is we’re not just looking at TSH, we're also looking at T4, T3, the thyroid antibodies, so just checking for a lot more different types of thyroid issues. 

 

And the treatments usually revolve around implementing dietary changes, lifestyle changes, sometimes some simple as vitamin D deficiencies. So, if you have autoimmune thyroid conditions, then they're a big role for vitamin D as well. So, it's - hypothesized mechanisms by which we lose kind of that regulatory function in the body and we start to develop these antibodies. So, vitamin D is something really important to look at as well. And then specifically for patients that are trying to conceive on their own, sometimes we're just jumping into the whole process and trying to conceive on our own without doing the proper testing ahead of time. So, it could be a good screening tool, especially for individuals that are higher risk. So, if you've had a family member who has had thyroid disease or thyroid condition or you know they're taking thyroid hormone, if you ever had surgery for thyroid gland, if you had nodules in the past, or if you have any, like the common presenting symptoms, which would be cold intolerance, constipation, we see like brain fog, weight gain, bloating, fluid retention. So, those are just a few of the main ones, there's a lot more as well, then it could be helpful to look into that before you start trying to conceive as well. 


Particularly with unexplained infertility because I think that's probably the most difficult diagnosis when we have unexplained infertility because we want something to know what we can do, what we can improve or change to improve our chances of getting pregnant. So, the antibodies for thyroid testing are super critical and super important in that scenario. Because it could be something that one out of every five women has, but we're not testing or checking for it. And if it is present, there's some very simple steps that can be taken ahead of time, prenatal periods, like three months before you try and start conceiving, and then during pregnancy to hopefully make things a lot easier. And there was a research paper published on that looking at how if you had like mild to moderate, decreased thyroid hormones, just improving your intake with a medication, or a supplement, we see a significant improvement in success rates of patients getting pregnant on their own.


So, it's a commonly overlooked condition and when we do the basic TSH testing, we're really just looking at a very small snapshot of thyroid function, and there's so much more to thyroid, the role of the thyroid hormone and thyroid gland in supporting every step of the fertility process; from follicle development to ovulation to conception, to implantation. So, there's really no step of that fertility mechanism that isn't influenced by the thyroid hormone. So, if we have low thyroid hormone or the thyroid hormone specifically like it will support healthy estrogen levels. Thyroid hormone directly stimulates the ovary to produce more progesterone, it will also help with implantation, help with brain development for the baby, so helps with intelligence. And then there's some research showing that women or mothers that are deficient in thyroid hormone, their children will score lower on certain intelligence scores or evaluations. So, that's a very small study, but it's still quite important to consider and look at that as well. 


So, if you are in the fertility journey, it would be worth speaking to a naturopathic doctor to do more advanced testing, and looking at other creative and adjunctive ways, integrative solutions to help support the thyroid gland before, during, and after the fertility journey.

 

Because once you're pregnant, once you have birthed, one year after giving birth, you're still at an increased risk for thyroiditis, inflammation of the thyroid gland. So, there are symptoms that can develop after the whole procedure and process and journey there.

 

So, if you have any questions, feel free to type them in here or get in touch with us at NutriChem. 

 





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