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July 17, 2023 13 min read

When it comes to getting pregnant, it's not just about the birds and the bees. There are actually a whole host of medical factors at play. One such factor is your thyroid function. It's time to shed light on an essential question: "How can hypothyroidism influence my chances of becoming pregnant?" Well, let's delve into the topic of hypothyroidism and fertility to find out.

What is hypothyroidism?

What are my chances of getting pregnant with hypothyroidism?

If you're unfamiliar with the term, hypothyroidism is a condition where your thyroid gland, a small but incredibly essential part of your body, is a little under-active. That's why it's sometimes called an underactive thyroid gland. The thyroid gland, although small in size, plays an essential role in the body. It is responsible for regulating several crucial body functions, such as metabolism, heart rate, and body temperature, through the secretion of thyroid hormones, mainly thyroxine (T4) and triiodothyronine (T3).

In the case of hypothyroidism, the thyroid gland's reduced hormone production can lead to a systemic slowing of bodily functions. This can result in a multitude of symptoms, including fatigue, unexplained weight gain, and potential complications with fertility. 

Can hypothyroidism affect fertility?

The thyroid disease hypothyroidism can indeed affect fertility. This is not a small matter, given that the thyroid functions as a regulator of several critical physiological processes, such as metabolism, heart rate, and body temperature. Surprisingly, when it comes to fertility, the thyroid's role becomes even more vital.

Link Between Hypothyroidism and Fertility Issues

The most direct link between hypothyroidism and fertility can be seen in menstrual irregularities. Hypothyroidism can lead to erratic periods, making ovulation more difficult to predict, and in some dire cases, ovulation may not occur at all. A research study discovered that a substantial 24% of women dealing with infertility had hypothyroidism. The silver lining, however, is that after initiating treatment for hypothyroidism, almost 80% of these women became pregnant within a timeframe of 6 weeks to 1 year.

The Role of Hypothyroidism in Anovulatory Cycles

Hypothyroidism can affect fertility through several mechanisms. The first one is anovulatory cycles, or menstrual cycles that occur without ovulation. The thyroid hormone plays a crucial role in the development of follicles, ensuring that an egg is mature enough for ovulation. In the absence of sufficient thyroid hormones, this process can be interrupted, leading to anovulatory cycles, which prevents the regular release of eggs.

Luteal Phase Defects and Hypothyroidism

Another way hypothyroidism impacts fertility is through luteal phase defects. The luteal phase, the second half of the menstrual cycle, begins after ovulation and ends right before the menstrual period. If this phase is shorter than normal, typically due to low progesterone levels, it can pose challenges to conception, with hypothyroidism being a contributing factor.

Hyperprolactinemia Induced by Hypothyroidism

Additionally, hyperprolactinemia, a condition characterized by high levels of the hormone prolactin, can develop due to hypothyroidism. Hypothyroidism can stimulate the overproduction of thyrotropin-releasing hormone (TRH), leading to an increase in thyroid-stimulating hormone (TSH) and prolactin.

Hypothyroidism and Sexual Hormones Imbalance

Lastly, hypothyroidism can induce imbalances in sex hormones. The relationship between thyroid and sex hormones necessitates balance; an imbalance in one can potentially trigger an imbalance in the other. For example, sex hormone-binding globulin (SHBG), a hormone that carries testosterone and estrogen, is regulated by the thyroid. When SHBG levels are out of sync, that, in turn, disrupts the levels of bioavailable hormones, hampering fertility.

Can I get pregnant with hypothyroidism?

Yes, you absolutely can get pregnant even if you have hypothyroidism! Having this condition can make it a little more tricky to conceive, but it's far from impossible. The edge you have is that knowing about your thyroid condition before you start trying for a baby can actually help you a lot. If you treat hypothyroidism early, it can really increase your chances of falling pregnant.

Consider this: in one study of nearly 400 women struggling to get pregnant, almost a quarter of them were found to have hypothyroidism. But the amazing part? Once they started treatment for their thyroid troubles, about three out of four of these women could get pregnant within a year. 

So, don't despair if you've been diagnosed with hypothyroidism. It definitely doesn't mean you can't have a baby. It might just be a little bump on your road to pregnancy. With the right treatment and care, you can still achieve that dream of becoming a mom.

How should I prepare myself for pregnancy if I have hypothyroidism?

Prepping for pregnancy when you have hypothyroidism might require a few more steps, but with the right care and approach, you can set the stage for a healthy pregnancy. Here's a simple plan to get you started:

Talk to your doctor and plan months in advance

Planning for pregnancy when you have hypothyroidism involves a comprehensive approach. Primarily, it necessitates scheduling an informative session with your healthcare provider to discuss your intentions to conceive. This conversation is critical as your ongoing treatment regime may need to be adjusted based on your pregnancy plans. Your doctor must be abreast of your intentions in order to effectively guide you through this period.

This pre-pregnancy consultation presents a golden opportunity not only to discuss and clarify any doubts you may have about hypothyroidism and its potential impact on pregnancy but also to cultivate a strategy to manage the condition. In all likelihood, your doctor will need to monitor your thyroid hormone levels more scrupulously, aiming for optimum levels that promote a healthy pregnancy.

Ideally, you should begin to prepare for conception six months prior to actively trying to fall pregnant. This time frame allows you to supplement any deficient nutrients and ensure that your thyroid levels are primed for fertility. Additionally, it provides ample opportunity to tailor a thyroid management plan in partnership with your healthcare provider. 

In essence, the fundamental goal is to ensure your body is in the most favorable condition for conception and carrying a pregnancy to term, navigating the intricacies of managing hypothyroidism with meticulous planning and careful supervision.

Make sure your thyroid levels are optimized for fertility and early pregnancy

Before embarking on your journey to pregnancy, it's crucial to ensure your thyroid levels are optimized for both fertility and the early stages of pregnancy. The thyroid-stimulating hormone, or TSH, is produced in the pituitary gland and directs your thyroid on the amount of T4 and T3 hormones it needs to create. If you have been managing a thyroid condition, you're probably already familiar with frequent blood tests to check these levels. An elevated TSH level often signals hypothyroidism, indicating that your thyroid gland is not producing sufficient hormones in response to the signals it's receiving. Hence the TSH level is unusually high.

Given its significance, The Endocrine Society advises that women with known thyroid dysfunction intending to get pregnant should have their TSH concentrations checked prior to conception. Importantly, during your first trimester, your TSH should ideally be below 2.5 mIU/mL. Although what qualifies as 'normal' TSH values can vary depending on the laboratory, typical values fall between 0.4 and 4.5 mIU/L. Intriguingly, a study involving nonpregnant women taking thyroid medication found that over 40% of them did not fit within the normal range, emphasizing the importance of regular monitoring of TSH levels, even when on medication.

Supporting this, guidelines published by the American Thyroid Association recommend that clinicians adjust the dosage of thyroid hormone replacement therapy for women planning to conceive, targeting a TSH level of below 2.5 mIU/L. If your TSH levels remain above this target, an increase in the dosage of your thyroid hormone replacement medication may be necessary, followed by repeated checks until your TSH levels drop to 2.5 or lower.

Learn how hypothyroidism will change with pregnancy

What are my chances of getting pregnant with hypothyroidism?

Pregnancy involves a significant shift in your body's hormone levels. In particular, two hormones, human chorionic gonadotropin (hCG) and estrogen, can cause a temporary increase in the levels of thyroid hormones in your blood. 

These adjustments in thyroid hormone levels aren't abnormal but rather a part of the standard physiological changes that occur during pregnancy. Therefore, laboratory values of thyroid function tests are interpreted using trimester-specific ranges. For instance, in the first trimester, the normal TSH range is less than 2.5 mIU/L, given that levels between 2.5 and 5.0 have been linked to increased pregnancy loss.

There are some ways in which thyroid hormones may change during pregnancy:

  • In the first trimester, high levels of hCG could lead to a slight decrease in TSH levels before they rebound to their normal range as pregnancy progresses.

  • Estrogen may elevate total thyroid hormone levels. Despite this increase, if the thyroid gland continues to function normally, maintaining TSH and free T4 (fT4) levels within the range specific to the current trimester, the thyroid gland can be considered to be functioning adequately.

Interestingly, aside from thyroid hormone levels, the thyroid gland itself may enlarge during pregnancy, although this tends to occur more frequently in iodine-deficient regions than in areas like the US with adequate dietary iodine. 

Therefore, it's fair to say that pregnancy will instigate changes in hypothyroidism, necessitating regular monitoring and adjustments of treatment as needed. By understanding these fundamental changes, you can better manage your hypothyroidism during pregnancy under the guidance of your healthcare provider.

Monitor your iodine levels

Iodine, a critical nutrient for thyroid hormones and overall thyroid health is essential, especially during pregnancy and lactation. The US Food and Drug Administration recommends increasing the intake of iodine from 150 micrograms (mcg) for nonpregnant individuals to 290 mcg during these periods. Noted for its significance, it is a common constituent of prenatal vitamins. 

However, if you are on levothyroxine (LT4), a manufactured form of the thyroid hormone thyroxine (T4), supplemental iodine might not be recommended due to potential interactions. Prenatal vitamins are quintessential to the nutritional needs during preconception and pregnancy. Hence, it's crucial to discuss your iodine intake and the potential need for a prenatal vitamin with iodine with your healthcare provider.

Being the fundamental building block for thyroid hormones, the requirement for iodine amplifies notably during early pregnancy. Individuals with hypothyroidism, who have not undergone thyroid surgery or received radioactive iodine treatment, should ideally check for iodine deficiency prior to conception. In case of deficiency, your healthcare provider can suggest an appropriate level of iodine supplementation, usually suggesting an iodine/iodide combination formula.

Even if your iodine levels are sufficient, guidelines by the American Thyroid Association (ATA) advocate supplementing with a multivitamin or prenatal vitamin comprising at least 150 μg of iodine. It's noteworthy that not all over-the-counter and prescription prenatal vitamins include iodine, so it's best to verify this by checking the label. The ATA recommends continuing the intake of iodine supplements throughout pregnancy and during breastfeeding. Thus, it's essential to have iodine levels closely monitored before and during pregnancy to ensure optimum thyroid health for a successful conception and healthy pregnancy.

Take folic acid

Let's discuss the importance of a vital nutrient - folic acid. Recommended before conception and consistently during pregnancy, folic acid plays a significant role in preventing neural defects in your baby.

However, there's a twist in the storyline. According to the National Institutes of Health, a quarter of the US population, to be precise, up to 25 percent, have what's called a methylenetetrahydrofolate reductase mutation, or simply an MTHFR genetic mutation. This mutation complicates the metabolism of folic acid, making it less effective.

Now, here's where it gets a bit more interesting - MTHFR mutation pops up more frequently among people grappling with autoimmune diseases and, yes, thyroid conditions. If planning for a baby, it's possible to undergo genetic testing to find out if you carry this MTHFR mutation.

Accurate information about your genetic profile can shape your medical approach to conceiving and pregnancy. For instance, if you test positive for the MTHFR mutation, experts often recommend a slightly different form of folic acid - methyl folate, before and throughout pregnancy.

What makes methylfolate worth considering? Simply, it's a form of folic acid that can fight against neural tube defects in your baby, even if you have this genetic mutation.

But let's say you have not submitted yourself for MTHFR testing. Should you be concerned? Here's the good news, a lot of healthcare providers suggest that you can still opt to take methyl folate instead of regular folic acid. The beauty of methyl folate is that it is beneficial for all women, including those with the MTHFR mutation. 

Start pregnancy testing soon after you try to conceive

When you're trying to conceive, timing is everything, especially for women with thyroid conditions. But why is this so critical? Well, ladies, we're about to discuss why confirming a pregnancy at the earliest can be game-changing, particularly for those with hypothyroidism.

For any woman, those initial moments after conception weave a fascinating story. Instantly, the thyroid gland embarks on a growth spurt and cranks up its thyroid hormone production by an astounding 50 percent. This hormonal upgrade is absolutely vital for the well-being of the developing baby whose own thyroid is still under construction and won't start making its own thyroid hormone until the onset of the second trimester.

Now, switch perspectives to a woman with hypothyroidism. The playbook changes slightly here. If you're trying to get pregnant and have hypothyroidism, confirming your pregnancy at the earliest becomes doubly essential. Why, you ask? As soon as a pregnancy is confirmed, your healthcare provider can adjust your thyroid medication dosage to meet your body's increased demand. Starting this process as soon as possible is key.

Early confirmation of pregnancy can trim down your risk of a thyroid-related miscarriage. Even if the pregnancy progresses, early identification can decrease the odds of developmental deficits in your baby. The message here is not to wait for a missed period.

To fast-track this process, it's suggested to initiate pregnancy testing soon after you start trying to conceive. Delivering hope to millions of women are home pregnancy tests, some of which are incredibly sensitive. They can cheer you on with a positive result as early as seven days after conception, thus setting the ball rolling for early pregnancy management, which is particularly crucial for those with hypothyroidism.

Expect to undergo more thyroid function tests during pregnancy

If you're pregnant or planning for pregnancy and have a personal history of thyroid disorders, you can expect to become well-acquainted with additional thyroid function tests during pregnancy. Leading health authorities like the American College of Obstetricians and Gynecology (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the Endocrine Society outline this in their clinical practice guidelines, where they recommend screening for thyroid dysfunction.

This vigorous screening protocol isn't part of standard prenatal care for the general population of expectant people. Still, it becomes necessary for those with thyroid conditions to sidestep potential complications. The thyroid plays a significant role in pregnancy, and ensuring its optimal function is essential.

As soon as your pregnancy is confirmed and you've started on your recommended dosage increase, it's time to roll up your sleeves. Coordinate with your healthcare provider to monitor your thyroid levels, particularly your thyroid-stimulating hormone (TSH). The aim is to maintain your TSH level within the recommended range of 0.1 and 2.5 mIU/L during your first trimester, denoting normal thyroid hormone production. In some cases, your doctor may also want to monitor thyroid antibodies.

Get ready to increase your dosage during pregnancy

For those living with a pre-existing thyroid condition, getting a positive pregnancy test can be thrilling but also a cue for some important medical adjustments. According to the guidelines from the Endocrine Society, being pregnant often means modifying your thyroid medication. If you were managing hypothyroidism (an underactive thyroid) before pregnancy, it's likely that you'll need to bump up your medication dosage or even switch to a new one.

Rest assured, it's safe to take thyroid hormone replacement during this special time. But as you open a new chapter in your life, it's natural to feel slightly overwhelmed by all these necessary changes. Here's where health specialists come into play, ready to assist you with the following:

But prior to all this, preconception planning naturally comes first. It's beneficial to work in conjunction with your doctor to have an agreed-upon plan in place for your thyroid medication dosage increase. Timing is of the essence here. This dosage hike should begin as soon as you have a positive pregnancy test. In some situations, healthcare practitioners may even advise their patients to up their dose by a considerable 50 percent upon confirming their pregnancy. 

What should I do if my TSH levels are not optimal?

What are my chances of getting pregnant with hypothyroidism?

Ensuring an optimal level of Thyroid Stimulating Hormone (TSH) is crucial, particularly if you're planning on becoming pregnant. If test results reveal TSH levels that are out of the recommended range, the first course of action typically involves initiating or modifying hormone replacement therapy. The aim is to stabilize TSH levels and alleviate symptoms of hypothyroidism that could potentially interfere with fertility.

The standard treatment for hypothyroidism is levothyroxine, a synthetic form of thyroxine (T4). It's generally the first choice of therapy due to its efficacy, safety profile, and the fact that the dosage can be precisely tailored to each individual's needs. Levothyroxine effectively compensates for the decreased production of thyroid hormones in hypothyroid patients.

However, suppose you've been taking levothyroxine for a period of time, and despite dose adjustments, your TSH levels remain less than optimal. In that case, it might suggest issues with converting T4 to T3, an active form of thyroid hormone that the body utilizes for various functions. Or it's possible that levothyroxine simply isn't the best fit for you. 

Natural desiccated thyroid (NDT)

In such cases, Natural Desiccated Thyroid (NDT) may be considered as an alternative therapy. NDT is derived from the dried thyroid glands of animals and contains both T4 and T3. This approach could be beneficial for those struggling with the conversion of T4 to T3 or for those who don't respond optimally to levothyroxine.

The treatment landscape for hypothyroidism in the United States is marked by trusted and popular brands of Natural Desiccated Thyroid (NDT), like Armour Thyroid and NP Thyroid. However, these are not the only options.

You can also buy desiccated thyroid online as a dietary supplement. A highly favored choice among many is VitaliThy. This supplement is crafted with a range of beneficial ingredients. It comprises porcine thyroid powder, which closely mirrors the thyroid hormones produced by your body. In addition, it contains spica prunellae siccus extract, a traditional herb with numerous reported health benefits.

But VitaliThy does not stop there. It's also enhanced with ashwagandha extract, a potent herb known for its high antioxidant content and stress-alleviating properties. Also included is selenium yeast, a crucial element that actively supports thyroid health.

And for those following specific diets or managing certain allergies, VitaliThy, a natural desiccated thyroid you can buy online, is an ideal choice. It's completely devoid of potential allergens such as gluten, lactose, eggs, fish, and shellfish. Plus, you won't find any artificial colors or flavors. It's a holistic, mindful choice for managing hypothyroidism.

Remember, it's important to have regular check-ups and blood tests to monitor your TSH levels and determine the effectiveness of your current treatment plan. Regular communication with your physician will allow for any necessary modifications in your treatment strategy and can put you on the best path toward optimizing your health and fertility.

Wojciech Majda
Wojciech Majda

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