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Fertility and Hypothyroidism

August 1, 2019
fertility hypothyroidism, fertility hashimotos, conception, ovulation, toronto naturopath, naturopathic doctor toronto

Becoming and staying pregnant can be difficult (and heartbreaking if the latter occurs). Oftentimes we don’t know exactly why miscarriage happens, but we do know about the involvement of the thyroid in some women. Recent studies have looked at the association between fertility and the thyroid gland and found that conditions like hypothyroidism and Hashimoto’s Thyroiditis are contributors to infertility. 

Thyroid disorders may affect your period in the following ways:

Hormones such as thyroid stimulating hormone (TSH) and thyroid hormones (T4 and T3) are important for menstrual regularity, egg development and implantation. 

Hypothyroidism

Hypothyroidism occurs when TSH levels are increased beyond their normal limits, when there is not enough T4 secretion, or when there isn’t enough conversion of T4 to T3. The latter means that you can have NORMAL TSH levels but T4 and T3 could be off.

Hypothyroidism signs and symptoms look like:

  • Low metabolism, which can lead to weight gain
  • Low basal body temperature
  • Low pulse or blood pressure
  • Dry and/or scaly skin
  • Dry hair and/or hair loss
  • Slowed reflexes
  • Intolerance to cold
  • Depression

Hashimoto’s Thyroiditis

Hashimoto’s is essentially an autoimmune version of hypothyroidism. It occurs when the body doesn’t recognize the thyroid gland as its own and attacks it, leading to the production of thyroid antibodies such as anti-TPO and thyroglobulin.

Additionally, there is also a connection between Hashimoto’s and gluten sensitivity/celiac disease. So if you’ve been looking for a reason to limit your gluten intake, here it is!

TSH During Pregnancy

During pregnancy, having ideal levels of TSH and thyroid hormones is important because they are associated with increased gestation (time between conception and birth), hypertension, growth restrictions, premature delivery and fetal hypothyroidism. It’s clear that the thyroid should be monitored throughout pregnancy.

Thyroid Testing

The American Thyroid Association recommends that TSH should be checked in all women experiencing infertility, and some groups indicate that TSH should be equal to or less than 2.5mIU/L to reduce miscarriage risk.

Here’s the thing though, usually only TSH will be tested but this isn’t good enough! It’s important to understand everything that’s going on with the thyroid so ask for a comprehensive workup that looks like:

  • TSH
  • T4
  • T3
  • Anti-TPO
  • Thyroglobulin

Thyroid and IVF

IVF can be a stressor to the thyroid. And although no studies have showed that treating hypothyroidism leads to an increase of live births, one study has shown that hypothyroid women have less of a response to ovarian stimulation and a lower rate of embryo transfer.

Next Steps

With infertility being so common nowadays, it’s important to take a good look at the thyroid – especially if you have a family history of thyroid disorders or experiencing any of the above signs or symptoms.

Treating thyroid conditions does not just require medication, particular nutrients like selenium or Vitamin D can also be helpful, as well as trying out some dietary changes if you happen to have high antibody levels. Speak to your naturopathic doctor to see how they can complement your treatment plan.

References

Busnelli, A., Somigliana, E., Benaglia, L., Leonardi, M., Ragni, G. and Fedele, L. (2013). In Vitro Fertilization Outcomes in Treated Hypothyroidism. Thyroid, 23(10), pp.1319-1325.

Biondi, B., Cappola, A. and Cooper, D. (2019). Subclinical Hypothyroidism. JAMA, 322(2), p.153.

Maraka, S., Singh Ospina, N., Mastorakos, G. and O’Keeffe, D. (2018). Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How?. Journal of the Endocrine Society, 2(6), pp.533-546.

Green, K., Werner, M., Franasiak, J., Juneau, C., Hong, K. and Scott, R. (2015). Investigating the optimal preconception TSH range for patients undergoing IVF when controlling for embryo quality. Journal of Assisted Reproduction and Genetics, 32(10), pp.1469-1476.

Orouji Jokar, T., Fourman, L., Lee, H., Mentzinger, K. and Fazeli, P. (2017). Higher TSH Levels Within the Normal Range Are Associated With Unexplained Infertility. The Journal of Clinical Endocrinology & Metabolism, 103(2), pp.632-639.

Sex and your Fertile Window

May 4, 2019
sex fertility, conception, ovulation, toronto naturopath, naturopathic doctor toronto

If you want to get pregnant, you might be wondering when the best time to have sex is, and how often you should have it to achieve a pregnancy.

Timing Sex

Your fertile window can be generally thought as a 6 day period, with the last day being ovulation. Your pregnancy chances increase when you have increased sex during this period, and it may result in pregnancy when it happens in the last 3 days of the window.

It’s important for you to know when you ovulate – and you may want to begin to think about finding this specific day before you start trying. First of all, you shouldn’t be relying on your period-tracking app to tell you when you ovulate. Instead, you should be paying attention to signs your body is sending you.

  1. Cervical fluid
  2. Cervical position
  3. Basal body temperature

A study has shown that tracking your cervical fluid changes across your cycle, can predict ovulation as well or better than basal body temperature and LH strips.

What you’re basically looking for is egg white cervical fluid, that will give you a tip that ovulation is set to occur. Cervical mucus will increase 5-6 days before ovulation and will reach its peak 2-3 days before ovulation.

Sperm and Sex

If a man has normal sperm quality, having sex every day sperm concentration and motility will reman normal. A study also indicated that men with a low sperm count, sperm concentration and motility may be highest with daily ejaculation.

If you were to space out sex, and your partner is ejaculating every other day, this wouldn’t negatively impact his sperm parameters. However, if he’s ejaculating every 5 days, sperm parameters at this point may be affected. By 10 days without ejaculating, sperm parameters begin to deteriorate.

The bottom line is, as long as sperm parameters are normal (and you probably wouldn’t find this out until after getting tested by a fertility clinic), having sex every 1-2 days in your fertile window can be beneficial.

One study showed that having sex daily, led to a higher chance of becoming pregnant in the menstrual cycle.

Final Thoughts

It’s important to note that even if you’re having sex daily in your fertile window, this may not lead to a pregnancy – and it may have you worrying about infertility.

Fertility can be incredibly stressful and it can affect your self worth. Women spend so much time in their teens and twenties avoiding pregnancy, only to be consumed with it when they’re finally ready to start trying.

If you can’t talk to your partner or friends about this, there are certainly people you can talk to about to help you get you through this journey.

Furthermore, support also exists in helping improve your chances at pregnancy.

References

Optimizing natural fertility: a committee opinion. (2013). Fertility and Sterility, 100(3), pp.631-637.

Types of Assisted Reproductive Technologies (ART): Ovulation induction, IUI, IVF, FET

March 19, 2019
types of ART, IVF, IUI, FET, fertility, toronto naturopath, naturopathic doctor toronto

In Canada, about 11.5 to 15.7% of couples experience infertility. After a certain period of time (1 year for people under 35, and 6 months for those 35 years or older), couples may choose to visit a fertility clinic to determine if there are any underlying issues keeping them from getting pregnant, and exploring what their options are.

Down below, I’ll be outlining the most common types of ART.

Ovulation Induction

Around ovulation, your body should be releasing an egg to be fertilized. However, if no egg is being released, this would lead to anovulation (which is the most common cause of infertility).

Ovulation induction uses certain medications to induce ovulation and lead to the release of an egg. These medications may include:

  • Gonadotropins (synthetic FSH or LH, GnRH agonist, GnRH antagonist)
  • Letrozole
  • Clomid citrate
  • hCG

Intrauterine Insemination (IUI)

IUI is a type of ART that inserts concentrated sperm (from a partner or donor) into a woman’s uterus (bypassing the cervix) around ovulation.

Cycle monitoring would be performed to determine when ovulation is happening.

This can be either a ‘natural’ cycle where no medications are used. Or, it can be a medicated cycle where there’s ovulation induction and/or a trigger shot.

Implantation will usually happen between 5-10 days later.

Who would benefit from IUI?

  • Anyone with unexplained subfertility
  • Male factor subfertility (ie. low sperm count, retrograde ejaculation, erectile dysfunction)
  • Cervical factors (ie. mucus or cervical hostility)
  • Endometriosis
  • Couples with sexual dysfunction

Who would not benefit from IUI?

  • Cervical issue (ie. blocked/narrow opening of the cervix, infections)
  • Blocked tubes
  • Severe sperm abnormalities (<5mil motile sperm)
  • Amenorrhea
  • After 6 failed attempts

In Vitro Fertilization (IVF)

This is the most common ART cycle in Canada. It involves the egg being fertilized by sperm in a lab setting. Medications are used throughout the cycle to produce around 10-22 eggs. Cycle monitoring is performed to assess follicular and endometrial development. Ovulation is stimulated to control for timing. Egg retrieval usually happens 36 hours after a trigger shot.

When eggs are retrieved, they are fertilized with sperm. This can happen naturally or through intra cytoplasmic sperm injection (ICSI) where sperm is injected into a mature egg.

The fertilized eggs (now called embryos) are incubated until the transfer day (usually day 3 or 5 of embryo development), where they are transferred into the uterus.

After retrieval, medications like progesterone can be used to produce a more favourable environment for the embryos.

Who would benefit from IVF?

  • Unexplained subfertility
  • Age-related subfertilty (ie. decreased ovarian reserve)
  • Tubal issues (ie. blocked or damaged tubes)
  • Endometriosis
  • Cervical isses
  • Uterine issues
  • Hormone disorders
  • Male factor infertility

Frozen Embryo Transfer (FET)

FET occurs when previously frozen embryos are thawed and transferred into the uterus. These embryos are usually prepared during a previous IVF cycle where there may be a surplus of embryos, if there were any complications or findings in a past IVF cycle, or simply for preserving fertility.

Implantation usually happens 2-5 days after the transfer.

Next Steps

Naturopathic Medicine can certainly play a huge role in combination with infertility. Particularly when we understand that it takes about 100 days for eggs to mature (that’s 3 menstrual cycles!).

Studies have shown that couple going through IVF specifically, are more successful if they are addressing their health prior to ART.

Things that I like to pay attention to, before and during IVF, are:

  • Nutritional support for mom and embryo
  • Supporting mitochondrial function
  • Supporting ovarian health
  • Protecting against oxidative stress
  • Decreasing inflammation
  • Managing and decreasing physical and emotional stress
  • Supporting the immune system

For more information on how Naturopathic Medicine can support you during your ART journey, I encourage you to book a free 15 minute consult with me.