THYROID & FERTILITY: Part 2 - Trying to Conceive, Fertility, Pregnancy and Miscarriage

**Learn more about my new fertility course to enhance your natural fertility and optimize your lifestyle**

Board certified OBGYN and REI, fertility doctor Natalie Crawford, MD discusses thyroid disease, screening, and treatment for people who are trying to conceive, undergoing fertility treatments, or having recurrent miscarriages. Listen as she reviews latest guidelines and updates - hitting on information that is controversial or uncertain.

Reviewed in this video:
Should you screen for thyroid disease in pregnancy?
What is a normal TSH in pregnancy?
Should you test for thyroid in infertility?
What are thyroid antibodies?
When should you treat if you have positive thyroid antibodies?
Does thyroid disease cause recurrent miscarriage?
Is it safe to take thyroid hormone?
When should you test your thyroid?

*PART 1 video reviews the basics of thyroid physiology, TSH and hypothyroidism and hyperthyroidism

*This is not medical advice but education. Please ask your doctor your general medical questions.

Resources:

Dosiou C. Thyroid and Fertility: Recent Advances. Thyroid. 2020 Apr;30(4):479-486. doi: 10.1089/thy.2019.0382. Epub 2020 Feb 4.

Chen LM, et al. Associations between thyroid autoantibody status and abnormal pregnancy outcomes in euthyroid women. Endocrine 2015;48:924-8.

Lee SY, et al. Monitoring, and Treatment of Thyroid Dysfunction in Pregnancy. J Clin Endocrinol Metab. 2021 Mar 8;106(3):883-892. doi: 10.1210/clinem/dgaa945.

Negro R, Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. The Journal of clinical endocrinology and metabolism 2011;96:E920-4

Cleary-Goldman J, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstetrics and gynecology 2008;112:85-92.

Karakosta P, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. The Journal of clinical endocrinology and metabolism 2012;97:4464-72

Abbassi-Ghanavati M, et al. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstetrics and gynecology 2010;116:381-6.

Abalovich M, et al. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid : official journal of the American Thyroid Association 2002;12:63-8.

Vissenberg R, et al. Effect of levothyroxine on live birth rate in euthyroid women with recurrent miscarriage and TPO antibodies (T4-LIFE study). Contemporary clinical trials 2015.

Vissenberg R, et al. Live-birth rate in euthyroid women with recurrent miscarriage and thyroid peroxidase antibodies. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2015:1-4.

Yan J, et al. Thyroid peroxidase antibody in women with unexplained recurrent miscarriage: prevalence, prognostic value, and response to empirical thyroxine therapy. Fertility and sterility 2012;98:378-82.

Negro R, , et al. Euthyroid women with autoimmune disease undergoing assisted reproduction technologies: the role of autoimmunity and thyroid function. Journal of endocrinological investigation 2007;30:3-8.

Velkeniers B, et al. Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs. Human reproduction update 2013;19:251-8.

Lepoutre T, et al. Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases. Gynecologic and obstetric investigation 2012;74:265-73

Thyroid Disease in Pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol. 2020 Jun;135(6):e261-e274.

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Fertility doctor, Natalie Crawford, MD is a double board certified OBGYN and REI, and co-founder of Fora Fertility, a boutique fertility practice in Austin, Texas.

COME SAY HI!!!

FORA FERTILITY:
715 W 34th Street, Austin, TX 78705

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#fertility #fertilitydoctor #nataliecrawfordmd #doctor #asawoman

Sharing fertility facts to educate women about trying to conceive, getting pregnant, ovulation, fertility treatments, IUI, IVF, becoming a doctor, life as a woman in medicine, and more.

[isabellegauthier]

I had difficulty TTC for 12 months with irregular periods. My doctor checked TSH and it was 7. I started synthroid and got pregnant on the same month 🥰🤗 I am now 5 months pregnant! I wish I could saw that video last year!! Well explained! Your patients are so lucky to have you.

[valeriestrokachenko]

Wow. Thank you for such good explanation. Wish my drs told me that over treating is better than under treating.

[MsJupiter]

THANK YOU, I have never gotten a normal period, I have always been told that I was a late bloomer and I had to go to a female fertility specialist in Iceland (where I'm from) to get answers that I could've been saved from infertility if my primary doctor had put me on hormonal replacement therapy, but I got put on the pill and felt instantly better since I wasn't making them on my own. So now I am doing egg retrieval in August and then freezing them cuz I need to get my relationship more stable before we do the rest and I need to get my financial situation better.

[ElizabethRhinehart]

I am currently going through my second miscarriage. I was diagnosed with Hashimoto's a couple days before I found out I was pregnant this time, but my endocrinologist never put me on medicine nor said I would need to be medicated during pregnancy even though I told him we were trying to have a baby and had already experienced loss. My OBGYN is pretty upset because she said I absolutely need to be on levothyroxine when TTC and during pregnancy. She put me on it, but I was already almost 7 weeks along so I think it was too late. I feel like this loss was completely preventable and it's incredibly frustrating. No living children yet, but hopefully we will have a successful pregnancy soon.

[claudiacapuano]

Thank you so much for explaining so clearly and so insightfully what most doctors don’t have the time to explain at appointments. 🙏

[l.ashleypalmer]

Thanks for pointing out those studies. I've been resisting taking thyroid medication even though my TPO antibodies are >900 with a TSH that fluctuates between 2.4 and 3.1. Most of the time the TSH is 2.6. Your videos are so informative! 🔥 ❤️

[brittainykyes]

I have Hashimotos and have been put on NP Thyroid and Low Dose Naltexone (LDN). My husband and I have not been able to get pregnant the 10.5 years we have been together. Hoping that my TPO Antibodies will work themselves down so we can finally have our baby.

[kadiekeeks]

Ive been struggling ttc for over 5 years. I do have Hypo, they just up'd my dosage to 137mg, my cycles are always on point, i can tell when my body ovulates. im fairly healthy, i do exercise. My life has been tough, especially with no answers as to why. Oh yeah, my husband is perfectly fine too. I've visited a fertility clinic in San Antonio just to be left in the dark, no further testing.

[christinag]

I just had a miscarriage at 13 weeks, my thyroid tsh was 85. I didn’t know I had hypothyroidism. I have an appointment to get me started on a thyroid treatment, how long should we wait until trying again? Should I wait until my levels are ideal for pregnancy. I had no weight gain no period issues, I did feel tired but not to warrant 85! My doctor said she doesn’t know how I’m even functioning and it’s a miracle I was even able to get pregnant let alone keep it for 13 weeks. I’m just devastated, if I would have gotten my blood work sooner the baby could have survived 😞

[kerrischroeder]

Have you found it not helpful to look at other thyroid numbers, T3, T4, reverse T3? Or only TSH matters?

[ukbeautyroom]

Thanks this is really helpful. I’ve been struggling to conceive for more than a year. My periods are regular but when my TSH was checked it was 6.17. I’m now taking 50mcg levothyroxine and will get my TSH re-checked soon. Do you think the reason I haven’t got pregnant is because my TSH is so high? My periods have always been regular. I’m 40 years old. Thanks so much for your videos 🙏

[lindseycurry]

I’ve had graves and was hyper, had 2 x rai treatments and now hypo since October 2019 and on levothyroxine since, not even a sniff of pregnancy and it’s seriously affecting my mental health

[fleon]

What about clinical hyperthyroidism and trying to conceive? Do you treat it at all?

[meganmaia]

Hi Docter Crawford, my mom and grandmother have hypothyroidism. I have never been tested but I have had 2 miscarriages and am currently 5w3d pregnant. Should I bring this up to my OB and have her check my levels? I don't want to lose another baby.

[makenziewehunt]

What if you have regular periods with subclinical hypothyroidism?

[CuriousCumin-ptcg]

My doc also had the idea that over treatment is better. I took 75 micrograms of Eltroxin daily and suddenly I had no balance, bad vertigo, double or blurred vision, sweaty palms and feet, migraines, nausea and extreme anxiety. I think I was bumped into Hyperthyroidism or I experienced severe side effects from this medication. I fell so ill and could not function at all. Completely debilitated. What to do in a case like this? I cannot take these meds, it makes me so ill. Any suggestions?

[chelseaselsor]

I accidentally hit dislike but changed it so hopefully that doesn’t show up!

Thank you for these Thyroid videos. They are very helpful! 😊 TTC for a year and a half and was diagnosed with PCOS in August 2021. Recently just got put on Levothyroxine because my TSH was 5.77. Do you see that thyroid issues with PCOS are common? Thanks!!

[jocelynbriant]

Hi Doctor,
Your videos are super helpful! I just have a question about thyroid and Clomid. My obgyn said everything in pelvic exam and bloodwork is normal, however, I do have Hypothyroidism and irregular and sometimes absent cycles. Would my obgyn prescribe me Clomid when I'm ready to conceive?
Thanks so much for your time!

[wakeupstylellc]

My doctor won’t treat my hypothyroidism, even at 5.6.. because my free T4 is normal.
I am seeing a gynecologist soon, hopefully they can help. I also have a gluten sensitivity and I heard thyroid pills are coated with something that contains gluten. That scares me, because I get very sick when I consume gluten 😢

[purplefreax]

My endocrinologist is giving levothyroxine for my thyroid problems &my high prolactin levels. They are now normal. But my TSH is still low ): I have been treated since a year& idk why my TSH is still low.. I am trying to conceive my first baby I am 30 years old.. but is difficult to get pregnant & I am afraid to lose my baby with low TSH levels... its scary& idk what to do... boost up my TSH levels):