Hashimoto's and fertility

[Anonymous]

Does anyone know of good sources of information about the effect of Hashimoto's antibodies on the ovaries and on response to FSH? Or any doctors well versed in this? Thanks so much and good luck to us all.

[Anonymous]

Unfortunately, I don't have any literature or research references to pass along, but I just wanted to tell you that my sister has had Hashimoto's for many years and had 4 children (her latest at age 41!) all without intervention. I too have Hashimoto's and am now beginning fertility treatments, so who really knows. I think the best thing to do is just make sure you have a good internist or endocrinologist who monitors you and keeps your thyroid levels stable. Good luck!

[Anonymous]

I don't think anti-thyroid antibodies have any impact on FSH or on the ovaries themselves, but it's my understanding that people who are prone to Hashimoto's tend also to be more prone to other auto-immune problems like anti-ovarian antibodies and NK cells (i.e. the kind that attack and kill developing embryos). If you've had miscarriages or issues with implantation failure, I'd get tested for NKs. If your ovarian reserve is low for your age, there's probably a decent chance that you have AOA's as well.

[Anonymous]

Anonymous wrote:I don't think anti-thyroid antibodies have any impact on FSH or on the ovaries themselves, but it's my understanding that people who are prone to Hashimoto's tend also to be more prone to other auto-immune problems like anti-ovarian antibodies and NK cells (i.e. the kind that attack and kill developing embryos). If you've had miscarriages or issues with implantation failure, I'd get tested for NKs. If your ovarian reserve is low for your age, there's probably a decent chance that you have AOA's as well.

Just wanted to add--your best bet would probably be to consult with a reproductive immunologist.

[Anonymous]

This is an interesting thread and I realize how little I know about this aspect of fertility/infertility. If you are found to have anti-ovarian antibodies, is there anything they can do for you? Or is the damage done, with the low ovarian reserve, etc.?

[Anonymous]

I have a close friend with Hashimoto's, who was told when she decided to TTC that keeping her thyroid levels good was key.

She got pregnant the first month. (The jerk! Took me way longer, and I don't have it ). So I think the PP who said that other related factors could make a difference, but I don't think just having Hashimoto's means anything, if it's controlled.

[Anonymous]

Anonymous wrote:This is an interesting thread and I realize how little I know about this aspect of fertility/infertility. If you are found to have anti-ovarian antibodies, is there anything they can do for you? Or is the damage done, with the low ovarian reserve, etc.?

Unfortunately, there's not much that can be done for AOAs. I have them. It's usually still possible to conceive but you have less time. AOAs are a common cause of premature ovarian failure. We're using donor eggs but we didn't start trying until I was 37. I don't have Hashimoto's but I do have elevated NKs.

[Anonymous]

Is there a doctor in the area that offers this kind of auto-immune testing? Thanks, everyone.

[Anonymous]

Dr. Abbasi at CFA does. Otherwise, you'll need to go out of town.

[Anonymous]

There are a lot of women with Hashimoto's who are undergoing immune testing/treatment on the yahoo reproductive immunology group: http://health.groups.yahoo.com/group/immunologysupport/. You can search the archive for more info or put a question out to the group.

I see Dr. Abassi in conjunction with a Reproductive Immunologist (Dr. Braverman in NY). She can do the blood work from here and he can arrange phone consultants to recommend a treatment protocol should your test results indicate you need treatment.

[Anonymous]

Hi. I stumbled across this thread trying to find some form of of virtual solidarity and or answers. For the last decade I had been told that once my thyroid levels were controlled, there would be no difficulty getting pregnant, though my risk of miscarriage was slightly greater, but regular testing of my thyroid during pregnancy should be "sufficient."

After my thyroid had been stable for a year, I stopped taking the pill, knowing that the risk of intellectual disabilities in the child were less at that point. When I stopped, I found that my cycle wasn't occurring as expected so I asked for hormone level testing. My Gyn explained that while I was on the pill, my eggs were still dying off, and that Hashimoto's did have a high co-morbidity with Premature Ovarian Failure. I had my levels tested, was diagnosed with "diminished ovarian reserve," and learned that I was already post-menopausal and being on the pill had created a medically-induced "cycle" of bleeding, but without ovulation. I was sent to a fertility specialist who took one look at my FSH levels and informed me my only chance was donor egg, but that I was at a higher risk of being a genetic carrier of things like Fragile X, Turners, etc. so I needed to undergo genetic testing first. I just turned 34.

I don't mean to alarm anyone, but if my devastation can help others to see answers and get help before it's too late than maybe the purpose of my loss is to prevent potential loss in others.

While I know the internet is full of half-truths and misnomers, subsequent Google searches are revealing that there is evidence of a link between Hashimoto's and infertility, not just miscarriage. People laugh at me when I tell them my gyn explained that while my body was attacking and destroying the thyroid tissue, other tissues were likely also being destroyed. Her explanation may be "new age." but it seems to also have a lot of truth in it.

Anyway, if you get your levels tested early enough, Diminished Ovarian Reserve can be counteracted through medication and can lead to good chances of fertility. But once "diminished" becomes "depleted" it's too late.

I hope my struggles result in new-found potential for someone. Don't let anyone tell you that your infertility is "unexplained." The number of people with true Hashimoto's with the antibody as opposed to just hypothyroidism explained by Hashi, is astounding. We can't all just be in this situation by chance.

[Anonymous]

I agree there may be immune issues with Hashimoto's but there are so many factors at play in this process, it's hard to tell what is creating havoc in any particular case. I'd suggest testing for everything under the sun so at least you have the info for diagnostic purposes. Working with a doctor who isn't dismissive of these things and open to flexible protocols is also important (after 2 other doctors, we are with Dr. Abbasi).

I have Hashimoto's and have been struggling with infertility for over two years. Three IVFs and 1 IUI - all BFN. I've been diagnosed with low AMH indicating diminished ovarian reserve and have been a low responder to meds (4th IVF got converted to an IUI due to low response). But we also have male factor issues and egg quality issues. Maybe the egg quality is related to Hashi or AMH (or maybe not). I'm turning 35 next week, so maybe its age kicking in? Who knows.

I've learned that you have to be your best advocate and really stay on top of the lingo, tests, diagnoses, medication, dosages, etc. Things get by doctors and they tend to focus on their own specialty instead of the whole person.

To get my TPO under control, I'm on Synthroid and am gluten free. My TSH has always been in the normal range. The Synthroid didn't do much for my TPO but when I went gluten free, I saw a huge drop in my TPO levels (from 1400 to 330). You may want to try dietary changes to see if it helps.

Good luck to everyone out there. This whole process sucks.

[Anonymous]

6:56, what is TPO?

[Anonymous]

6:56 here. TPO stands for thyroid peroxidase antibodies. It is not generally tested in most thyroid panels and you may have to request that it be tested. I came across it when one of our earlier REs tested for it. It came back high around 800 (normal is 35 or below) and he blew it off as inconsequential (we blew him off shortly thereafter). A high TPO is generally an indication of Hashimotos.

One endocronologist wouldn't treat it because my TSH was normal and the Hashi wasn't advanced (so we're going to wait for my thyroid to be destroyed and then deal with it??). Finally found one that would treat it and monitor my TPO levels after hunting around.

I've become pretty versed in the medical lingo now. One thing I've learned is that there is no one answer to anything - if you ask 5 doctors, you're likely to get five different opinions. That's what it all comes down to - they are giving you their informed opinions. Then its up to you to make an informed decision on what to go with. So it's helpful to learn the lingo so you can make sure you understand what the hell they're all talking about.

[Anonymous]

Thanks PP. My elevated TSH was noticed around 10 or more years ago (way before TTC started). At the time my doctor must have looked for TPO because she said it didn't seem like Hashimoto's based on my antibodies (or lack of them). Around that time my TSH was just 5. It climbed to 10 (took about 8 years) before we treated (zero symptoms). I should ask my RE to retest for TPOs just because I had a chemical recently and want to rule out immune explanations.