Frustrated-TSH/infertility

[vfunk]

We've been trying for over a year and I've never gotten pregnant.

History: OB-GYN did a TSH test back in Jan. My level was 3.03.  Fast forward to July…my new RE said he wasn’t concerned about my TSH level. I’m assuming it’s because I ovulate. My prolaction levels were normal and my FSH is a 4.

I wasn’t satisfied with that and I had my GP test me again towards the end of July. She did a full panel and my TSH this time was 5.09 – I was told the rest of my panel was “normal.” So, my RE finally said he would treat me and he sent me for bloodwork. I gave more blood on August 22. My numbers:

TSH: 3.14
T4 free – 1.07
Antibodies – less than 20/should be less than 40
TP – less than 10/should be less than 35

I am still mildly high on the TSH and I’m so frustrated right now. Should I be treated? My RE isn’t going to do it and everything else came back perfectly normal. By the way: my husband’s most recent semen analysis showed morph problems and he has to get tested again and I just had surgery to fix a uterine septum so we may have other infertility problems.

At this point, I don’t know what to do. Do I trust my RE? Why did my TSH fluctuate like that? Do I seek out a specialist?

In the back of my mind I keep thinking about how for optimal fertility a woman should be between a 1 and 2. I’m sure women have gotten pregnant with a higher TSH level than that but of course I want everything to be in place “healthwise.”

[Forum-M.D.-SP]

Dear vfunk-

You are focusing on the wrong issue, being so concerned about your TSH levels. Unless your TSH is VERY high, you do not have clinical hypothyroidism and do not need to be treated. Additionally, although we routinely check for thyroid dysfunction when couples are having difficulty getting pregnant, and believe it to be important to treat abnormal thyroid levels, this is only to 'fine tune'. Correcting a truly abnormal TSH with medication will render infertility treatment more effective, but will not in and of itself cure infertility. With TSH levels between 3.1-5.09 I am not sure you need to be treated. If a 4th TSH level came back borderline elevated perhaps a low dose of thyroid replacement, but again this is not likely to be the 'cure.'

There are four common causes of infertiliy:
1) irregular or absent ovulation - if your periods are regular this is not the case with you
2) anatomy problems - blocked fallopian tubes, uterine septum, etc. Has your septum been repaired recently? Blocked tubes are more important than a septum, but if the septum was large fixing it was probably a good idea.
3) sperm problems
4) unexplained - which means that after all the testing is completed there really is not anything obvious

Treatment for infertility is based on which of the above causes you have:
1) fertility medicines if you are not ovulating
2) fixing blocked fallopian tubes or IVF to by-pass blocked fallopian tubes
3) intrauterine insemination with fertility drugs for mild sperm abnormalities, IVF for severe sperm abnormalities, or rarely a urologist trained in male infertility can correct sperm abnormalities although most of these are not amenable to correction
4) fertility drugs with intrauterine insemination for unexplained infertility, or if you are still not getting pregnant after other abnormalities (like your septum) have been corrected.

Based on what you have told me, the advice you have received from your RE is appropriate.

Good luck!

[kais]

Hi,
We are in Santa Clara, California.
Can some one suggest the best(most economical) medica insurance policy wherein can we can get covered for infertility treatment. The insurance through my employer doesn't support infertility treatment. I wish to take one on my personal expenses. I appreciate a your help.

Thanks,
Khaleel

[cheshire]

Your TSH is fluctuating because it sounds like you have hashimotos thyroidis. You really do look hypothyroid to me. I believe you should follow your instincts on this one, and find an OD, or more holistic MD to take these thyroid concerns seriously. I'd also be particular with treatment, and not settle for anything else but Armour thyroid. Also check all vitamin and mineral status, including ferritin and make sure they are in the healthy part of the range. As a women who was diagnosed with Hashis but left untreated, and then experienced three early preg losses with a high range TSH, I feel very strongly about correcting thryoid issues before embarking on fertility. Here are a few blood tests I suggest:

TSH But this lab is only for diagnosis of hypopituitary, NOT to diagnose or dose your hypo by. For pregnency i believe you want to see this between 1 and 2, with the Frees in the upper part of the range

Free T4 and Free T3 (note the word “free”): You want both in the upper part of the range.

Thyroid Antibodies (anti-TPO and TgAb. YOU NEED BOTH.)

Ferritin (and do stress FERRITIN, not just RBC). healthy is 60-100.

Adrenals Cortisol levels (but I strongly recommend saliva tests, not the one time blood test your doctor will do. You don’t need a prescription)

B-12: Over 600 is good

estrogen, progesterone, testosterone, DHEA

Reverse T3

if you give me your location (closest city) I could possible recommend a good thyroid doctor.