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Infertility: Is your thyroid to blame?

Michele Borboa, MS is a freelance writer and editor specializing in health, fitness, food, lifestyle, and pets. Michele is a health and wellness expert, personal chef, cookbook author, and pet-lover based in Bozeman, Montana. She is also...

Infertility & your thyroid

Having trouble getting pregnant? Your thyroid could be the problem - and your doctor may not even know it. According to renowned endocrinologist and expert on thyroid issues Dr Kent Holtorf, founder of California and New York-based Holtorf Medical Group, standard blood tests miss up to 80 percent of cases in which low tissue thyroid levels are causing or contributing to infertility.

Woman with Pregnancy Test

How your thyroid affects your ovaries

Your thyroid is responsible for the metabolism of every cell in your body. It converts iodine into two thyroid hormones: thyroxine (T4) and triiodothyronine (T3). When you have low thyroid function (hypothyroidism) or high thyroid function (hyperthyroidism), it is no surprise that this imbalance can have an effect on your ovaries.

"We know that ovaries are very sensitive to changes in thyroid levels and seemingly small declines in thyroid levels (that are still in the normal range) can adversely effect ovarian function," explains Dr Holtorf. In fact, research indicates that about 70 percent of women with PMS have low thyroid levels, which make the ovaries less able to produce progesterone leading to PMS symptoms.

Low thyroid also contributes to another condition, polycystic ovarian syndrome, which affects about 10 percent of the female population and is a factor in infertility.

Dr Holtorf says that many women experiencing infertility or other women's health issues are told their thyroid is fine despite having low ovarian thyroid levels because standard thyroid testing often misses it. However, the thyroid specialist adds that with proper supplementation and optimization of thyroid levels, many women are able to conceive naturally or with subsequent IVF.

Tips to fight infertility if you have a thyroid disorder

In addition to following a healthy lifestyle, Dr Holtorf offers the following tips to improve your chances of conceiving.

1. Get properly diagnosed

Since standard thyroid blood tests are not sensitive enough to detect low ovarian tissue levels the majority of the time, Dr Holtorf advises, "Women must find a knowledgeable physician who understands that standard tests will often not be useful in detecting low ovarian thyroid levels."

2. Ask your doctor about Free T3/Reverse T3 ratio

If you've had your thyroid tested and the results indicated you are fine but you are still having trouble conceiving or you are experiencing continued fatigue, weight gain, PMS, cold hands or feet, or depression, ask your doctor for another test. "Currently, the best marker for tissue thyroid levels is the freeT3/reverse T3 ratio – low tissue thyroid levels are associated with a value less than 2," says Dr Holtorf.

3. Talk to your doctor about different thyroid medications

There are a number of thyroid medications that may be beneficial in improving your thyroid function. Though Synthroid and Levoxyl are standard, Dr Holtorf says these medications may not be effective in improving fertility. "Standard thyroid preparations such as Synthroid and Levoxyl are often not adequate to optimize ovarian thyroid levels…a T3 containing preparation is often needed." Talk to your doctor about your options, particularly if the medication you currently take is not providing results.

4. Lose weight

In addition to fatigue, weight gain is often a dreaded symptom of low thyroid function – and being overweight can hinder your ability to get pregnant. Having worked with many clients who are overweight due to endocrinal issues, Dr Holtorf does not buy the "no willpower" stigma that is placed on people who are overweight. Instead, he sees weight problems for many people as being hormonal in nature. "One major sources of weight gain is low tissue T3 levels that are often associated with leptin resistance, the doctor explains. (Leptin is a hormone that regulates body weight and metabolism.)

"Correction of low tissue T3 levels can result in dramatic long-term successful weight loss," he says. "Time released T3 [medications] are the most effective at restoring tissue T3 levels and are often effective when Armour thyroid, Sythroid, and Levoxyl fail to restore normal tissue levels of thyroid."

5. Don't diet

Before you start – or continue – restricting calories or exercising to exhaustion, Dr Holtorf warns that starvation dieting can actually decrease resting metabolic rate by up to 40 percent and that food restriction to maintain a 10 percent decrease in your weight can result in significantly decreased thyroid hormones. Worse, the diminished metabolic rate from starvation dieting and the decrease in thyroid hormones doesn't return to normal even after a normal diet is resumed. "When combined with the effect of leptin resistance, this accounts for the majority of regained weight in [people who have lost and regained weight]." The key is to eat sensibly, do moderate exercise, and most important, get properly diagnosed and on the right thyroid medication.

6. Limit your intake of soy and cruciferous vegetables

Though healthy in moderation, soy and cruciferous vegetables, such as cauliflower, broccoli and Brussels sprouts, have been associated with disrupted thyroid hormone production. "These foods, however, have high antioxidant and nutritional value so total elimination is not recommended and, in moderation, should pose no problem," says Dr Holtorf. And besides, eating a variety of fruits, vegetables, legumes and lean proteins will be healthier and definitely more fun to eat than filling up mostly on soy and cruciferous veggies.

7. Avoid toxins

"More and more studies are showing that environmental toxins are major sources of hormonal disturbance. Plastics, including the component Bisphenol A, are leading the list of thyroid disruptors," warns Dr Holtorf. "Bisphenol A is contained in many bottled water bottles and as part of the epoxy that lines cans, including soda and food cans." The doctor adds that significant use of plastic bottles or canned goods can result in severely reduced tissue thyroid levels, weight gain and infertility and he recommends to avoid them altogether. (More on Bisphenol A)

8. Get adequate sleep

Many hormones, including growth hormone, are produced during sleep. In addition, getting quality rest is essential for your health and can help you better deal with daily stress. (Click for reasons women have trouble sleeping and natural ways to sleep better.)

9. Reduce your stress

There is no doubt that stress disrupts your body's balance – the stomachaches, racing heart, difficulty breathing, migraines, and additional physical and mental angst are strong indications that stress can wreak havoc on your health, including your ability to conceive. Dr Holtorf says, "Stress will reduce tissue level of thyroid and suppress the secretion of many hormones." If you are having trouble dealing with stress, our Stress Section can provide you with expert tips to stress less.

10. Get adequate exercise

Along with maintaining an optimal weight, regular exercise is good for your overall health, but it also helps with hormonal balance (not to mention dealing with stress and boosting your mood). According to Dr Holtorf, hormonal production is stimulated with exercise and can help prevent weight gain, which suppresses thyroid production. Visit our Diet and Fitness Channel for fitness tips, workouts and other ways to get in shape.

Getting your thyroid checked and finding the right treatment plan for thyroid issues is not only beneficial to your health but also the health of your baby. "Suboptimal thyroid levels are not only a cause of fertility problems, increased risk for miscarriage, premature delivery and other complications, they can also hinder brain development in a fetus. Optimizing thyroid levels can result in a 10 percent increase in a child's IQ and improved neurological development," says Dr Holtorf. Isn't it time for you to get your thyroid checked - or checked again?

More information on infertility and thyroid health


What you need to know about hypothyroidism
Is soy making you sick?
Infertility at Pregnancy & Baby

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