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Interesting new study: IVF & Thyroid


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#1 DrFionaMcCulloch

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Posted 28 February 2012 - 05:17 PM

Hello there,

for all the ladies who have borderline hypothyroidism - meaning anything above a 2.0 TSH...

This study published in Fertility and Sterility found that IVF stimulation itself led to significant increases in TSH levels, often to above the recommended pregnancy guidelines. This would increase the chance of chemical pregnancy, early pregnancy loss, or an unsuccessful cycle.

A great reason to have your thyroid fully assessed with regards to medication and supplement needs prior to IVF - especially if you have a family history of hypothyroidism, or have ever had borderline or subclinical hypothyroidism.

http://www.fertstert...bstract?rss=yes
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Dr. Fiona McCulloch, BSc., ND : Naturopathic Doctor, Integrative Women's Health & Fertility
White Lotus Integrative Medicine
Greenfield Ave, Suite 201
North York, Ontario, M2N 3CBCanada
phone (416) 730-8218



 
 

#2 Calgarybsjl

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Posted 03 March 2012 - 06:36 PM

Thanks Dr. Fiona! Is it possible to access the article without a subscription?

Also, would it ever be worth re-testing if TSH had been normal (1.59) as of a few months ago? And what symptoms would you look for with sub-clinical hypothyroidism? I'm a complete believer in the enormous impact of TSH!

#3 PaleSpring

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Posted 14 March 2012 - 01:40 PM

Thanks for this. My thyroid levels have always been normal, but my last bloodtest a few weeks ago revealed a TSH of 5.2, with rest of levels normal, so am having it retested to confirm whether it is subclinical hypothyroidism. I am expecting to start cycling for IVF in a few weeks. My doctor [family doctor, not my RE] had said to retest within 1-3 months, not immediately. But reading this is making me wonder if I should get it rechecked before starting the IVF meds, in case it is high and needs to be treated?

Me: 32, DH: 34

Unexplained Infertility

Nov 2010: IUI#1 -BFN

Jan.& Feb '11: IUI#2,3 -BFN

Mar: Polyp in uterus

Apr: Hysteroscopy & Polypectomy.Pathology normal

May-July: IUI #4,5,6 -BFN

Aug-Jan'12: Trying naturally, with acupuncture, fertility yoga, herbal supplements

 

IVM#1: Feb 2012

ER: Feb.7: 9 eggs retrieved, 6 mature(d), 2 fertilized

ET: Feb.10: 4-cell day2 embryo and 5-cell day3 embryo

BFN

 

IVF#1: April 2012

ER: April 4th: 14 eggs retrieved, 7 mature, 5 fertilized

ET: Apr9. day5 transfer of 1 blast, 2 more frozen

BFN

 

FET #1: ET Sept 7th 2012

Transferred one d5 blast

Beta Sept 18 --BFP!!!!!!!!!!! Thank You God!!!! aH

Viability Scan: Oct 2nd. Heartbeat viewed, everything normal!

Anatomy Scan: Jan 14th. Its a boy!!

DD: May 25th, 2013
May 17th, 2013. Emergency C-section. Baby is here!! aH What did my arms do before they held him, what did my heart do with its love!! Thank You God!!! aH

 

 

Round 2: Project Sibling!

IVF#1 November 2014

ER: 21 eggs retrieved, 19 mature. 9 fertilized. 3 frozen

Transfer delayed because of OHSS

FET#1: February 2015. 1 blast transferred = BFN

FET#2: May 2015. 1 blast transferred =  BFN

FET#3: Sept..Transfer cancelled, blast didnt survive thawing

 

IVF#2 January 2016

ER: 19 eggs retrieved, 17 mature, 11 fertilized

6 ice babies: 4 day5 blasts and 2 day6 blasts

Transfer delayed because of OHSS

FET#1: April 2016 = BFN

 

May-July: Lupron & Letrozole

FET#2: Aug 2016 = BFP!!!!!!! Thank You God aH aH

 

 

"There are two ways to live, one is as though nothing is a miracle. The other is as if everything is"- Albert Einstein

 


#4 Arbutus

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Posted 14 March 2012 - 08:16 PM

Hello Palespring,

You might want to advise your RE of your thyroid test results and let him/her determine if they want to presribe any medication or retest prior to your iVF. If medication is required you will want to be on it long enough for it to take affect so you'll need to let your RE know in advance of starting IVF meds.

#5 DrFionaMcCulloch

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Posted 23 March 2012 - 10:51 AM

Hi Pale

Your TSH of 5.2 is definitely concerning and i would bring this up for certain to your RE before doing IVF.

Calgary - no, unfortunately you need a subscription!
The symptoms to look out for are : fatigue, weight gain, feeling cold, constipation, dry skin, hair loss, depression or mood changes. I would retest your TSH prior to doing any IVF cycle, as often times thyroid issues can spring up unexpectedly, especially if you have noticed a change in how you feel!

Thanks for your questions! Glad you found the article interesting!

Dr Fiona
Dr. Fiona McCulloch, BSc., ND : Naturopathic Doctor, Integrative Women's Health & Fertility
White Lotus Integrative Medicine
Greenfield Ave, Suite 201
North York, Ontario, M2N 3CBCanada
phone (416) 730-8218



 
 

#6 Zeukko

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Posted 09 June 2012 - 08:14 PM

After my first ivf cycle, my TSH jumped to 5.2. After time, it did drop to about 3.2 -3.7. My REs at my other clinic weren't concerned. But at my new clinic, the new RE flagged it as a possible issue. So went in this morning for another TSH test and it came to 2.9. The RE gave me a prescription just in case. So happy that this RE is taking my concerns about my thyroid seriously.
Me:42 and DH: 44
Married since 2004
Two amazing furbabies
TTC since Feb 2009
Sept-Dec 2010: Clomid + 5 IUIs = BFN :(
March 2011- IVF/ICSI#1: antagonist - BCP, Puregon, Orgalutron, Ovidrel, Crinone = BFN
22 follicles; 14 eggs; 11 fertilized; 2 transferred; 1 snowbaby
FET #1 May 2011- 1 grade 2 blastocyst = BFN
August 2011 - IVF #2:antagonist - BCP, Puregon, Orgalutron, Ovidrel, Crinone = BFN
21 follicles; 12 eggs; 10 fertilized; 3 transferred; 5 3d embryos frozen
FET #2 Oct 2011 = BFN FET#3 July 2012 = BFP @ Genesis Fertility Clinic Beta #1= 41 (gulp); Beta #2= 47 (ugh) = Chemical pregnancy
February 2013 - IVF #3 = BFP - Estrace, Menopur, Puregon, Orgalutron, Endometrin - Retrieved 14 egg, 11 mature, 9 fertilized. Transferred 2 blastocysts. 1 blastocyst snow babyBeta#1: 45 (uh oh)Beta#2: 555 (what?! Wow!)
Beta #3000+.
U/S shows not viable pregnancy. Stopped growing at 5w5days.


July 1st: Natural BFP on HPT - First Beta in the 400s; Second Beta dropped to 200s

April 2014: Single embryo transfer = BFN

Looking into adoption.

#7 tjluvbug

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Posted 10 June 2012 - 06:55 PM

Dr. Fiona,
My TSH level is exactly 2.5, at the moment my doc says it is fine. I have also had a test to look at whether I have anti thyroid antibodies and I do not. Is there any need for further testing in your opinion?

<p>Me 38 (28 when we did first IVF) DH 52 3 IVF's, 2 FET's, & 2 IUI's.  Boy/Girl twins born March 12th, 2015 at 33w6d. Our family is complete


#8 tjluvbug

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Posted 10 June 2012 - 06:57 PM

Dr. Fiona,
My TSH level is exactly 2.5, at the moment my doc says it is fine. I have also had a test to look at whether I have anti thyroid antibodies and I do not. Is there any need for further testing in your opinion?

<p>Me 38 (28 when we did first IVF) DH 52 3 IVF's, 2 FET's, & 2 IUI's.  Boy/Girl twins born March 12th, 2015 at 33w6d. Our family is complete


#9 Cheddar

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Posted 11 June 2012 - 03:46 PM

oh my goodness! I wonder if this is why I've been so exhausted and have gained weight since my first cycle!? I had a physical last week and had my blood tested. I'm just waiting to hear back. This is definitely something I'll look out for.

Should we be taking thyroid meds, though, while doing IVF?
TTC since February 2010IUI #1: October 2011, cycle cancelledIUI#2: December 2011: BFNIVF #1 in March 2012: BFNIVF #2 in July 2013: BFN Got divorced, spend several years having fun, met the best man Iíve ever known in 2016 and married in 2019IVF #3 in summer 2018: BFNIVF #4 in 2018 fall 2018: BFNMoving on to donor eggs at Shady Grove in guaranteed, shared risk program.Transfer #in August 2019: BFNTransfer #2 in September 2019: ?

#10 Blinkie

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Posted 11 June 2012 - 05:17 PM

Cheddar, I am one of the people that ended up on thyroid meds while doing IVF. My dr advised that even though I was in the normal range - I was 3.79 (0 to 5 is considered normal)...to get pregnant they prefer that you be lower than 2. I started thyroid meds prior to my last cycle and have continued to take it throughout my current pregnancy. It is my understanding that thyroid levels affect getting pregnant and maintaining pregnancy as well. They check my levels once a trimester and am currently maintaining below 1.

#11 Cheddar

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Posted 11 June 2012 - 05:40 PM

Crap. Does this mean this cycle is no good if my thyroid is out of whack? Do I still have time to start thyroid meds (I'm 10 days away from stims)?
TTC since February 2010IUI #1: October 2011, cycle cancelledIUI#2: December 2011: BFNIVF #1 in March 2012: BFNIVF #2 in July 2013: BFN Got divorced, spend several years having fun, met the best man Iíve ever known in 2016 and married in 2019IVF #3 in summer 2018: BFNIVF #4 in 2018 fall 2018: BFNMoving on to donor eggs at Shady Grove in guaranteed, shared risk program.Transfer #in August 2019: BFNTransfer #2 in September 2019: ?

#12 Zeukko

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Posted 11 June 2012 - 08:58 PM

Crap. Does this mean this cycle is no good if my thyroid is out of whack? Do I still have time to start thyroid meds (I'm 10 days away from stims)?


Not sure. But I know the my new RE wanted to stabilize my TSH before we go forward with transfer. The maximum they allow is 2.5. Ask them to look at it. Doesn't hurt.
Me:42 and DH: 44
Married since 2004
Two amazing furbabies
TTC since Feb 2009
Sept-Dec 2010: Clomid + 5 IUIs = BFN :(
March 2011- IVF/ICSI#1: antagonist - BCP, Puregon, Orgalutron, Ovidrel, Crinone = BFN
22 follicles; 14 eggs; 11 fertilized; 2 transferred; 1 snowbaby
FET #1 May 2011- 1 grade 2 blastocyst = BFN
August 2011 - IVF #2:antagonist - BCP, Puregon, Orgalutron, Ovidrel, Crinone = BFN
21 follicles; 12 eggs; 10 fertilized; 3 transferred; 5 3d embryos frozen
FET #2 Oct 2011 = BFN FET#3 July 2012 = BFP @ Genesis Fertility Clinic Beta #1= 41 (gulp); Beta #2= 47 (ugh) = Chemical pregnancy
February 2013 - IVF #3 = BFP - Estrace, Menopur, Puregon, Orgalutron, Endometrin - Retrieved 14 egg, 11 mature, 9 fertilized. Transferred 2 blastocysts. 1 blastocyst snow babyBeta#1: 45 (uh oh)Beta#2: 555 (what?! Wow!)
Beta #3000+.
U/S shows not viable pregnancy. Stopped growing at 5w5days.


July 1st: Natural BFP on HPT - First Beta in the 400s; Second Beta dropped to 200s

April 2014: Single embryo transfer = BFN

Looking into adoption.

#13 Cheddar

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Posted 11 June 2012 - 09:33 PM

Yeah ... I'd rather put it off a month and have a shot at success than rush into it without being physically ready. I'll call the clinic. This could totally explain my weird weight gain (despite doubling my exercise), depression and exhaustion.
TTC since February 2010IUI #1: October 2011, cycle cancelledIUI#2: December 2011: BFNIVF #1 in March 2012: BFNIVF #2 in July 2013: BFN Got divorced, spend several years having fun, met the best man Iíve ever known in 2016 and married in 2019IVF #3 in summer 2018: BFNIVF #4 in 2018 fall 2018: BFNMoving on to donor eggs at Shady Grove in guaranteed, shared risk program.Transfer #in August 2019: BFNTransfer #2 in September 2019: ?

#14 ---

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Posted 11 June 2012 - 09:41 PM

Dr.Fiona,
Thank you for posting that article. I have done 6 ivf cycles and through trail and error we noticed after IVF#2 that we have to increase my thyroid meds by 50% during stims (and continue that dosage if pregnant) as the estrogen has an effect on how the T4 medication is absorbed. Also for anyone reading TSH levels the new standard is that TSH should be at 2.0 or close to it before cycling/transferring. From my own experience I can say that if taking synthroid (or it's counterpart) then thyroid levels/TSH should be checked frequently and adjusted as your hormone levels increase during pregnancy and therefor your thyroid medication may have to be increased. This is not only important to avoid m/c and chemiacl pregnancies but also baby's development.

Cheddar- If you are about to stim I would say that your clinic has already run the thyroid tests along with many others before letting you begin but it never hurts to ask what your level is. Good luck on your cycle!

Stacy
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#15 Highest hopes

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Posted 21 June 2012 - 01:49 PM

This is great info - thanks everyone.

For those of you on medication who are doing continual testing to monitor it, is it just the TSH that you get checked?
Dx: Age & Endometriosis & Tubal

IUI & IVF & FET = BFN
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#16 tjluvbug

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Posted 21 June 2012 - 04:45 PM

My TSH level was exactly 2.5 and my RE said it was fine, no mess necessary for me.

<p>Me 38 (28 when we did first IVF) DH 52 3 IVF's, 2 FET's, & 2 IUI's.  Boy/Girl twins born March 12th, 2015 at 33w6d. Our family is complete


#17 judes

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Posted 27 June 2012 - 08:28 AM

Just thought I would share my experience with thyroid meds and ivf. My RE actually only discovered my tsh was at 4.2 the day before I was to trigger. My clinic has a threshold of 2 and under for tsh. They prescribe synthroid for anything above, cause they believe 2 and under is what is optimal for pregnancy. Anything too high, in their opinion, will either result in a failed implantation or a miscarriage.

She prescribed synthroid and I started taking it and we still went ahead with retrieval 3 days later and the transfer 5 days later. Apparently, that was enough time for the meds to kick in cause I got a BFP and am now 12 weeks along. We retested my tsh last week and it came back at 1.26. I need to keep taking synthroid throughout the pregnancy and they will be retesting my levels every 4 weeks to make sure they don't need to readjust my meds.

Me: 34 Him: 35
Married since 2006 TTC ever since
Diagnosis: PCOS 

 

For complete history, see about me.

 

2012

 

IVF 1.3
12/26 - Mackenzie born 7:54 am, 6 lbs 3 oz

wFsTm5.png

 

2013 - Project sibling

 

IVF 2.1

4/17 - consult - Project sibling is a go.  same protocol as last time pending bloodwork and sonohysterogram. 

Projected beginning of cycle - August 2013.

 

5/8 - sonohysterogram: tubes clear, no residual placental tissue, ovaries still polycystic. Green light to cycle when ready.

 

8/9 - baseline scan. begin meds, 150 puregon, 50 menopur

8/13 - add orgalutran

8/18 - trigger half ovidrel, half hcg

8/20 - ER - 17 retrieved. 8/21 - 8 mature, 7 fertilised

8/23 - ET - One 8-cell grade 2 embryo transfered

8/26 - One embaby made it to the freezer!

9/1 - HPT - BFP!!!!

9/5 - Beta - 295!

9/9 - Beta - 1550!

9/18 - we have a heartbeat. Little Shrimp is 4.5mm and heart is beating at 109 bpm

10/25 - Turns out Little Shrimp is actually Little Shrimps! We had identical twins! Twin A 174 bpm, Twin B 183 bpm. Both measuring 11wks + 4 days

 

11/1 - NT scan. 1.5 and 1.6mm. Twins both measuring 12wks + 5 days, 2 days ahead.

 

Week 24 - put on modified bed rest due to softening of the cervix

Week 27 - hospitalised with pre-term contractions

Week 29 - put on strict bed rest

 

Seamus and Ronan born March 13 at 31 weeks and 2 days

 

Ronan came home April 7 and Seamus came home April 11.

 

SFCBm4.png
 

My blog - Geeky.Mama.Life

 

My YouTube channel - Geeky Mama Life

 

My day in the life vlog - Geeky.Mama.Vlogs

 

 

 


#18 tjluvbug

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Posted 27 June 2012 - 03:58 PM

it really bugs me when RE's use different thresholds!! If my TSH at 2.5 is questionable i would prefer to err on the side of caution and treat!
  • Highest hopes likes this

<p>Me 38 (28 when we did first IVF) DH 52 3 IVF's, 2 FET's, & 2 IUI's.  Boy/Girl twins born March 12th, 2015 at 33w6d. Our family is complete


#19 Highest hopes

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Posted 27 June 2012 - 04:59 PM

My RE told me that my TSH was "fine" at 2.9 & 2 GP's agreed. This was in addition to clinical symptoms I discussed with them including always being cold, freezing hands & feet, as well as hair loss.
This was before stimming so who knows if it went up during IVF - good chance it could have.

After 2 failed IVF's I am uneasy knowing that this was ignored, though they likely failed due to my age, but I'll never know for sure.

Now I am looking into it with my naturopath - got some more thyroid tests done this week. I've read that I need to find out if the cause is the thyroid itself or the adrenals, so I'm still looking into it.

Cheddar, did you postpone your cycle & get treatment?

Judes, congrats on your BFP!! Did you have a high TSH before you started stimming do you know?
Dx: Age & Endometriosis & Tubal

IUI & IVF & FET = BFN
Pinterest.com/aquablueglow


#20 judes

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Posted 27 June 2012 - 08:44 PM

Highest Hopes - Thanks! I did not know about my tsh being high before stimming, my RE did bloodwork while I was stimming cause my results were over a year old. That is when we discovered my tsh was high the day before I triggered. We went ahead with the ER and ET, but she prescribed synthroid and I started it immediately. I am glad we caught it when we did cause I am pretty sure I would be in the middle cycling again if we had not.

Me: 34 Him: 35
Married since 2006 TTC ever since
Diagnosis: PCOS 

 

For complete history, see about me.

 

2012

 

IVF 1.3
12/26 - Mackenzie born 7:54 am, 6 lbs 3 oz

wFsTm5.png

 

2013 - Project sibling

 

IVF 2.1

4/17 - consult - Project sibling is a go.  same protocol as last time pending bloodwork and sonohysterogram. 

Projected beginning of cycle - August 2013.

 

5/8 - sonohysterogram: tubes clear, no residual placental tissue, ovaries still polycystic. Green light to cycle when ready.

 

8/9 - baseline scan. begin meds, 150 puregon, 50 menopur

8/13 - add orgalutran

8/18 - trigger half ovidrel, half hcg

8/20 - ER - 17 retrieved. 8/21 - 8 mature, 7 fertilised

8/23 - ET - One 8-cell grade 2 embryo transfered

8/26 - One embaby made it to the freezer!

9/1 - HPT - BFP!!!!

9/5 - Beta - 295!

9/9 - Beta - 1550!

9/18 - we have a heartbeat. Little Shrimp is 4.5mm and heart is beating at 109 bpm

10/25 - Turns out Little Shrimp is actually Little Shrimps! We had identical twins! Twin A 174 bpm, Twin B 183 bpm. Both measuring 11wks + 4 days

 

11/1 - NT scan. 1.5 and 1.6mm. Twins both measuring 12wks + 5 days, 2 days ahead.

 

Week 24 - put on modified bed rest due to softening of the cervix

Week 27 - hospitalised with pre-term contractions

Week 29 - put on strict bed rest

 

Seamus and Ronan born March 13 at 31 weeks and 2 days

 

Ronan came home April 7 and Seamus came home April 11.

 

SFCBm4.png
 

My blog - Geeky.Mama.Life

 

My YouTube channel - Geeky Mama Life

 

My day in the life vlog - Geeky.Mama.Vlogs

 

 

 


#21 Cheddar

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Posted 28 June 2012 - 07:34 AM

My TSH was fine, actually. Low iron's the reason I've been cold and tired and having other low thyroid symptoms. I've been taken a supplement and am in the middle of my stims already feeling much better.
TTC since February 2010IUI #1: October 2011, cycle cancelledIUI#2: December 2011: BFNIVF #1 in March 2012: BFNIVF #2 in July 2013: BFN Got divorced, spend several years having fun, met the best man Iíve ever known in 2016 and married in 2019IVF #3 in summer 2018: BFNIVF #4 in 2018 fall 2018: BFNMoving on to donor eggs at Shady Grove in guaranteed, shared risk program.Transfer #in August 2019: BFNTransfer #2 in September 2019: ?

#22 Highest hopes

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Posted 28 June 2012 - 06:28 PM

Judes, that's great that your clinic was so on top of the situation.

Cheddar, awesome that it was not serious & easy to treat!
Dx: Age & Endometriosis & Tubal

IUI & IVF & FET = BFN
Pinterest.com/aquablueglow


#23 ally86

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Posted 29 October 2013 - 11:57 AM

I just got put on Synthroid. I haven't started any medications for IVF yet but my preliminary bloodwork showed TSH averaging at 2.68, which for a normal person is fine as the currently accepted "normal range" is between 0.3 and 3, however for IVF the window is a lot smaller and so they cut off the upper level at 2.5 (I am at the Edmonton Fertility Clinic) so the synthroid should bring me down into that level and help me to maintain it there.

Once you are done trying to conceive, you may not have to keep taking it because your levels might be acceptable otherwise.


me: 27, DH- 31

DH had testicular cancer, froze semen in '08, ready to get going now
 

IVF 1
Oct 2013- Cd3 blood test, AF ultrasound- Count looks good, hopefully this is the first of a list of good news items.eusa_pray.gif

Oct 23 2013- SIS, looks great

Oct 24 2013- HSG- plumbing looks good, tubes are clear.

Nov 3 2013- last minute start of estrace-estrogen priming for 7 days.

Nov 11 '13- CD1

Nov 13'13- CD3 blood and baseline ultrasound- looks like a few cysts but nothing too scary. 

Nov 13 '13 -antagonist protocol with estrogen priming. Menopur- 450 

Nov 17 '13- U/s and bloodwork- LOTS of follies, most def not a low responder, added orgalutran to keep them in there a little longer.
Nov 24- trigger...

Nov 26- ER- 10 fertilized, only 9 made it past day 3....now waiting to see on Day 5. please let there be enough to complete my family.....eusa_pray.gif eusa_pray.gif eusa_pray.gif

Dec. 2- 6 made it to blast and are frozen.

Feb 3-  cd 21-starting suprefact and ASA

Feb 17-CD3 (AF was 5 days late!) start estrace and antibiotic.

March 1- lining check.

March 8 Transfer one 5 day blast.....now we wait...

March 15/16- Home pregnancy test th_abfp.gif 
March 17- beta at 95 yahoo.gif

March 19- 2nd beta 229. Looking great.

March 23- 3rd beta at 1132.

April 9- u/s showing one bean at 7 weeks 1 day.

DD born Nov 2015