The hormones of the thyroid gland play an important role in reproductive physiology. They affect ovulation, menstrual regularity, the endometrial environment and ovarian follicle development, which are required for implantation. Even the presence of thyroid antibodies could increase the risk and complications related to early pregnancy, which stimulates the IVF cycle. As many thyroid problems are curable, it is essential to improve safety by identifying and optimising thyroid function before the stimulation of the ovaries. It would be a low-risk as well as a high-value step. It will offer every IVF cycle the chance to succeed. Targeted screening is recommended for the management of thyroid in women who are planning pregnancy or ART.
Thyroid physiology that matters in IVF
The clinically important conditions that matter in IVF are
- Hyperthyroidism – It is not so common, but it needs specialist stabilization before conception.
- Thyroid autoimmunity – it has a high miscarriage risk. It refers to the presence of antibodies without an abnormal TSH/fT4.
- Overt hypothyroidism – Overt hypothyroidism is very harmful in pregnancy and requires urgent treatment.
- Subclinical hypothyroidism – There is a controversy about it among fertile and infertile women. It is often monitored when there is a substantial elevation of TSH, and it is treated when autoantibodies are present.
Impact of thyroid function on fertility and early pregnancy
Thyroid hormones come into contact with reproductive hormones at various levels. Inadequate thyroid function can disturb the gonadotropin signalling, impair follicular development and can even cause menstrual disturbance, thereby reducing spontaneous conception. Abnormal thyroid status can have a negative impact on embryo development, oocyte quality or endometrial receptivity in the ART cycle. They are all critical for implantation as well as progression to IVF pregnancy.
Pregnancy increases the demand for thyroid hormone. During the first trimester, an under-replaced hypothyroid patient can even become more hypothyroid if she is not anticipated or monitored. Therefore, for IVF, optimizing thyroid function before as well as during stimulation and also in early pregnancy is the recommended strategy. With the increase in the impact of thyroid on pregnancy outcomes, the risks to the health of the mother increase due to overt hypothyroidism. Therefore, it should be treated before conception.
Target screening before IVF
Various baseline tests are recommended for patients preparing for IVF. For the patients who already have thyroid disease, targeted screening is recommended. Age, IVF history, antibody status and even prior pregnancy losses are taken into account for making the decision about the individual treatment.
Management of thyroid disorders
Counselling should be provided about the future risks, and also, frequent thyroid monitoring should be done if pregnancy occurs. During the stimulation of the ovaries after the pregnancy test comes out to be positive, you need to check TSH/fT4 quite often in patients who already have thyroid issues. Patients may require a higher dose. A disciplined coordination between the IVF team and endocrinology guarantees safe care.
Dr. Sumita Sofat Hospital treats every case like its very own. Every treatment is tailored to the patient’s needs. The dream of every woman who wishes to be a mother is fulfilled here. We focus on specialised IVF treatment to give women the chance they want – to live with their baby.
