Recent research suggests that thyroid function and fertility are related. According to a 2021 study published in the medical journal Fertility and Sterility, by Seungdamrong, and others, it isn’t the commonly measured TSH that correlates with infertility, rather it is the presence of thyroid antibodies that correlates with a woman’s ability to conceive and carry a baby to term.
The standard way thyroid function is assessed, is by measuring a thyroid stimulating hormone (TSH) which is released by the pituitary as a messenger to the thyroid to tell it to produce thyroid hormones. The most common of these hormones are triiodothyronine (T3) and thyroxine (T4). TSH correlates inversely with thyroid function. In other words, as thyroid function drops, TSH typically goes up. Thus, an elevation in TSH is a sign of low thyroid function or hypothyroidism.
A typical thyroid lab test will also include the measurement of T4. This is primarily because the standard treatment is a drug called levothyroxine, a synthetic form of T4. The idea is to use levothyroxine to supplement the body’s T4 to the point that the TSH is no longer elevated.
But that doesn’t consider T3, which arguably has a greater impact on how the patient feels. While the thyroid does produce T3, much of the T3 in the bloodstream is converted from T4. So, the idea of using levothyroxine alone (without T3), will result in the body converting T4 into T3 and rebalancing the thyroid hormones. While there are medications that contain T3 for direct supplementation, they are seldom used due to the greater occurrence of side effects.
The conversion of T4 to T3 takes place primarily in the liver and intestinal lining. Many people who have thyroid problems have conversion problems as part of it. Unfortunately, this is not assessed or addressed in the standard approach. To properly assess the conversion, other lab values including T3, T3 uptake, free T3, and free T4 need to be measured.
Additionally, as much as 90% of hypothyroid in developed countries is autoimmune (Hashimoto’s). This could be revealed by the presence of thyroid antibodies, but they are not typically measured. The primary reason antibodies are not checked is that it does not change the primary treatment approach of supplemental T4 (levothyroxine).
Recent research including a meta-analysis (an aggregate view of the data from multiple studies) suggests that under autoimmune hypothyroid conditions, the ability to conceive and carry a baby to term are compromised resulting in higher rates of infertility and miscarriage.
A logical theory is that when the immune system is attacking “self ” as is the case in an autoimmune situation, it is not just attacking one area. It is attacking multiple things. The uterus and ovaries appear to be vulnerable to attack by the immune system. This seems particularly true in cases of reduced ovarian reserve.
Unfortunately, the standard treatment of levothyroxine not only fails to address this, but it also tends to cover up the existence of autoimmunity. Even if the autoimmune condition is recognized, corrective treatments through pharmaceuticals are not readily available leaving medical doctors relatively helpless.
Additionally, unrecognized autoimmunity can further compromise ovarian reserve, complicating the infertility diagnosis even more and potentially eliminating any chance of natural conception.
Like so many other conditions, Western medicine is great when it comes to heroic medicine and not very good when it comes to supporting healthy function. Enter assisted reproductive therapy (ART) which “hijacks” your system, forces conception and hopefully implantation which would lead to a healthy, 40-week pregnancy and the delivery of a healthy baby.
Conversely, healthy function is where functional medicine and Chinese medicine shine. Using this approach, the first thing that needs to be done is proper testing to detect the antibodies and markers that indicate the conversion of T4 to T3. The next issue that needs to be addressed is the reduction of inflammation followed by the balancing and modulating of the immune system. Additional testing including saliva and stool would reveal the overall state of hormones as driven by cortisol (a primary stress hormone) as well as the state of the intestinal lining, digestive inflammation, and microbes that make up the flora of the intestines. Then, depending on the results of those tests, supportive measures would be directed to the liver and intestines to support the conversion process.
Treatments could include herbs, supplements, nutraceuticals, acupuncture, dietary changes, sleep improvements and other lifestyle adjustments. The beauty of testing is to direct the focus of care such that maximal results are achieved with minimal effort. Amazing results are often attained with this type of approach. It isn’t nearly as easy as taking a pill or submitting to a medical procedure, but one could certainly argue that it is far healthier in the long term!
Michael Buyze, L.Ac. is a healthcare entrepreneur and visionary who has over 40 years of healthcare experience with expertise in acupuncture, traditional Chinese medicine, functional medicine, clinical exercise physiology, and nutrition. He owns and operates East Wind Healthcare, an acupuncture and wellness clinic with a 24-year history of helping people in the Fox Valley with offices in Appleton, Oshkosh, and Fond du Lac. He holds Master of Science Degrees in Chinese Medicine, Business Administration and Physiology. He and his team offer acupuncture as well as wellness programming for acute and chronic pain, fertility, autoimmune and many other chronic disease states. Acupuncture consultations and wellness consultations are available by appointment. Contact information: East Wind Healthcare, 3000 N Ballard Road, Unit#3, Appleton, WI 54911; 404 N. Main St., Suite 201, Oshkosh, WI 54901 and 180 Knights Way, Fond du Lac WI 54935 (inside Forum Health); Tel: 920-997-0511; Website: eastwindhealthcare.com