TTC with Anti-Thyroid Antibodies and Hypothyroid-IUI

Discussion in 'Fertility & Trying to Conceive' started by miraclemagic, Feb 11, 2012.

  1. miraclemagic

    miraclemagic New IL'ite

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    Dear All,
    This is my very first post in this site and Im truly hoping that I can get some advice,words of encouragement and help!
    I have read in the forums here how many have conceived after getting their thyroid levels stabilised within months. Its been more than a year now for me(after the thyroid diagnosis) and total of 3 yrs of TTC and 2 IUIs with injectibles,but without success:-(
    I have read that anti thyroid antibodies also can sometimes prevent the implantation from taking place. Any ladies out there who have had success with a similar history?My questions are:
    1)Any medications/treatment that helped in reducing your antibodies?
    2)What were the other medications given to you prior and post the IUI ?
    2)Size and number of follicles on the day of trigger for IUI.
    3)Estrogen and progesterone levels prior to and post IUI.
    4)Do i even look at IUI or should i try for IVF?

    Medical History
    TSH-1.67
    Tested positive for Anti thyroid antibodies and Hashimotos Thyroid
    Diagnosed with mild PCOS
    History of Diabetes in Family
    Low estrogen level prior to IUI- 185


    Prescription
    Fertomid for 5 days
    Glycomet-500
    Progynova 6 mg
    Omnicortil(prednisone)
    Ecosprin 75(baby aspirin)
    Folic Acid

    Please help me out and share your stories and journeys too.
    Thanks in advance.
     
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  2. RamyaSridhar1978

    RamyaSridhar1978 Gold IL'ite

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    Hi
    Well I have done iuis but it's been pretty long I can't help you with the I depth facts and figures relating to it. But I can let you know of one thing that thyroid doesnot affect getting pregnant. I too am a thy patient with the same .. Antibodies hypothyroid and Hasimoto thyroid since 8-9 yrs. . Just take the medicine regularly without fail and constant monitoring is required I believe in india they prescribe elthroxin or thyroxin ? Visit a good endocronologist for proper monitoring.
     
  3. sweetnilla

    sweetnilla Senior IL'ite

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    I can comment on thyroid only from experience. Hashimoto's thyroiditis makes you more likely to develop hypothyroidism in the future. This is if you do not already have developed it. Hashimoto's patients who become pregnant have to have their thyroid function tests monitored frequently. I do not think the antibodies interfere with implantation . However pregnancy can precipitate post partum thyroiditis which can become permanent hashimoto's thyroiditis. The antibodies have nothing to do with preventing pregnancy. If your ob/gyn tells you that then get a second opinion , get a new ob or get an endocrinologist.

    Once you get pregnant you have to be monitored closely with treatment to keep TSH<2.5

    Best of luck,
    Sweetnilla
    :thumbsup
     
  4. miraclemagic

    miraclemagic New IL'ite

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    Thank you Ramya!
    I have been taking the medicines regularly.They do prescribe Eltroxin,but I have been taking Thyronorm. I have been visiting Dr. Prakash Pania (in Dubai,I basically live in Dubai,have been in India for the past few months for my IUIs).Hes a highly recommended endocrinologist in Dubai.Only thing his waiting period is 2 weeks. This is my last attempt at IUI before taking a 4 to 5 month break of trying naturally and shifting to IVF. My levels have stabilised now.Lets see what the future has in store for us.
     
  5. miraclemagic

    miraclemagic New IL'ite

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  6. sweetnilla

    sweetnilla Senior IL'ite

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    Dear Miracle magic,

    I did read the article. It was not personal experience but rather clinical experience. I also want to say that i do not treat Infertility but have referred pts to and have had referrals from reproductive endocrinologists.

    [B]TIImmune testing in fertility practice: truth or deception?[/B]
    AUKallen CB, Arici A
    SOCurr Opin Obstet Gynecol. 2003;15(3):225.

    PURPOSE OF REVIEW: Much attention has been paid to the role of immunology in reproductive success or failure. Every step in the establishment of normal pregnancy has been implicated as a possible site of immune-mediated reproductive failure. The widespread testing of antiphospholipid, antinuclear, antithyroid, and antisperm antibodies, as well as generalized immune testing, have thus been employed to diagnose patients with otherwise unexplained infertility or recurrent pregnancy loss. Controversial data surrounding the widespread and variable use of immune testing in current fertility practice is reviewed to determine which tests are warranted based on sound scientific evidence.
    RECENT FINDINGS: Despite the increased prevalence of abnormal immune testing associated with early reproductive failure, the most rigorous studies have not proven a cause and effect
    SUMMARY: Great variability exists in identifying candidates for immune testing, determining which tests to order, interpreting the test results, and offering immunologic treatments. This review argues that the use of widespread immune testing in clinical practice can not be supported by existing data. The resulting therapies are similarly of unconfirmed benefit and may cause harm.

    :my2cents

    I agree that women with auto-immune diseases are at risk for infertility. Like the article you quoted says the anti-thyroid antibodies do not interfere with implantation but have been associated in some studies with recurrent miscarriages/placental abruptions. AntiPl and anti cardiolipin are associated with both infertlity and miscarriages. But you must know that they may be a harbinger for other AI diseases-Polyglandular Autoimune diseases, Autoimmune oophoritis, celiac disease.

    So in conclusion:

    1.Anti-thyroid antibodies may indicate presence of other autoimmune diseases
    2.Anti-thyroid antibodies do not prevent implantation and we do not treat these patients unless they become hypothyroid. I usually get pts who are pregnant and are antibody positive. We monitor and do not treat.
    3.Anti-thyroid antibodies however may make you more resistant to medicines like Clomiphene citrate and Metformin that are used in PCOS.
    4.You are appropriately treated with thyroid hormone to keep your TSH in pregnancy specific ranges. There are trimester specific TSH ranges.
    5.Prednisone is used in treating autoimmune diseases and It reduces autoimmunity of any kind. I do not use prednisone to treat hashimoto's since I am not an reproductive endocrinologist I do know of a study with 100 pts done some years ago where prednsione treatment increased conception rates. I will send you the link as soon as possible.

    Do make sure to keep following up with the endocrinologist.

    Good Luck
    Sweet Nilla
     
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  7. miraclemagic

    miraclemagic New IL'ite

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    Dear Sweet Nilla,

    Thank you so much for your response:). It was very informative. I had no idea that the ATAs make you more resistant to medicines like clomiphene citrate and metformin. I have tried to go through so many forums to get a clearer idea about thyroid and antibodies,but nowhere has it been discussed from this angle,and Im always left wondering as to what could be causing my infertility.:-(...and quite frankly,all this antibody talk is a little confusing for a layman like me:confused2:

    Its nice to read abt the survey reg prednisone and the conception rates for 100 pts..it gives me hope...:thankyou2:

    Waiting for the link.....
     
  8. cj1980

    cj1980 Gold IL'ite

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    Hi MM,

    I was diagnosed with hypothyroidism in 2009...I have been taking Eltroxin 25mg since then...we did have some fertility issues but they were not related to thyroid. Happy to tell you that I conceived naturally and am expecting my baby in August. So don't let this get to you. Just take your medication without fail everyday...I have not even checked my thyroid levels in over 8 months, so I have no clue if it is up or down! Just wanted to let you know that having a thyroid condition does not mean you will have difficulty getting pregnant. As long as you keep it within normal levels it should be fine. Good luck!
     
  9. miraclemagic

    miraclemagic New IL'ite

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    Dear Cj,
    Firstly heartiest congratulations on your pregnancy!:) Regarding my thyroid,it took me some 8 odd months for my levels to stabilise and to figure out my correct dosage.It kept fluctuating from hypo to hyper..Im on 75mcg of Thyronorm and that seems to be suiting me just fine now.Have had 2 IUI's since dec last year but both were unsuccessful. It does give me hope to know that you conceived naturally!

    Also,I must share that my post coital test(PCT) showed 0% motile sperms,so none of them seem to be swimming through my CM. That is the reason we opted for IUI thinking that this may place the sperms closer to the tubes as they bypass the cervix.Otherwise my DH's count and motility are fine.This was something that really bothered me as I thought that we would never be able to conceive naturally becoz of hostile CM,but my doc seemed very confident in assuring me that she has come across many patients who have concieved even after such results in the PCT.So yet another ray of hope,for us to try naturally.

    This month is my last shot for IUI. Doing it only with injectibles this time and not Clomid.And then we try naturally for 5 months.

    Praying for a BFP this year...!

    P.S...you said that you did not check your TSH for the past eight months.I hope you're getting them checked now!All the very best for a safe and happy pregnancy!:thumbsup
     
  10. sweetnilla

    sweetnilla Senior IL'ite

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    I could not get the entire article. This is just an abstract. this was published in
    Clin Therapeutics. 2010 Dec;32(14):2415-21.

    Preconception steroid treatment in infertile women with antithyroid autoimmunity undergoing ovarian stimulation and intrauterine insemination: a double-blind, randomized, prospective cohort study.
    Turi A, Giannubilo SR, Zanconi S, Mascetti A, Tranquilli AL.
    Source
    Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
    Abstract
    OBJECTIVE:
    This study investigated the role of a steroid pretreatment on the pregnancy rate and pregnancy outcomes in patients positive for antithyroid antibodies who were undergoing induction of ovulation and intrauterine insemination (IUI).
    METHODS:
    A double-blind, randomized, prospective cohort study was conducted on infertile women who met the following criteria: infertility for ≥ 1 year, age 20-38 years, no more than 2 previous assisted reproduction treatment cycles, regular spontaneous menstrual cycles, no treatments 1 month before recruitment, normal uterine cavity, and bilateral tubal patency. The patients were divided into 2 groups: a study group of infertile women with antithyroid autoimmunity (radioimmunoassay positive with titer >100 U/mL) and a control group of infertile women without antithyroid autoimmunity. The patients with antithyroid autoimmunity were randomly assigned in a blinded manner to an intervention group treated with prednisone (administered orally for 4 weeks before IUI) or a group given matching placebo. The primary objective was to compare the pregnancy and miscarriage rates among all 3 the groups.
    RESULTS:
    The study included 98 infertile women: 48 with antithyroid autoimmunity (antibody positive) and 50 without antithyroid autoimmunity (antibody negative). The study groups were comparable for baseline characteristics (age, race, body mass index, hormonal pattern, number of smokers, previous miscarriage). In the antithyroid antibody-positive group, the pregnancy rate was 33.3% (8/24) among women treated with prednisone compared with 8.4% (2/24) among women who received placebo (odds ratio [OR] = 5.5; 95% CI, 1.13-25.76; P = 0.03). In the antibody-negative group, the pregnancy rate was 8.0% (4/50). Among the pregnancies, the miscarriage rate was 70% (7/10) versus 75% (3/4) for women with or without antithyroid antibodies, respectively (P = NS); the miscarriage rate was 75% (6/8) for women treated with prednisone versus 50% (1/2) for women taking placebo (P = 0.49). No adverse effects were reported.
    CONCLUSIONS:
    In this small cohort study of infertile women with antithyroid antibodies undergoing induction of ovulation and IUI, prophylactic therapy with prednisone was associated with a significantly higher rate of pregnancy compared with placebo. The miscarriage rate was not significantly different among the 3 groups.
    Copyright © 2010. Published by EM Inc USA.

    You will be fine. Ask questions to your ob/gyn/reprospecialist/endocrinologist. Dont feel bad about getting a second opinion. Any suggestion from your docs that worries you-politely sweetly ask questions. As a patient it is the duty of your doctor to make you understand about every stap that is planned. That is your right. Good luck and hope to hear good news from you soon:).

    Warm regards,
    Sweet nila
     
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