Does Having Hashimoto’s Affect Your Fertility?

Deciding that you would like to start trying to conceive can be such a beautiful and exciting time in life, but in the event that it becomes more difficult than expected, these feelings of excitement and joy can start to be overshadowed by fear, frustration, and disappointment. There is so much information (or sometimes, misinformation) out there about what factors positively or negatively affect a person's fertility.

Hypothyroidism vs. Hashimoto’s Thyroiditis

First, it’s important to distinguish the difference between Hashimoto’s and non-autoimmune hypothyroidism. Over 90% of hypothyroidism cases are due to Hashimoto’s. So what is the difference between these two conditions?

Well, hypothyroidism is when the thyroid gland is under-functioning and cannot produce and release enough thyroid hormones (T3 and T4).

Hashimoto’s thyroiditis is an autoimmune disorder. There is also a lack of thyroid hormone production, hence why it is a type of hypothyroidism. However, in the instance of Hashimoto's, the lack of hormone production is specifically brought on by an autoimmune process in which the thyroid is being attacked by the immune system. As a result, the thyroid suffers damage and is unable to produce enough T3 and T4.

Fertility Challenges with Hashimoto’s

The Anti-Mullerian Hormone (AMH) test determines how many eggs a person has; the lower the AMH, the lower the egg count. Research shows that there is a linear relationship between AMH and thyroid antibodies (AMH decreases as thyroid antibodies increase).

The presence of thyroid antibodies also has an effect on how a person's eggs mature and develop. Since having antibodies indicates an immune dysfunction, this can compromise egg implantation.

In addition, research has also shown a correlation between high antibodies and an increased risk of miscarriage and preterm delivery.

That said, even after taking all of those risk factors into consideration, it does not mean that you can’t have a healthy and successful pregnancy! With proper nutrition, thyroid assessment and management, and supplemental support, having a healthy pregnancy is possible.

Important Questions to Ask Your Doctor

Whether you have a family history or current diagnosis of Hashimoto’s thyroiditis, if you are trying to conceive or are pregnant, there are questions that are important to ask your health care providers. If you have hypothyroidism but are unsure if it is autoimmune or not, this is something that should be investigated.

Questions for your doctor(s):

“Have I had a recent full thyroid panel?”
“Is my TSH at an optimal level for conception/pregnancy?”
“Should medication (i.e., levothyroxine) be considered? Why or why not?”
“Is there a plan in place to monitor my thyroid health throughout my pregnancy (i.e., TSH and free T4)?”

The Endocrine Society and American Thyroid Association (ATA) recommends T4 replacement in women with subclinical hypothyroidism who are trying to conceive or who have ovulatory dysfunction or infertility. The ATA also recommends that treatment should be considered in pregnant women who are TPOab positive with a TSH concentration more than 2.5 mU/L.

Looking For More Support?

Whether you are thinking about trying to conceive, are currently trying to conceive, or are pregnant and are either unaware of your thyroid health or are looking for more guidance in managing your Hashimoto’s thyroiditis in order to ensure you sustain a healthy pregnancy, there is so much we can do to support you! If you want to learn more about how having Hashimoto’s affects your fertility, you can reach out to us for more information or book a complimentary consult with me here!