One of these such issues is thyroid health. Thyroid health is imperative in becoming pregnant and in holding the pregnancy so when a fertility issue persists, in my opinion, more detailed screening of the thyroid should be done, even if the standard tests have come up normal.
This is not only a woman's issue, i.e. any time there is an issue with the sperm count and quality, it could be related to the thyroid. So many times we see patients who have classic thyroid symptoms but have never had their thyroid screened beyond just doing the standard TSH testing. Most times if their TSH has come in within "normal" limits, they are told their thyroid is "normal" and there is nothing wrong. Then they begin doing their temperature charts for me and the temperatures indicate that the thyroid is not working optimally so I come back to them and request that they have their thyroid screened. Some people look at me like I am crazy and others just scratch their heads.
The confusion with the thyroid starts in the standard tests. Normally a physician will test TSH which is the hormone that is supposed to be reflective of how the thyroid is working. The pituitary makes more TSH if thyroid hormone is not enough or slows down in production if the thyroid is making too much. The pituitary which secretes TSH is continually monitoring the blood to see how much thyroid hormone is present so in theory this should be an accurate indicator of thyroid function, but it doesn't always seem to work that way. A scientist and MD Dr. George Gillson from Canada once stated in an International Hormone conference that TSH really only tells us what the brain needs for thyroid hormone, not what the rest of the body needs.
Therefore TSH can be normal but the thyroid hormone out put may not be optimal for you. Another excellent reference for this http://thyroid.about.com The range of "normal" for thyroid hormone varies quite significantly from lab to lab. One lab may say that .4 to 4.0 is normal where another lab may say .3 to 6.0 is normal. Our normal reference range, based onwhat we see in the clinic is 1.5 to 2.0 (with .3 to 3.0 being the full range we use), anything over 2.0 or below 1.5 gets our attention and we support the thyroid.
However even men and women who have TSH within this optimal range can show low thyroid out put on further inspection. I know, its confusing. If you have been dealing with fertility issues for awhile though its a good idea to have a more thorough screening. For example, I would suggest that you ask your doctor to test FT4 and FT3, and Reverse as well as thyroid antibodies.
T4 is the hormone produced by the thyroid. T3 and Reverse T3 are a byproduct of T4 and influence reproductive hormones such as estrogen, testosterone and progesterone. Your physician may be resistant to testing these if there is no apparent thyroid history or if TSH is normal so be ready to take responsibility for your own health and give him/her good reasons to test these. Or ask your naturopath if you can get them tested through him or her if your doctor refuses. Realise you will likely have to pay out of pocket for these tests.
The other test as above that should be considered if you have been dealing with fertility issues for a while and/or if you have had recurrent miscarriages or difficulty getting pregnant after a miscarriage or stillbirth, is thyroid antibodies. These are tested even less frequently than the thyroid hormones and its a shame as it has been shown that a woman with elevated thyroid antibodies (which can be elevated even if TSH is "normal") are 3 times more likely to experience post natal depression and more likley to experience miscarriage.
Most physicians do not test this if TSH is normal however thyroid antibodies can be elevated even with normal TSH. This fact has been cited over and over in scientific literature. Though traditionally physicians not familiar with its signficance regarding miscarriage will not treat elevated thyroid antibodies but instead they will usually tell you to wait until the thyroid fails (or TSH rises above its "normal" range before they will treat this. Based on research reviewed in the New york Times medical treatment for this is typically Thyroxine. This treatment apparently decreases the incidence of miscarriage by half.
Natural remedies for optimising thyroid function are also available from herbs and nutritional supplements. An Ayurvedic herb called Withania Somnifera and Chinese herb Bacopa Monneri are a few herbs that have been shown to effect support optimal hormone levels.
Reverse T3 is also an important test as it tells us whether the majority of T3 (which influences testosterone, estrogen and progesterone production) is active. If Reverse T3 is on the high end of the range or elevated, this can mean that you aren't producing adequate amounts of reproductive hormones. Most times Reverse T3 is elevated due to stress on the system. This could be emotional stress and or physiological stress such as being overweight or having irritants such as gluten in your diet.
All of these tests are extremely important for assessing your fertility as a whole. Many times our unexplained cases are "explained" once these tests are done and compared to our optimal levels for fertility.
