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Thyroid and Infertility

by Anne Elliott, April 12, 2007

Prevalence of thyroid and fertility problems

In our country, infertility is a problem that is on the rise.  Many factors contribute to infertility, and we can’t cover them all today, but I would like to speak to you about the part that hormones play in helping a woman conceive.  Hormones control countless activities in our bodies, especially when and if a woman ovulates and whether her body will be a hospitable place for any baby that is possibly conceived.  Current statistics show that 25% of all menstruating women are not ovulating each month, so obviously infertility from just that cause alone is at a staggering high.   

Thyroid problems constitute the largest percentage of hormonal imbalances that affect infertility, mostly because a low-functioning thyroid gland causes problems for the manufacture of all other female sexual hormones.  While medical sources estimate that only 2% of women show evidence of “clinical” hypothyroidism, in reality up to 90% of all women experience “functional” hypothyroidism during their lifetimes.  What is the difference between “clinical” and “functional” hypothyroidism?  Clinical hypothyroidism can be seen with standard blood tests.  Functional hypothyroidism is often felt first merely as a symptom or a feeling that something is off-balance in a woman’s body. 

Because it can take months and even years for hormone levels to become so unbalanced that they show up as a “clinical” problem, many women never receive help for the symptoms that they feel.  They are told that the problems are in their heads or that they are simply getting older.  However, sexual reproduction is one of the first systems in the body to be turned off if there is any disease or dysfunction whatsoever, since an unhealthy body is never a good place to harbor a growing human being.  Therefore, many cases of infertility go undiagnosed each year, simply because a woman’s symptoms are not yet severe enough to show up on standard blood tests.

When a woman’s hormones are disrupted, the first sign is often a lack of ovulation.  Not only does a lack of ovulation cause infertility, it also places a woman at a greater risk for PCOS (polycystic ovarian syndrome), diabetes and uterine cancer.  While infertility is often felt with a sense of deep loss by a woman, her healthcare providers need to be aware of the greater risks that it signals.

Why are hormone imbalances and infertility rates rising?  Many factors are involved, but a problem that affects almost all women in our country is the rising level of environmental toxins that we face.  Many toxins in our food and water supply compete for the same receptor sites as the hormones that control fertility.  In addition, many food additives affect the glands in our brains that control the manufacture of hormones.  The widespread use of birth control pills and hormone replacement therapy affects fertility because the synthetic hormones used, while similar to the ones our bodies produce, are not identical and therefore can have numerous affects on other hormones in our bodies.  High levels of stress in our lives also affect hormones, including a lack of healthy sleep patterns and unresolved emotions such as anger and fear.  Finally, poor nutrition is a major cause of infertility because hormones cannot even be manufactured without the proper building blocks being available in our food.  We will discuss all of these causes and some possible solutions below.

Knowing the root cause of a hormonal problem is essential to healing.  Imagine that an invisible little man with an invisible little hammer was beating on your toe.  Suppose you went to your doctor and complained about how badly your toe was hurting.  Your doctor, rather than finding out why your toe was hurting, might prescribe a large amount of bubble wrap for you to wrap around your toe.  This “prescription” would help relieve the pain for a short time, until the invisible little man’s hammer wore through the bubble wrap.  Now your doctor would need to prescribe a better cushion, or maybe he would prescribe an anesthetic so that you wouldn’t feel the pain anymore.  As comforting as these measures would be, until someone discovers and removes the “root cause” of your toe problem, you will never receive healing in your toe. 

In the same way, medications and even more natural alternatives such as herbs can often relieve the symptoms of a hormonal imbalance temporarily.  However, until the root cause is discovered and removed, true and lasting healing simply cannot be found.

Hormone Pathways

The most important fact to keep in mind as we begin our discussion of hormones is that when we influence one hormone, all other hormones in the body are affected as well.  Let’s take a few moments for a tour of the pathway a hormone must follow from its production to its end results.

Click here to see a diagram of the endocrine system for reference as you read.

The first gland responsible for hormone production is the pineal gland.  The pineal gland is seated deep within our brains, and it manufactures melatonin.  Melatonin plays a key role in sexual development, metabolism, and circadian rhythms. 

From the pineal gland, melatonin travels to the hypothalamus, a gland that is rich in melatonin receptors.  The hypothalamus is often called the “master gland” of the body because it makes five major classes of hormones that each in turn regulate all other hormone secretions in the body.  These five classes of hormones control the further release of growth hormones, LH and FSH (hormones necessary for ovulation), TSH (necessary for proper thyroid function), CRH (necessary for proper adrenal function), and dopamine (which inhibits the release of prolactin and affects breast-milk production).

These five groups of hormones then travel to the pituitary, where further hormones are then produced.  The posterior pituitary makes oxytocin & antidiuretic hormone.  The anterior pituitary makes numerous other hormones as controlled by the hypothalamus, as well as endorphins.  The release of the hormones manufactured in the pituitary is completely controlled by the levels of hormones in the target glands.  For instance, as the thyroid gland later makes its respective hormones and the levels of these hormones in the blood are increased, the pituitary senses that it can slow down its production.  This amazing relationship between the pituitary and all other glands ensures that the proper hormones are always in correct balance.  You can imagine how molecules that have similar structures to our natural hormones and bind to the same receptor sites can cause the pituitary gland to slow down production of the true hormones we need.  Environment toxins and synthetic hormones can be especially confusing to the pituitary. 

In women, the pituitary affects the function of the adrenal, thyroid and ovarian glands, among others.  In addition, how well one of these glands is performing affects the performance of the other glands. 

The adrenal gland makes numerous hormones that affect nearly every process in the human body.  The adrenal cortex makes aldosterone (which controls fluid balance & blood pressure) and cortisol (which controls metabolism and countless other processes).  The adrenal medulla makes sexual hormones such as estrogen and DHEA.  The adrenal gland also makes adrenaline (which controls heart & metabolic activities) and noradrenaline (which controls peripheral vasoconstriction).

The thyroid gland produces thyroxine (commonly known as T4) and triiodothyronine (T3), as well as a lesser known hormone called calcitonin.  Up to 80% of T4 is converted to T3 by the liver, spleen, and kidneys, so the healthy functioning of the thyroid gland is also dependent on the health of those organs.  These hormones are responsible for countless metabolic tasks in the body, as well as the proper functioning of the adrenal glands, ovaries, and even the pancreas.

The two ovaries produce steroid and peptide hormones, the most important classes of which are estrogens and progesterone.  These hormones all control numerous operations in the body, but the most famous tasks they control involve the delicate events leading up to ovulation, menstruation, and the sustenance of a healthy pregnancy.

The most amazing thing about hormones is how much they depend upon each other.  For instance, the pineal gland produces melatonin but the hypothalamus depends upon that melatonin for all of its tasks.  In addition, other glands such as the ovaries also contain melatonin receptors.  Therefore, if anything hinders the production of melatonin, all other glands, organs, cells, and functions of the body are affected.  Our hormones are like Dominoes.  If one Domino is tipped over, all the other Dominoes down the line will also fall. 

Phases of ovulation and hormones involved

Click here to see a chart showing the phases of ovulation and some hormones involved.

On this chart, you can see the interplay between hormones over the course of a woman’s normal 28-day cycle. There are more than twelve hormones that have been identified as playing a role in the ovulatory cycle, but four hormones especially play a key role:

This chart shows relative values of each of these hormones during the course of a normal cycle.  The book Taking Charge of Your Fertility contains a thorough description of the role of each of these hormones in Appendix E.  For our purposes, it is important to note that estrogen ("oestrogen") is highest during the Follicular Phase of the cycle, when a follicle in the ovary prepares to release an egg.  It is useful for the build-up of healthy cervical mucous, without which it is difficult for sperm to reach the egg.  Progesterone is highest during the Luteal Phase, when the lining of the uterus thickens and prepares to receive a fertilized egg.  The fertilization of an egg must occur during a tiny window of only a few hours after ovulation, near the middle of the cycle.

Note also the relationship between body temperature and estrogen and progesterone.  When the estrogens are at their highest level, body temperature is normally lower than when progesterone is at its highest.  Body temperature normally increases by at least four tenths of a degree if ovulation has occurred.

Hormones as messengers

In chapter 2 of the book, What Your Doctor May Not Tell You About Premenopause, Doctors John R. Lee and Jesse Hanley explain just a few reasons why the endocrine system can break down (see resources):

1. The messenger may not reach the queen.  In other words, hormones (the messengers) must not only be present in our bloodstream; they must pass into our cells in order to work. 

2. The queen may not be in the castle.  For hormones to work, they must pass into the cells and attach to specific receptors inside the cells.  For many, genetic glitches have influenced how their receptors are formed.  There may be too many, too few, or no appropriate receptors available, so therefore, the hormones cannot do their jobs.

3. The queen is unavailable or occupied with other messages.  Hormones that have different messages to deliver may occupy the same receptor sites.  For instance, the adrenal hormone cortisol competes for the same receptor sites as the ovarian hormone progesterone.  Synthetic hormones also compete for these same receptor sites.  Unless the needed hormone can find an available receptor site, no hormone message can be relayed.

4. The message may be miscommunicated to the queen.  Once a hormone arrives at a receptor site, it is transported deep within the cell to the nucleus.  If a genetic glitch within the nucleus causes the message to be miscommunicated, the action that the hormone was supposed to produce will not happen.

5. The messenger may be delayed or blocked.  The actions of cells need the help of enzymes, vitamins, minerals and other nutrients to work.  If the hormone tells a cell to begin a certain action but there is no nutritional support, that action will fail.

6. The message is captured by the rival queen.  Substances within the body can interfere with the actions that a hormone produced.  Some examples of these substances could be excess iron, goitrogens or phytoestrogens found in nutritious foods but eaten in excess, fluoride, chloride, and numerous other toxins.

7. The volume of the message has been turned up or down.  If there is too much or too little of the hormone in the system, the message will not have the desired affect.

Symptoms of hormone problems

According to Dr. Bruce Rind, the following symptoms are indicators of hormone problems in general:

Source:  http://www.drrind.com/article.asp#symptoms

Since as we’ve seen, if one hormone level is out of balance or unable to perform its duty, all other hormone levels in the body are affected, figuring out which hormone to fix first can be a daunting task.  Let’s look at some of the common hormone problems that women with infertility often deal with.

Thyroid

Polycystic Ovarian Syndrome (PCOS)

Progesterone

Insulin Resistance

Testing

Body Temperature

Long before our modern, sensitive blood and saliva tests were available, doctors relied upon checking body temperature to figure out what was happening in a person’s hormonal system.  Still today, body temperature can be a first indicator of metabolism.  The thyroid gland is principally responsible for maintaining metabolism, but the adrenal glands and ovaries also have an effect on metabolism.  Therefore, the function of each of these glands must be considered when looking at body temperature.

Basal body temperature (BBT) is the first-morning temperature, taken before a woman moves around, eats, or even sits up.  It is usually the lowest body temperature of the day.  It is most accurate if a woman has been lying down, asleep, for at least four hours.  The oral BBT should generally be higher than 97.5 degrees Fahrenheit. 

If the BBT indicates a problem, the next step should be to evaluate the woman’s body temperature every three hours during the daytime.  Normal body temperatures rise and fall with circadian rhythms, so monitoring these temperatures tells us much about how her hormones are functioning.  It is generally easiest to record at least three temperatures each day and then to average these temperatures together.  Over a period of at least five days, these temperature averages can tell us which gland is malfunctioning.  The highest body temperature is usually measured in the late afternoon.  The average of each day’s temperatures is ideally as close as possible to 98.6 degrees Fahrenheit. 

Standard Thyroid Lab Tests

Nutrition

Hormones simply cannot work properly in the absence of proper nutrition.  The problem comes in figuring out what proper nutrition is!  A multitude of nutritional myths abound, making it very difficult for the average woman to make choices that will increase her fertility.

Some poor choices that are made by many women include eating a vegan diet, eating soy, maintaining a high-stress life (which interrupts hormone manufacture as well as sleep cycles and the ability to prepare healthier foods), and eating foods such as sugar, processed grains, and hydrogenated and trans-fats.

For instance, sugar has been shown to disrupt the endocrine system.  Sugar can take many forms, from table sugar to too much consumption of fruit and fruit juices.  In fact, excessive carbohydrate consumption of any type causes excessive insulin production and hormonal shifts.  Restrict carbohydrate consumption to 75 grams per day if a thyroid problem is present, and restrict sugar severely.

Strict vegetarianism suppresses thyroid function and minimizes the intake of essential vitamins (ex. Vitamins A and B12).  Many vegetarians consume large amounts of soy products.  The phytoestrogens in soy are endocrine disrupters and depress thyroid function.  Use fermented soy products only (ex. miso, natto, tempeh).  Unfortunately, soy is a main ingredient in almost all processed foods, so all women, whether vegetarian or not, need to be careful to read labels.  Many women on diets consume soy protein powders, which are high in thyroid-depressing phytoestrogens.

Vegetarians also lack Vitamin A in their diets.  While it is true that Vitamin A can be made from beta-carotene (derived from plant sources), many people with poor thyroid function cannot make that conversion.  Without Vitamin A, many other hormones cannot be properly manufactured.  True Vitamin A is only available from animal sources.

Women with thyroid problems would do best to avoid raw broccoli and raw cabbage, which are goitrogenic.  For women with such severe thyroid problems that they develop goiters, iodized salt is often recommended.  However, iodized salt shrinks goiters only; it does not prevent sexual problems resulting from hypothyroidism, such as infertility.  The best form of salt for all women to consume is unprocessed, unrefined sea salt, which has a gray color that indicates its high mineral content.  Other rich sources of iodine include fish broth, fish eggs (especially recommended for those with under-active thyroid, with infertility, and pregnant and nursing moms), and fish sauce (add to soups instead of salt).  Note that most of these foods are severely lacking in the standard American diet.

Many women also make mistakes when choosing which fats to include in their diets.  Popular thought says that we should restrict saturated fats and consume large amounts of vegetable oils.  However, in reality, those with under-active thyroid often do best on a diet restricted in unsaturated fats.  The cholesterol present in saturated fats is absolutely essential for the manufacture of estrogen and progesterone, as well as numerous other hormones from the thyroid, adrenal and ovarian glands.  Cholesterol-starved ovaries will tend to become cystic.  This is the perfect example of a time when one diet does not fit all!  The best diet for couples trying to conceive includes ample amounts of cholesterol, such as fish eggs and seafood, cod liver oil (1 teaspoon per day), liver and organ meats (weekly), eggs (2 per day), best-quality butter, cream (not ultra-pasteurized), and fermented milk products.  Many women with thyroid problems avoid these foods because their blood panels indicate that they have high cholesterol levels.  In reality, the liver will continue to over-manufacture cholesterol (indicated by elevated blood levels) until enough cholesterol is supplied in the diet for the production of hormones. 

Medications and Alternatives

Reminder:  If adrenals are out of balance, they must be treated first!  See The Safe Uses of Cortisol by William Jefferies, M.D.  Please also read my article on adrenal problems.

When treating hormone problems, our goal is to provide “physiologic” doses of hormones rather than “pharmacologic” doses.  Physiologic doses mimic the amounts normally made by a healthy body and are careful to be bioidentical in make-up.  Pharmacologic doses typically supply up to four times greater than the amount made in a healthy body; therefore, symptoms of hypersecretion typically show up quickly.  For instance, natural hydrocortisone supplied at the same rate and dosage as the hormone cortisol is an effective treatment for fatigued adrenal glands, where Prednisone (up to four times stronger than hydrocortisone) can quickly cause symptoms mimicking Cushing’s disease.  In addition, pharmacologic doses often make use of synthetic hormones that can turn off symptoms but do not allow hormones to continue down their hormonal pathways, which results in a new set of symptoms further on down the line. 

Treating Low Progesterone

Treatment goals:

While transdermal creams are a convenient way to deliver Progesterone USP, be sure to note how much progesterone is delivered by the product you recommend.  For instance, the brand Progestecreme delivers 38 mg per ¼ teaspoon.  It is very easy to overdose on progesterone.  (See discussion on progesterone above.)

When figuring a proper dosage, remember that transdermal creams are effective for about 8 hours, so 2 small doses are best, providing a total of 15-20 mg of progesterone each day.

If a woman conceives, during pregnancy she should continue to use transdermal progesterone until the third trimester, when the placenta is making so much that it won’t notice a drop of 15-30 mg/day.

For infertility, Dr. John R. Lee suggests the use of transdermal progesterone for 2-4 months on days 5-26 of cycle (suppressing ovulation), then stop progesterone altogether.  He also recommends the herb Vitex (including during menses) for 3 months (stop if pregnancy is achieved).

Treating Ovarian Cysts (PCOS)

Regulating Hormones by Night-Lighting

As we discussed at the very beginning, the pineal gland controls the function of all other glands throughout the body.  Its production of melatonin is absolutely essential to the health of the entire body. 

It is interesting to note that exposure to light at night can inhibit the pineal gland’s production of melatonin.  The hypothalamus is richly supplied with melatonin receptors, which in turn stimulates the anterior pituitary gland to secrete its hormones, and these, in turn, stimulate the thyroid, adrenals and ovaries.  The ovaries are also rich in melatonin receptors.

If the hypothalamus does not receive sufficient melatonin, its ability to regulate the hormonal system will be impaired.  The ideal way to ensure sufficient melatonin production is to go to sleep when the sun goes down and to rise when the sun rises.  However, very few American women can match this ideal, whether because of work schedules or choice.  In addition, exposure to light in the evening from television, computers, or artificial lighting (including night lights) further complicates the production of melatonin.

Studies have shown that going to bed by 10:00 p.m. and sleeping in total darkness except for three nights before ovulation (usually days 14-17, mimicking full-moon light) triggers ovulation simply by helping to correct proper melatonin levels, which in turn affect the production of thyroid, adrenal and ovarian hormones.  Benefits include ovulation, discernible and healthy cervical mucus build-up, regular cycle length (27-31 days, mimicking the moon’s cycles), healthy FSH levels, spotting during cycles reduced, progesterone levels strengthened, fewer miscarriages, and reduced intensity of premenopausal symptoms (hot flashes, sleeplessness, mood changes).  Many women are encouraged by these studies and feel that this is an area they can actually control.  (Click here for a source with more information on "night-lighting.")

Treating an Underactive Thyroid (Hypothyroidism)

Alternatives to Medication (Available Without a Prescription)

While many people have found relief with non-prescription alternatives, be aware that their success is certainly dependent upon several factors.  First of all, how early we intervene determines our success.  If too much damage has been done to a gland so that it is unable to be repaired, alternatives may do nothing to help.  In the case of hypothyroidism, we should also check whether any antibodies are present.  Antibodies are indicators of poor nutrition, stress, and possibly unresolved emotions.  Unless these root causes are addressed, non-prescription alternatives are unlikely to be of much help.  Finally, for the treatment of hypothyroidism, many people feel that there is simply no herbal substitute that can match the effectiveness of a combination T4/T3 prescription medication, such as Armour.

Common Alternative Products:

Recommended Reading

What Your Doctor May Not Tell You About Premenopause, by Dr. John R. Lee, M.D. and Jesse Hanley, M.D.

Taking Charge of Your Fertility, by Toni Weschler

Solved:  The Riddle of Illness, by Steven E. Langer, M.D.

Nourishing Traditions, by Sally Fallon and Mary G. Enig

Your Guide to Metabolic Health, by Dr. Lowe and Dr. Gina Honeyman-Lowe

Food Is Your Best Medicine, by Henry Bieler, M.D.

What the Bible Says About Healthy Living, by Rex Russell, M.D.

The Safe Uses of Cortisol, by William Jefferies, M.D.

Dr. Bernstein's Diabetes Solution, by Richard K. Bernstein, M.D.

I would love to assist you if you need help.  I'm just a mother, not a doctor, but I can help you research, study, and learn more about how your body is working.  You may use this form or simply email me at anne@anneelliott.com. 

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