Dr Amit Basnotra, Dr Richa Sharma
Praenthood is a dream which every couple has but not all fortunate enough to have smooth journey.What all needed is the right skilled approch for whuch as patient you need to have awareness.
Reasons cannot always be big but there can be minor factors also which can be a hindrance.
Hormonal disturbances is often a term you must have heard while undertaking treatment for fertility and it can impact both male female, no gender bias so one shouldnot hesitate to seek for multidiscplinary approach.Pregancy doesn’t end with beta hcg value but has a long way to go till nine months till you have a healthy baby.
Today via this article we will share insights regarding the same
Thyroid Disorders-
Thyroid is an important hormone secreting gland which controls almost all systems of body- so any disturbance or fluctation in its functioning can affect a lot
What are Various Types ?
Thyroid disorders can be either Hypothyroidism or Hyperthyroidism and both hav ebeen seen to have a major effect on pregnancy and reproduction
Hyperthyroidism
Here the levels of thyroid hormones may be very high and accordingly severity varies and so is the impact
Various causative factors can be-
* Graves disease
* Solitary toxic nodule
* Toxic multinodular goiter
* Acute thyroiditis-Viral
a. Autoimmune b. Postradiotherapy
* Thyrotoxicosis facititia
* Metastatic differentiated thyroid carcinoma
* Hyperfunctioning ovarian teratomas
How It can manifest ?
Patient may be asymptomatic or may have various sign symptoms like -Weight loss, Irritability ,Increased appetite ,Psychosis , Restlessness, Muscle weakness, Tremors, Goiter, Breathlessness , Palpitations ,Tachycardia Heat intolerance, Vomiting,diarrhea ,Eye complaints , Neck swelling.
In Females – Oligomenorrhea ,Irregular , menstrual periods, oligovulatory or anovulatory cycles with a wide range of menstrual disorders (ranging from amenorrhea to menometrorrhagia) which is one of factor for the infertility
In Males- A relatively hyper-estrogenic state in these men; manifested by gynecomastia, spider angiomas, decreased libido and impaired sperm parameters-mainly sperm motility
Diagnosis and Management- Its by the clinical profile and various Hormone tests are done with add on investigations as per severity of situation
As soon as an infertile patient is found to be hyperthyroid, immediate therapy to restore a euthyroid state is recommended. The benefit of treating patients with subclinical hyperthyroidism is not proven. However, in the presence of ovulatory dysfunction where no other cause can be determined, empirical therapy may be attempted to establish a biochemically euthyroid state. Hyperthyroidism can be treated medically, surgically or by irradiation, depending on the etiology
Hypothyroidism-
Hypothyroidism is characterized by a spectrum of clinical manifestations that are directly or indirectly related to the deficiency of the thyroid hormones.
Causative Factors For Hypothyroidism-
It can be Primary or can be seconday to some underlying pathologies like Antithyroid drugs, Autoimmune-Hashimoto’s thyroiditis , Infective, Postsurgery, Postradiotherapy
Sign /Symptoms-
Tiredness, Mental slowness, Unexplained weight gain, Psychosis,dementia ,Anorexia, Poverty of movement, Cold intolerance , Loss of eyebrows, Depression, Dry thin hair , Deafness, Deep voice Poor libido, Anemia, Goiter, Hypertension, Puffy eyes, Bradycardia, Dry skin , Obesity, Constipation, Menstrual disturbances
Impact On Fertility-
Moderate and severe degrees of hypothyroidism have a detrimental effect on the reproductive potential of both men and women, but the same cannot be said of the mild and subclinical forms
In Females-
The effect of hypothyroidism on the reproductive potential has been well-documented in women and often seen in almost every third female who visit fertility clinics
Female may present with-
* Menstrual irregularities 23 to 25% with anovulation in 70%
* Spontaneous first trimester miscarriages
* Premature deliveries
* Unexplained stillbirths
* And Infertility are some of the manifestations.
* Oligomenorrhea is probably the most common clinical manifestation. Menorrhagia, sometimes seen in these women is due to a combination of anovulation, poor uterine muscle tone and platelet dysfunction.
In Males- Less know impact seen but can present as non-specific findings of decreased libido, it has been claimed that hypothyroidism in males is associated with testicular dysfunction that’s why its function needs to be ruled out while planning Surgical sperm retrieval and in MicroTESE
Diagnosis and Management- Clinical and biochemical and needs supplementation accordingly
Conclusion- ART is an advanced procedure.It doesn’t always need to look for major factors only to be culprit in course of parenthood, there can be minor factors which may have been ignored which may be the only ones to help you ontrack.So awareness is the key as THE EYES CANNOT SEE WHAT THE MIND DOESN’T KNOW.
(The authors are Senior Gastroentrologist and Senior IVF and Fertility Consultant)
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