hypothyroid and Hashimoto issues- a potential solution?

zeynsom

I have hypothyroid but it is under control (TSH never above 2.5 over the past year). But I keep reading that TSH is only a part of the story. Thyroid antibodies is another concern. I have Hashimoto disease which is an autoimmune disease related to the thyroid glans. My thyroid antibodies are around 1200 (the max should be only 40). A friend of mine is specialized in thyroid disease and she told me that this clearly shows that I have Hashimoto and there is no cure for it. She even suggested me to stop testing my antibodies and that they will not change, ever. 

So, is there an effect of the Hashimoto on IVF success? Sure there is. It appears that controlling TSH is good for producing eggs but if antibodies are high, implantation rate is very low. Solution? I found the following article online. I am no doctor so I cannot tell you how good it is but it basically says that if I combine my thyroid TSH hormone medication (levothyroxine) with baby aspirin and medrol (or some other form of prednisolone), implantation chances significantly improve. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788572/

We will start our second IVF cycle in August and I already have asked my doctor to add baby aspirin and medrol to my plan. We'll see whether we'll have a better result this time.

So, if you have hypothyroid issues, I'd strongly recommend you to get your antibodies checked and then discuss this article with your RE.

Carol77B

That sounds very promising. I have mild hypothyroidism and we added Lovenox (blood thinner), baby aspirin, and prednisone to help with implantation, so I feel better that we are trying everything.

I hope this helps you!

AMShark

Interesting.  Do you think this is also a discussion for the endocrinologist? My RE first diagnosed me as hypo, and referred me to an endocrinologist, who's listed me as having Hashimoto's.  

I have to say, I'm often confused about who to go to with issues, but since I see my RE so frequently, I suppose she'd be the first person that I ask.

Does anyone else with both an endocrinologist and RE get confused about which issues to take where?

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Carol77B

@AMShark my endocrinologist doesn't deal with any fertility-related issues. She just monitors and treats my thyroid levels. My RE has left anything involving my thyroid treatment up to my endocrinologist, so honestly, I think it is something that could slip through the cracks in my case.

ronniesgirl1981

I see a regular endocrinologist, too.  My TSH is occasionally low.  Last check was .3something.  My RE--who monitors my TSH--simply reports it to me for follow up with my regular endo. 

poohniki

My antibodies are around 900 and was diagnosed based in that alone once I went to the reproductive immunologist. I am on lovenox, prednisone, and baby aspirin. I also have a few other implantation issues and this protocol is supposed to address all of them.

zeynsom

Thanks all. 

@poohniki and @Carol77B, couple questions for you:

- Do you take these during the stims or continuously in between cycles as well? I have already started on baby aspirin (we are trying natural cycles until our IVF. Even though I have almost no chance of getting pregnant on my own I take baby aspirin just in case an egg fertilizes).

- The article also does not mention lovenox. Is it over the counter, or prescription only? When should I start on that?

Carol77B

The Lovenox is a prescription; apparently, often prescribed for deep vein thrombosis. I was started on the Lovenox and baby aspirin two days after ER. You didn't ask about the steroid, but I started the prednisone on day six of stimming.   

poohniki

I take the baby aspirin daily. Prednisone starts at ovulation of previous cycle. And I shouldn't have AF while on lovenox so I am starting it tonight which is CD6.
Lovenox is pretty expensive and s prescription.

Carol77B

@poohniki do you know what happens with AF while on Lovenox? Really heavy bleeding? I stimmed for longer this time so AF is due before beta; assuming it isn't suppressed by the Estrodiol and Endometrin. The cramps I'm feeling make me think its coming  

zeynsom

@poohniki @Carol77B 

So, I emailed the study to my RE and asked for adding the prednisone to my cycle (alongside with baby aspirin). She rejects that, says it is a strong steroid and felt that the overall risks of high dose steroids was too great, and was not convinced of the results. She says that the risks involve adrenal suppression and bone issues such as an increased risk of fractures.  She is concerned that the study was a pilot study with small numbers of patients in each group.  

Did you experience/warned about these side effects? I am just not sure why it should affect me so badly in a such a short period of time. I will research a bit and may push her to prescribe it to me, although I am not sure how she will react (and I have not even asked for Lovenox yet)

missmarypoppins

Prednisone is the same thing as medrol which I thought was fairly standard for IVF cycles. But I do understand the worry with using it for Hashi's because you're on it for so much longer.
Honestly there's bound to be side effects from any and all fertility meds that were on so my thinking is what's a few more because of prednisone?

zeynsom

I am prescribed medrol actually (starting on the day of ER for four days, using it for 16mg/day). However, the study advocates 10 mg medrol from the first day of stimulation; to be increased to 30 mg/d for 5 days starting the day of ET, and subsequently returned to 10 mg/d until the day of hCG test. If pregnancy happens it should be continued until 10 weeks of gestational age. I guess she was reacting to these amounts, which may be a bit too much. I am also not sure whether I'd like my baby to be exposed to steroids for 10 weeks. However, maybe we can start early and have a higher dosage for a while after ET?

Carol77B

I wasn't given any specific warnings about the prednisone (I'm on the lowest available dose and will only be on it for a max of 10 weeks, if pregnant). I did read the info warnings and didn't see anything to really raise my concern (i.e. nothing about risk of fractures). The only slightly concerning thing is that I have to be weaned off of it. Also, I agree with @missmarypoppins that the steroids are the least of my worries. Luckily, I haven't really noticed any side-effects from the steroids or blood thinners besides more easily bruising. 

pblge

Are Lovenox and Heparin essentially interchangeable? And what does the blood thinning have to do with the thyroid?

Sorry to jump in, like @Carol77 I'm low hypothyroid and wondering. Doc had me on baby aspirin, but none of these other things.

Carol77B

@pblge my RE added the Lovenox, prednisone and baby aspirin to try and help implantation- apparently its a fairly common protocol if implantation problems are suspected at my clinic and has nothing to do with my hypothyroidism, so I was very interested to see the study above.

zeynsom

@Carol77B Thanks! Do you know the dosage of medrol you take every day?

Carol77B

Just grabbed the bottle- I'm on Millipred (generic for Prednisolone- how did I not know there was an "L"?) 5 MG tablets once a day.

zeynsom

@Carol77BThat is a quite low dosage. And, that is why it is probably safe to use it for 10 weeks. I'll check with my RE whether she is okay with a low dose like that.

poohniki

I was told to go on calcium supplements when I started the lovenox. I did hear from a 2nd opinion RE that prednisone is no longer used because of the higher incidence of fractures. I'm taking 10mg daily- starting after ovulation of the of the previous cycle.  I think I have a slightly higher risk since I was cancelled and was on prednisone now for 2 months. 

@carol77b Yes, way too much bleeding if you get your period with lovenox. I am supposed to stop with AF or BFN (or week 34). 

Carol77B

Thanks, @poohniki I will be hopeful I won't have to experience that. My nurse said with the prednisolone I would wean off for two weeks if I got a negative beta and but if it was positive I would take it until the first u/s (around 10 weeks) and then wean off of it for two weeks.  My nurse said something about only being on the Lovenox and baby aspirin for a couple of weeks after a positive beta.