background / written sept 28th, 2016.

Yesterday morning, I got a call from our Reproductive Endocrinologist. I had received a blood test the Friday before to test my thyroid to see if this cycle we could try. My charts are filled with a lot of numbers and next to those numbers is a scale that reads, “low, normal, high.” If it’s low or normal, the scale marks green. Green is good, green means go, green means that my body is capable of accepting and sustaining a pregnancy. My chart reads like a twisted Christmas commercial. It’s green and then it’s red and then it’s green. “We want to be aggressive with these issues,” we told our Reproductive Endocrinologist. When she called, her voice wasn’t filled with the usual energy that we had previously had. The confidence that helped us trust her just wasn’t there. “Your thyroid went up,” she said. “I am going to up your dosage and we can try again next month.” We have dived into this pool of trying to conceive and now I feel like I am drowning in it. 

For this particular research paper, I could have taken any kind of route. I could have easily thrown together all of my research and experience in in the Montessori pedagogy. I could have taken the time to discuss the importance of sensitive periods from birth to six years old and the planes of development. I could even have taken the time to talk about birth and the doula’s role. These are fields of study that have become my livelihood. But I wanted to research something that I haven’t already dived completely in, but I did want to research a particular topic that has recently become my life.

In our small home we have a second bedroom that we immediately called “the baby’s room”. Since the moment we set foot in this house, our first instincts were to weave a story together about the tiny feet that would explore book shelves and forts inside this warm, cozy home. My wife likes to spend weekends cuddled up on the floor bed in our baby’s room and daydream about who they would become. The decision to have a child was easy for us. We sat in a hole in the wall cafe on our first date and asked, “Do you want children?” I promptly replied, “Yes.” The “when” was the hardest. Are we planning too soon? Are we rushing? Do we have enough? Each question ran through our minds until one Summer evening when my wife turned to me and suggestion, “Let’s set up an appointment.”

During our first appointment we learned from our reproductive endocrinologist that a fertile, healthy, heterosexual couple has a one in five chance of conceiving a child naturally – 20%. As a lesbian couple who has to source sperm from a cryobank, our chance of conceiving a child naturally falls down between 15 to 18%. Our first appointment we learned that I have PCOS (Polycystic Ovarian Syndrome). After our first round of blood work, we further learned that I have a hypothyroid. Both of these issues inhibit my ability to have a successful chance at trying to conceive a child without the help of a reproductive endocrinologist. It takes time, lifestyle change, and a ton of research to continue forward in this process. I have poured hours in learning about PCOS and hypothyroidism. I have researched how the chance of miscarriage is statistically higher with people who have PCOS and why. I have become anxious in this process and discovered the mind and body connection to trying to conceive. During this process, I have also extended my knowledge as a doula to support groups of women who struggle with infertility. Bringing both my professional and personal understanding of this subject, I felt that this would be the best direction for research that I could go in.

We met with our Reproductive Endocrinologist, back in July to start figuring out a course of action for us to conceive. I have a past history of irregular periods and various weight loss and gain, so we were concerned how it would become into play when take the leap and try to get pregnant. For us, the route to conceive that we have chosen is using an open sperm donor from a sperm bank. It was days and weeks of poring over profiles, medical information, and childhood photos of donors before we decided on a dimpled, Indian donor who resembled my wife. Since the cost of sperm is so high, we ended up purchasing three vials. We would have three tries. Our team of R.E.s understood completely during our first meeting. They discussed a procedure called IUI (intrauterine insemination) but they were also a little elusive about what was wrong with my body until our first round of blood tests came back.

The first call that we received was to tell me that I have PCOS. PCOS is an endocrine system disorder that causes irregular periods, hirsutism (excess facial and body hair due to excess testosterone), weight gain, and infertility [7]. The exact cause of this syndrome isn’t completely known but it’s speculated that it’s a combination of thyroid issues, an autoimmune issue, and insulin intolerance. It’s estimated that one in ten women have PCOS [7]. The treatment for PCOS is different depending on the person who has it.  Lifestyle changes, such as a specific diet and exercise routine, is common for many people. In our case of trying to conceive, our reproductive endocrinologist was excited to tell us that they know exactly what to do for a person who has PCOS. My treatment would include hormones to induce my menses, then hormones to stimulate healthy follicles, and finally a hormone shot to trigger ovulation the day of our procedure.

We were both very excited. We proceed to tell my wife’s family of our experiences and our hopes of trying. Her sister, a functional medicine doctor, got serious when we mentioned that I was diagnosed with PCOS. She was immediately curious about my thyroid and asked to see the blood work information. She was immediately concerned about my thyroid and urged me to see a practitioner who focused on exactly how treat it. She stressed that I should get on a natural thyroid (thyroid that comes from pig glands instead of a synthetic thyroid). We were concerned when she told us that PCOS and hypothyroidism go hand in and hand and that it would drastically affect our chances. So, we went back to our doctor and had my thyroid rechecked. It went up and they put me on a medicine to help even it out. The Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum recommend that the TSH in pregnancy should be as below:

First Trimester, TSH 0.1 – 2.5

Second Trimester, TSH 0.2 – 3.0

Third Trimester, TSH 0.3 – 3.0 [5]

They also recommend that if hypothyroidism has been diagnosed before pregnancy, then the TSH level shouldn’t be higher than 2.5 prior to pregnancy [6]. My thyroid TSH level had come back at 5.3. It is from here that we both dove into researching how the thyroid affects pregnancy and conception. My sister-in-law kept urging us to find a doctor who would be more helpful in helping lower my thyroid, but we wanted to believe that our team of reproductive endocrinologists knew what they were doing.

The thyroid is a little butterfly-shaped organ in our neck. This little organ has a very important job. Its job is to produce hormones – thyroxine (T4) and triiodothyronine (T3) – which impact how your body functions and its health [2]. These hormones affect your metabolism, your mental health, your immune system, your body’s overall health, and, yes, fertility.  Furthermore, I learned that over 80% of people with a hypothyroid also has Hashimoto’s, an autoimmune disorder [2]. During the weeks of taking my medicine, I continued to research the thyroid. I came across many articles and books that discussed various things that the thyroid controlled.  I have always struggled with major depression and anxiety. So much that it has made it difficult to go out into the world to work or go to school. I began to learn that a lot of my depression, anxiety, and fatigue could also be attributed to a hypothyroid. I learned that my doctors didn’t do the recommended thyroid tests that so many professionals recommend [9]. They tested my TSH (thyroid stimulating hormone) and Free T4 but didn’t check my Free T3, Reverse T3, thyroid antibodies, or listen to the other symptoms I had. I learned that there are other options for medicine and exactly how the thyroid can be such a quintessential part in conception and sustaining a pregnancy [2].

With this new information, I called my doctors twice over the course of a few weeks. I asked for a deeper test but they reassured me that they were not worried and that the low dosage of a commonly prescribed drug, Synthroid, a synthetic Free T4 replacement, would be enough to get my TSH levels in gear. When I mentioned that the TSH levels were like only seeing a cover of a book, that there is more that we can do, they told me that it’s okay and I shouldn’t stress. I called back in regarding wanting to try a different medication. The Synthroid seemed to make me feel even more exhausted and depressed. It was hard getting out of bed most days. From my research, a natural thyroid was more successful for many patients with a thyroid disorder and contains all the components to help the thyroid. When I told them my concerns, they responded that this was a routine diagnosis and to trust them. So, my wife and I sat all my research to the side. We both refused to listen to her sister and we changed our entire diet and took the medicine.

PCOS makes it hard for a person to get pregnant [1]. PCOS causes too much testosterone and, with irregular periods, we are unsure if I am ovulating and when I will have my period. With hormones and fertility drugs, a lot of women with PCOS is successful in getting pregnant. A hypothyroid often makes it hard to sustain a pregnancy [1]. The American Thyroid Association has issued multiple statements to warn about how thyroid disease increases the risk of miscarriages, still birth, infertility, preeclampsia, congenital malformation, and impaired brain development in infants. Despite numerous warnings, many doctors under treat the thyroid or don’t do a full panel of tests on a thyroid [6].

After receiving the call from our Reproductive Endocrinologist, I was heartbroken. My TSH went up to 5.6.  I had changed my family’s entire diet, the way we moved, in hopes that I had some kind of control over this situation. I felt like I was grasping and grasping for something to hold onto but my fingers only found water. I have had time to sit with the call from Dr. Mann. I have time to realize that she may be a great with the fertility side of our issues but both my PCOS and hypothyroidism are lifelong diseases that I will need to treat adequately. Reading article after article and getting a full understanding of both of these diseases help me feel fully prepared to fight this battle. I got a call from my wife earlier today. She was calm and reassuring and simply said, “I have an appointment with the doctor my sister recommended. You see her Friday morning.” It was simple, really, how easily I felt like I could swim again.   Moving forward, I feel that I will use the access I have to our library’s system to continue learning about the thyroid and how to care for it. I feel that PCOS is manageable, there isn’t too much that I can do with it, but I feel that I have more control over my hypothyroidism. I feel that after researching and talking about these issues in support groups, that I can move forward in our journey.


References:

1. Ndefo, Uche Anadu, Angie Eaton, and Monica Robinson Green. “Polycystic Ovary Syndrome: A Review of Treatment Options With a Focus on Pharmacological Approaches.” Pharmacy and Therapeutics 38.6 (2013): 336–355. Print.

2. Kharrazian, Datis. Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal: A Revolutionary Breakthrough in Understanding Hashimoto’s Disease and Hypothyroidism. Garden City, NY: Morgan James, 2010. Print.

3. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy

4. The Endocrine Society. Management of Thyroid Dysfunction During Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism 2007; 92(8)(Supplement):S1-S47

5. American Thyroid Association (2012, June 4). Thyroid Disease and Pregnancy. Retrieved from http://www.thyroid.org/thyroid-disease-and-pregnancy

6. American Thyroid Association. American Thyroid Association Statement on Early Maternal Thyroidal Insufficiency: Recognition, Clinical Management and Research Directions. Thyroid 2005; 15(1):77-79

7. Eunice Kennedy Shriver National Institute of Child Health and Human Development (U.S.). Beyond Infertility : Polycystic Ovary Syndrome (PCOS).Bethesda, Md.: Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2008. Web. NIH pub, no. 08-5863; NIH publication, no. 08-5863.

8. Best-Boss, Angie., Evelina Weidman Sterling, and Richard S. Legro. Living with P.C.O.S. : Polycystic Ovary Syndrome.Omaha, Neb.: Addicus Books, 2001. Print.

9. Robinson, John A. “The Two BIG Problems with “Typical” Thyroid Hormone Treatment – Part 1 of 2.” Hypothyroid Mom. N.p., 14 May 2015. Web. 20 Sept. 2016.

* most references found via. hypothyroidmom.com

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