The Link between Hypothyroidism and Infertility

This article originally appeared in Paleo Magazine.

In this article, I’ll explain why hypothyroidism and infertility are linked, and provide some advice on how to correct the issue with an ancestral health approach.

Hypothyroidism is linked with infertility. Check out this article to find out how thyroid health impacts your ability to conceive, and learn how to correct the issue. #optimalhealth #healthylifestyle #chriskresser

How Does Hypothyroidism Affect Fertility?

Every cell in the body has receptors for thyroid hormone. If anything goes awry during the production, conversion, and uptake of thyroid hormone, it can cause an underactive thyroid gland (hypothyroidism) or an overactive one (hyperthyroidism). (2) Both conditions can impact every major system in your body, including your reproductive system. (3)

The thyroid impacts levels of female reproductive hormones. (4, 5, 6) An imbalance in thyroid hormone can lead to too much or too little of these key hormones, which could impact fertility:

• Estrogen levels regulate patterns of ovulation, fertilization, and menstruation.
• Together with estrogen, progesterone prepares the uterine lining to accept a fertilized egg; it also helps a fertilized egg implant successfully into the uterine wall.
• Gonadotropin-releasing hormone signals the pituitary gland to produce follicle-stimulating hormone, causing the follicle to burst and release an egg that makes its way from the left or right ovary into the fallopian tube to await fertilization.
• Luteinizing hormone is also crucial for ovulation, signaling the ovaries to release a mature egg.
• Prolactin is associated with the production of breast milk in pregnant and breast-feeding women.

Hypothyroidism can lead to hormonal imbalances and trigger: (7, 8)

• Infrequent menstrual periods, abnormally heavy or prolonged bleeding, or the absence of a period altogether
• Anovulation, a condition where the ovaries do not release an egg
• Trouble conceiving

For pregnant women, hypothyroidism can result in: (9)

• Preterm birth
• High blood pressure in women without a history of it (an early indicator of preeclampsia)
• Problems with fetal growth and development
• Miscarriage or stillbirth

What Causes Hypothyroidism?

Hypothyroidism can often be traced back to one of two major causes:

• Nutrient deficiency
• Autoimmunity

In cases of nutrient deficiency, often a lack of iodine, zinc, and/or selenium is causing the problem. These are critical for proper thyroid function, as well as the production and conversion of thyroid hormones triiodothyronine (T3) and thyroxine (T4). (10, 11, 12)

Autoimmune-related hypothyroidism, known as Hashimoto’s disease, occurs when the body attacks its own thyroid gland, eventually destroying its ability to produce thyroid hormone. Hashimoto’s disease could be responsible for approximately 90 percent of adult hypothyroidism. (13)

Testing for Hypothyroidism

Conventional medical testing often focuses on testing T4 and thyroid-stimulating hormone (TSH) levels, but this approach can miss vital information about thyroid function and metabolism (and it can fail to detect an underactive thyroid that is not yet full-blown hypothyroidism by clinical standards).

If you are unable to become pregnant and you’re experiencing hypothyroid symptoms (such as fatigue, weight gain, mood swings, cold hands and feet, and hair loss) but haven’t yet been diagnosed, I recommend working with a Functional Medicine practitioner. They will look at additional thyroid health markers beyond T4 and TSH, including T3, free T3, free T4, and thyroid antibodies, before beginning treatment.

Seven Ways to Treat Your Hypothyroidism and Improve Fertility

As a Functional Medicine practitioner, my mission is to discover and treat the root cause of a condition using the treatment method that works best with minimal (preferably no) harmful side effects. Many women have found relief taking hypothyroid hormone replacement medication, especially those with chronically elevated levels of TSH. Every autoimmune condition is complex and individualized, including Hashimoto’s disease. Sometimes, a treatment protocol that is effective for one woman won’t have the same benefits for another. That’s why it’s best to work with a knowledgeable practitioner who can guide you to an effective hypothyroidism treatment for your own condition.

In addition, you can improve your thyroid health and fertility with diet and lifestyle changes rooted in an ancestral health approach.

1. Heal Your Gut

Dysbiosis has been implicated in countless autoimmune diseases—no surprise, since much of our immune response is mitigated by our gut. Given that our gut microbes recognize a number of endocrine molecules, including sex and thyroid hormones, it’s likely that an altered gut microbiome plays a role in hypothyroidism. (14, 15) And it follows that healing your gut can counteract hypothyroidism.

In addition to the gut-health-promoting tips that follow, I also recommend seeking treatment for any intestinal pathogens you may have, and adopting healthy sleep and exercise habits.

2. Remove Inflammatory Foods from Your Diet

If you have Hashimoto’s, adopting an anti-inflammatory diet can help regulate your immune response and alleviate symptoms. A basic Paleo diet is anti-inflammatory and a great start, but if you’re still experiencing symptoms, try the autoimmune protocol (AIP) diet. The AIP diet recommends the initial removal of eggs, nightshades like tomatoes and eggplants, coffee, alcohol (which you’d avoid anyway during pregnancy), nuts, and seeds (in addition to typical Paleo recommendations like removing grains, legumes, dairy, industrial seed oils, and excess refined sugar).

In one promising study, women who followed the AIP diet, coupled with lifestyle interventions, reported improved quality of life, including more energy and better emotional health. Some even decreased their thyroid hormone replacement medication. (16)

3. Eat Iodine- and Selenium-Rich Foods

Iodine and selenium are critical for healthy thyroid function. Adding these foods to your diet can help alleviate any deficiency that’s driving your hypothyroidism. Iodine-rich foods include:

• Fortified table salt (sea salt generally does not contain iodine)
• Sea vegetables like kombu, nori, and kelp
• Freshwater fish and fish heads

Selenium-rich foods include:

• Brazil nuts (these are particularly rich in selenium—it takes only one or two per day to improve your selenium status) (17)
• Cremini mushrooms
• Cod
• Tuna
• Halibut
• Salmon
• Scallops
• Chicken
• Eggs
• Shiitake mushrooms
• Lamb
• Turkey

Supplementation is an option, but some research suggests potential complications with long-term selenium supplementation, ranging from gastrointestinal upset and fatigue to irritability and mild nerve damage. (18) And, while the amount of iodine present in food isn’t usually a concern—especially if your selenium levels are sufficient—I don’t recommend that people with Hashimoto’s supplement with high doses of iodine. Increased supplemental iodine intake can worsen your body’s autoimmune attack on your thyroid. (19) If you choose to supplement, work with a nutritionist who is familiar with treating hypothyroidism. (And if you’re concerned about mercury intake from fish when you’re pregnant, speak to your practitioner—there are safe seafood choices.)

4. Be Aware of Goitrogens

Goitrogens interfere with the thyroid’s iodine uptake. Cooked goitrogenic foods are rarely a problem (especially if your iodine intake is sufficient), but if you consume large amounts of these foods raw each day, you may need to offset the risk by taking 800 to 1,000 mcg of iodine. In general, steam or boil goitrogenic foods and try not to eat them in excess. (20) Goitrogenic foods include:

• Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, bok choy, and cabbage)
• Fruits like cherries, peaches, apricots, strawberries, and raspberries
• Soy, spinach, sweet potato, and tapioca

Certain medications also qualify as goitrogens, including some antibiotics, nonsteroidal anti-inflammatory drugs, and lithium, as do chemicals like bromides, dioxins, pesticides, and thiocyanate (found in cigarettes).

5. Increase Your Carb Intake

Very-low-carb (keto) diets can worsen thyroid problems. Your thyroid needs adequate insulin to convert T4 into the active form of thyroid hormone, T3. The keto diet (no more than 10 percent of daily calories come from carbs) has been shown to reduce levels of T3, which would worsen hypothyroid symptoms. (21)

If you’re experiencing hypothyroidism and infertility, you may do better on a moderate-carb diet (up to 30 percent of daily calories come from carbs). Another option is cycling into and out of a keto diet on a weekly or monthly basis. That said, this is another case where the results vary considerably from person to person. I’ve had patients who don’t experience a decrease in thyroid function on a low-carb or ketogenic diet.

6. Manage Your Stress

I can’t overstate the detrimental health effects of chronic stress. Uncontrolled stress can release inflammatory cytokines, which can harm normal thyroid function, including thyroid hormone production. (22, 23, 24, 25, 26) Chronic stress can also impact reproductive hormones, including estrogen. (27)

Mindfulness meditation, yoga, deep breathing exercises, and spending quality time with your loved ones can help reduce your stress levels.

7. Get Some Sunshine

Sun exposure has protective effects against autoimmunity, and vitamin D deficiency is associated with several autoimmune diseases, including Hashiomoto’s. (28, 29, 30) If you’re considering vitamin D supplementation (which may be necessary if you don’t get enough through sunlight), I recommend working with a practitioner. A number of factors influence how your body absorbs vitamin D, including: (31)

• Gut inflammation
• The fat content of your diet
• Your age
• Your cortisol levels
• A specific genetic polymorphism that is somewhat common in people with autoimmunity

Learning how to incorporate a new diet or lifestyle can be a challenge. Fortunately, health coaches are here to help. Health coaches excel at supporting people who are trying to change their behavior—whether they’re trying out the AIP diet for the first time, starting a new mindfulness meditation practice, or adopting a more disciplined sleep schedule to support their gut health. Health coaches empower their clients to use their own strengths and motivation to achieve long-lasting change and hit their health goals.

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One More Tip for Thyroid Health and Fertility: Avoid Environmental Toxins

Industrial chemicals, pesticides and herbicides, toxins in consumer goods, and heavy metals can harm your thyroid health. If you are pregnant or are trying to become pregnant, many harmful environmental toxins can also cross the placenta and reach your baby. Here are some simple ways to limit your exposure:

• Use a high-quality water filter for your drinking and bathing water (as tap water can be a significant source of toxins).
• Eat organic foods that are free from excessive herbicides and pesticides.
• Limit your use of bisphenol A (BPA)-containing plastics, and keep in mind that BPA-free plastics can contain bisphenol derivatives, which are also disruptive to the thyroid.
• Replace non-stick cookware (which can leach perfluorooctanoic acid into food) with stainless steel or enameled cast iron.
• Ensure you have optimal levels of iodine and selenium, which can counter the effects that industrial chemicals and heavy metals can have on the thyroid.

I hope this article has helped you gain a better understanding of what could be causing your thyroid disorder and infertility. If you do need further help, I encourage you to work with a Functional Medicine practitioner who understands how to address the root cause of your thyroid condition.