ATA Guidelines Tools

7 The Impact of Thyroid Illness upon Infertility and Assisted Reproduction Î Evaluation of serum TSH concentration is recommended for all women seeking care for infertility. (W-M) Î LT4 treatment is recommended for infertile women with overt hypothyroidism who desire pregnancy. (S-M) Î There is insufficient evidence to determine if LT4 therapy improves fertility in subclinically hypothyroid, thyroid auto-antibody negative women who are attempting natural conception (not undergoing antiretroviral therapy [ART]). However, administration of LT4 may be considered in this setting given its ability to prevent progression to more significant hypothyroidism once pregnancy is achieved. Furthermore, low dose LT4 therapy (25–50 mcg daily) carries minimal risk. (W-L) Î There is insufficient evidence to determine if LT4 therapy improves fertility in nonpregnant, euthyroid, thyroid autoantibody positive women who are attempting natural conception (not undergoing ART). Therefore, no recommendation can be made for LT4 therapy in this setting. (I) Î Subclinically hypothyroid women undergoing in vitro fertilization or intracytoplasmic sperm injection should be treated with LT4. The goal of treatment is to achieve a TSH concentration <2.5 mU/L. (S-M) Î There is insufficient evidence to determine whether LT4 therapy improves the success of pregnancy following ART in TPOAb-positive, euthyroid women. However, administration of LT4 to TPOAb-positive, euthyroid women undergoing ART may be considered given its potential benefits in comparison to its minimal risk. In such cases, 25–50 mcg of LT4 is a typical starting dose. (W-L) Î Glucocorticoid therapy is NOT recommended for euthyroid, thyroid auto-antibody positive women undergoing ART. (W-M) Î When possible, thyroid function testing should be performed either before or 1–2 weeks after controlled ovarian hyperstimulation, since results obtained during the course of controlled ovarian stimulation may be difficult to interpret. (W-M) Î In women who achieve pregnancy following controlled ovarian hyperstimulation, TSH elevations should be treated according to the recommendations outlined under Hypothyroidism and Pregnancy. In non-pregnant women with mild TSH elevations following controlled ovarian stimulation, serum TSH measurements should be repeated in 2–4 weeks, since levels may normalize. (W-M) Infertility

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