44: The #1 Hormone Women Aren’t Testing – The Best Way to Protect Fertility & Pregnancy with McCall McPherson

Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. Today we are talking all things thyroid infertility and we're doing it makeup free. I'm about to leave for some travel for some interviews, and this lady's going to get a spray tan after this. So let's dig in. I want to talk to you about fertility, pregnancy, postpartum, all of these different aspects that certainly are intricately connected to thyroid. I get a ton of fertility questions, so let's dig in. I really have seen truly in my clinical practice, but also in research that mild, mild thyroid dysfunction impacts fertility all it impacts egg quality, ovulation, implantation, miscarriage, and even still versus live birth rates. This is something that we take extraordinarily seriously at Modern Thyroid Clinic. We have a whole pre pregnancy planning phase and then when we move into actual pregnancy management of people's thyroid, we, we are baseline neurotic, we're extra, extra neurotic at that point because it is so incredibly important. So let's talk about fertility outcomes first. So women with a TSH level in what medicine generally calls normal, so 2.5 to 4.5 had a 15% lower live birth rate compared to women with a TSH less than 2.5. And I think that could improve even further if we got TSH close to one. So what that means is medicine isn't even treating these people. They're saying they're, quote, subclinical. But even at subclinical levels, and I mean a lot of subclinical goes up until a TSH of 10, y', all, which is ludicrous. We are seeing fertility impacted. Subclinical hypothyroidism affects 2 to 4% of reproductive aged women and is certainly linked to these poor fertility outcomes, especially in IVF settings, y'. All. And so it breaks my heart because I've seen this in my practice when people transition to us that spend thousands of dollars, tens of thousands of dollars, that even is a high cost. But the true high cost is the emotional, psychological, hormonal impact of IVF and their tsh, their thyroid, their output hormones, their hashimoto is wildly unregulated, unaddressed. And of course, these women have poor outcomes. So, so incredibly important that if you are going to, as a family make the decision to pursue ivf, please, please have your Thyroid sorted out to a very, very tightly, tightly controlled place. Women with a TSH of 2.6 to 4.5 were twice as likely to miscarry or have suboptimal embryo quality as those compared with a TSH of 1.9 in another study. What's my range? Less than 1.8. Ideally closer to 1. And it is so fascinating because what is unraveling and being revealed in medicine, specifically in this fertility. These fertility people are like the canary in the coal mine. They are showing all of these implications of mild and, quote, subclinical hypothyroidism impacting people's health. Right? And they're actually looking deeper at these women. But this can be extrapolated to baseline everyday people as well. So when we think about embryo quality, one study said top quality embryos were achieved in 66 to 68% of women with lower normal TSH and only 58% of women with a high normal TSH. Again, that's, quote, high normal. That's 2.5 to 4.5. Medicine, y', all, is letting people go up until 10 these days in so many cases. Thyroid dysfunction is present in about 40% of women with unexplained infertility. Can't be overstated. Let's talk about T3. I get this question all the time. Can I take T3 when I'm pregnant? Can I take T3 now if I know I want to get pregnant in the future? So let's talk about T3 and fertility. T3 plays a crucial role in egg quality, ovulation and cycle regulation. Without sufficient T3, egg maturation, ludal phase function and implantation success might be compromised. So I always say this. T3 helps get pregnant and stay pregnant. Now, medicine in general says, oh, my God, do not, do not use T3 in pregnant women. The baby won't have access to enough T4 and the T3 doesn't cross the placental barrier. Guess what, guys? Two things can happen at once. People can have an FT3 and they can also have an FT4. You know how I know? I actually freaking check it, right? Like, if you're trying to infer all of these data points all from a tsh, I can see how clinicians would be anxious. There's a really simple solution, and it's just to check TSH free T4 to ensure the baby has access to it free T3, reverse T3 and antibodies. So let's just do it. I have successfully taken women with infertility a history. Literally, one of them had nine miscarriages and took her through successful pregnancy by optimizing thyroid and hormones to an extent too. Right. Progesterone, et cetera. So T3 versus T4 in pregnancy. Right. So to get pregnant, stay pregnant, T3 improves my ability to get patients pregnant to maintain pregnancy, especially early on. Then guess what? We move into an emphasis on T4. If T4 is what nourish, nourishes the baby. If T4 is what crosses the placental barrier, the baby's access to T4 in pregnancy takes precedence. So we would never suppress a pregnant woman's T4 in order to give her enough T3. That's not going to happen. Obviously moms who are pregnant value the health and development of their baby. Of course we do too. And so we ensure the entire pregnancy they have access to enough T4 often by supplementing with T4, Levothyroxine, Synthroid, et cetera. So T3 and T4 Balanced also help, you know, in the pre pregnancy planning phase of ensuring there's enough progesterone. Progesterone is responsible to keep women pregnant to protect them from miscarriage. Okay. When you don't have enough progesterone, you are at the highest risk of miscarriage in early pregnancy. It is the most common cause of miscarriage in early pregnancy. And thyroid is crucial for progesterone production. Let's talk about why TSH is invalid during pregnancy. So y', all 9 out of 10 OB GYNs that I've encountered when I am balancing someone's thyroid and they get pregnant and they go to see their OB GYN, 9 out of 10 are checking TSH for thyroid function. And again, they are trying to infer T3 and T4 output hormones based on that TSH number. You all know I do not believe TSH is a valid rep representation of T3 and T4 in any people pregnant or otherwise. It accounts for about 1% of the fluctuations in T3, our most important hormone, meaning 99% of the time. Those two numbers do not correlate. TSH does not add adequately reflect T3, so we need to be checking it. But it's more important in pregnancy, y'. All. TSH is heavily influenced by HCG hormone, so it becomes suppressed from HCG hormones, which we have a lot of during pregnancy, especially immediately early on. And so if your OB GYN is trying to reduce your medication based on your TSH saying you're over medicated based on your tsh, guess what? Like you need to have a come to Jesus conversation because that is not an accurate representation of what's happening with your thyroid output hormones because it's being artificially influenced by your hcg. And again, you need to be checking a full thyroid panel. You know, there's another study that supports this that emphasizes reproductive health outcomes correlate more closely with actual hormone levels than with tsh. Of course. Right. Like, I don't need to tell you all that. If you've tuned into my content before, you probably already know, But I want to move into, you know, autoimmunity and fertility. Hashimoto and fertility. And part of what we do at Modern Thyroid Clinic that I think is really valuable for you all to try to facilitate elsewhere is trying to reduce your antibodies before becoming pregnant. So that can be things like lifestyle. I have a ton of content about this. Lotos, naltrexone, et cetera. And yes, I actually do keep people on Lotos naltrexone very commonly during pregnancy. So Hashimoto is present in about 27% of women with PCOS, or unexplained infertility, which increases miscarriage risk. Women with positive TPO antibodies are three times more likely to have pregnancy complications or miscarriage. So clearly, this is an important thing to address. Reducing antibodies, they don't need to technically be in remission. Reducing them as much as possible can correlate with risk reduction in so many of these facets of fertility. So work with the functional medicine clinician, track your antibodies, check them every time. This is valuable, valuable information. Okay? And then obviously, as you move through pregnancy, and I think I have a whole separate podcast about pregnancy and thyroid, so please tune in to that. But again, postpartum, your highest risk for autoimmune thyroiditis is postpartum. And so you want to again, be screening for antibodies postpartum. You want to be checking thyroid function hormones postpartum. And then I believe I also went into this in my other podcast on pregnancy. But during early pregnancy at Modern Thyroid Clinic, we actually check immediately a full thyroid panel with antibodies and progesterone. Again, progesterone protects you from miscarriage, Right? And a lot of women with thyroid issues are walking around with low progesterone. It's one of the first hormones to get influenced in hypothyroidism. So check it. We check it, we supplement with it, and we actually check it the next week again, y', all, to ensure that it's increasing. Because in early pregnancy, progesterone is skyrocketing week over week. If that's not happening, we're at an increased risk of miscarriage, and we need to be supplementing. Supplementing. And I don't mean supplements. I mean a prescription progesterone. We use a vaginal trochee or a suppository. Actually, a suppository, not a trochee in this case. And we use it nightly. Dosing depends, you know, varies between 100 and 200 milligrams. But we want to immediately locally increase progesterone for these women to reduce their miscarriage risk. We continue to check it every week and adjust it until it is sufficient or these women are out of the risk of early miscarriage, which happens around week 12 to 14. Outside of progesterone, we are checking thyroid hormones roughly every six weeks, every four, if we're having a difficult time getting their levels up. But that is rare. Women generally need an increase in thyroid medication of about 30%. Okay. During pregnancy, the demand for thyroid hormones increases because we have this little baby that we're also supplying with thyroid hormones. So you have to be mindful of that, and you want to stay ahead of any significant shifts in need for thyroid hormones. And about every four to six weeks, if you're checking labs and making adjustments, that's plenty of opportunity to do that. But I really, truly encourage women to be diligent with that, especially in second and third trimester when big, big shifts are happening, and then obviously in first trimester for progestero, et cetera. Just starting out strong in pregnancy is very, very important. So I know this was a quick, quick run through. I know we breezed through this, but I wanted to get it out. I've been doing a little bit of a deep dive on statistics and research for fertility, and I think you guys deserve to be in the know. So I hope you found this useful, helpful, and see you next week.