If you suffer from hypothyroidism, Low T3, or Hashimotos follow these 10 steps to improve and optimize your chances of fertility. In today’s article, I will explain how Fertility is intricately linked with thyroid disease. Follow these 10 tips, to maximize your chances of fertility and achieving conception when you are hypothyroid.

The thyroid gland, known for producing hormones that regulate metabolism, also plays a significant role in reproductive health, conception, and fetal development. Hypothyroidism also plays an important role when it comes to fertility. Sometimes the slightest changes in thyroid hormone levels can disrupt the menstrual cycle and ovulation.

1. Get Your Thyroid Properly Tested.

If you have hypothyroidism and you are struggling with fertility, it’s important to go beyond the standard thyroid markers that traditional medicine focuses too much on. Most doctors today only run A TSH and a free T4. These markers do not show the entire picture missing many patterns of subclinical hypothyroidism, Low T3, elevated Reverse T3, and Autoimmune Thyroid disease.

Women struggling with fertility will need to have a complete and comprehensive thyroid panel including thyroid antibody testing. Subclinical Hypothyroidism affects the menstrual cycle and fertility in several ways. (*)(*),(*)

Optimizing thyroid health can be an essential step in fertility treatment plans for patients with hypothyroidism but without proper testing, proper treatment can be hard to accomplish. For many of my patients struggling with both hypothyroidism and Fertility, I will run a more comprehensive thyroid panel to better understand what we are up against.

2. Stress

Work with a doctor who understands the connection between the adrenal glands and the thyroid. Stress hormones like cortisol have an impact on sleep, energy, mood, brain function, and yes even your sex hormones. Stress triggers the release of cortisol, a hormone produced by the adrenal glands. Elevated cortisol levels can disrupt the normal balance of other hormones necessary for fertility, such as estrogen, progesterone, and testosterone. Cortisol also affects your Thyroid hormones.

Cortisol can interfere with the release of gonadotropin-releasing hormone (GnRH).(*),(*) Gonadotropin-releasing hormone (GnRH) is a hormone that regulates the reproductive system by causing the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). GnRH is the key regulator of reproduction when it comes to estrogen and progesterone. Stay with me…. Here’s why this is important.

Problems with Gonadotropin-releasing hormone will cause problems with luteinizing hormone (LH) and follicle-stimulating hormone (FSH)- The hormones that make estrogen and progesterone(*). The Hormones that are essential for ovulation! ( I know that was a bit technical but as you can see its a snowball effect.

High levels of stress and cortisol can lead to anovulation, where the ovaries do not release an egg during a menstrual cycle. Without ovulation, you don’t get progesterone production and without progesterone, conception cannot occur.

As for the Thyroid- Cortisol connection. This is important as well. Cortisol also affects the conversion of inactive T4 thyroid hormone into its active Thyroid hormone T3. This is sometimes known as Low T3.  This low thyroid reserve ultimately affects progesterone levels and fertility.

3. Get Your Thyroid Antibodies Tested.

Hashimotos thyroiditis, an autoimmune disorder affecting the thyroid gland, can have a substantial impact on fertility and reproductive health. Hashimotos leads to hypothyroidism, characterized by an underactive thyroid gland. Since the thyroid hormones (T4 and T3) regulate numerous bodily functions, including metabolism and reproductive hormones, imbalances can disrupt the menstrual cycle and ovulation.

In hypothyroidism, when thyroid hormones (T3 and T4) are low, the pituitary gland increases TSH production to stimulate the thyroid. Elevated TSH levels can sometimes also lead to increased prolactin production.

Elevated Prolactin will prevent conception by also suppressing the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus.(*) This suppression leads to decreased production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the pituitary gland, which is crucial for normal ovulation. Elevated Prolactin can also cause anovulation.(*)

A common issue with Hashimotos is a luteal phase defect, where the second half of the menstrual cycle is shortened. This can affect the uterine lining’s ability to support a fertilized egg, reducing the chances of successful implantation.

Here’s What To Look Out For When It Comes to Hashimotos

If your TSH was slightly elevated or even on the very low end, and you are experiencing bouts of both Hypothyroid and Hyperthyroid, have your antibodies tested.

Ask your doctor to run BOTH TPO antibodies and TGB antibodies. (Read here to learn why you need BOTH) If you test positive you have Hashimoto’s disease. Symptoms to look out for include anxiety, inward trembling, heart palpitations, and hair loss.

4. Low T3

Low levels of T3, a key thyroid hormone, can have significant implications for reproductive health and pregnancy, including an increased risk of miscarriage (*),(*),(*). The reality is that family doctors and reproduction specialists don’t always test for low T3. Here’s why Low T3 is important for fertility conception and fetal development. 

1. T3 levels are crucial for preparing the uterine lining for implantation and supporting the embryo’s early development. Insufficient levels can disrupt these processes, increasing the risk of miscarriage.

2. In the early stages of pregnancy, the fetus relies on the mother’s thyroid hormones before it can produce its own. Low maternal T3 can impact the early development of the fetal brain and other organs.

Maintaining a diet rich in nutrients that support thyroid function, managing stress, and avoiding known disruptors of thyroid health (like certain chemicals or a lack of iodine) can help maintain healthy hormone levels.

If your doctor did test your T3 levels and you were told you have Low T3, Here are some Tips to improve Low T3

5. Blood Sugar Has A Profound Impact on Hormones and Thyroid

Problems with blood sugar, particularly those related to conditions like diabetes and insulin resistance, can significantly impact fertility for both men and women. High blood sugar levels can disrupt the hormonal balance necessary for regular menstrual cycles and ovulation.(*) This disruption can make it more difficult to conceive. Chronic high blood sugar levels can affect the health and quality of eggs, leading to difficulties with conception and an increased risk of miscarriage(*). Elevated blood sugar levels can alter the lining of the uterus (endometrium), making it less receptive to implantation by a fertilized egg. (*),(*)

Management Strategies For High Blood Sugar Fertility

Adopting a diet rich in anti-inflammatory foods is a fundamental step in balancing hormones and enhancing thyroid health. Whole food options like fruits, vegetables, whole grains, and healthy fats can naturally support the body’s healing processes. Functional medicine emphasizes understanding and addressing food sensitivities or allergies personally tailored to promote optimal health and alleviate menstrual discomfort. Prioritizing balanced meals that stabilize blood sugar levels can markedly improve hormonal regulation, addressing a core issue often left unchecked by conventional medicine.

Together, hyperglycemia (Fasting Glucose levels greater than 100) and hypoglycemia (Fasting Glucose levels under 85) are referred to as dysglycemia.   Dysglycemia is one of the most common problems seen in patients with hormone imbalances and thyroid disease. If you have dysglycemia follow these 12 tips to balance your blood sugar

6. Healthy Liver Function and Toxins.

We can’t talk about hormones without also talking about the Liver and gallbladder- part of your liver’s responsibility is to break down, recycle, and reuse hormones. If your liver and gallbladder have been taxed the ability to break down and recycle these hormones, will be compromised. This is a common problem with women who have been on birth control pills for many years. The bottom line here………….you cannot have healthy hormones if your liver and gallbladder are not working optimally.

7. Gluten, Thyroid Disease and Fertility

Gluten is a group of proteins found in wheat, barley, and rye. It provides elasticity to dough, allowing it to rise and maintain its shape. While many consume gluten without issue, it poses a challenge for individuals with certain conditions, such as celiac disease and gluten sensitivity.

Studies indicate a higher prevalence of celiac disease among those with Hashimoto’s thyroiditis. Both are autoimmune disorders, suggesting a potential shared genetic predisposition. This increases the interest in how gluten may influence thyroid function.

One hypothesis for the link is molecular mimicry. Proteins in gluten might resemble thyroid tissue, prompting the immune system to attack the thyroid when responding to gluten. This can exacerbate autoimmune thyroid conditions.

Gluten can trigger inflammation and may contribute to gut permeability issues, sometimes termed “leaky gut,” especially in sensitive individuals. A compromised intestinal barrier might allow larger molecules to enter the bloodstream, stimulating an autoimmune response affecting the thyroid.

Gluten has also been linked to over 55 diseases according to the New England Journal Of Medicine. Gluten is no longer being seen as a fad diet, Gluten has been linked to Hashimoto’s, PCOS, endometriosis, and low progesterone during the second phase of your cycle.

Because optimal hormone levels are not only needed for ovulation but also for sustaining the embryo it only makes sense to eliminate foods like gluten that may be contributing to a hormone imbalance.

8. Make Sure To Get Your Vitamin D Levels Tested

When it comes to vitamins, Vitamin D is critical for healthy thyroid levels.  Given that Vitamin D is one of the most talked about nutrients, it should come as no surprise that its effect on the thyroid has been studied extensively.

Vitamin D plays a vital role during pregnancy for both the mother and the developing fetus. It is crucial for maintaining proper calcium and phosphate levels in the body, which are essential for healthy bone development and overall health. Adequate levels of vitamin D may help reduce the risk of pregnancy complications such as preeclampsia, gestational diabetes, and preterm birth.

Vitamin D deficiency is relatively common, especially during winter months or in women with limited sun exposure. Testing for vitamin D levels can help assess whether supplements are needed. Don’t forget to routinely retest your levels!

The bottom line that has been established by these studies is that a lack of Vitamin D can have devastating effects on the thyroid, as well as the rest of the immune system. A good healthy range of vitamin D should be between 60-90 nmol/L. Concerned about your Low Vitamin D Levels?

Read my 4 part Vitamin D series here

9. Avoid Plastic and BPA When Your Pregnant

Today more so than ever, we are seeing the consequences of environmental toxins on hormone health. Researchers have identified one specific endocrine disruptor in particular known as Bisphenol A. Bisphenol A otherwise known as BPA has been shown to be one of the most damaging endocrine disruptors to Thyroid and ovarian health. BPA can be a major contributor to autoimmune Hashimotos.

Children and Pregnant Women are particularly vulnerable to the hormonal disruptions caused by BPA. Proper thyroid function is critical during pregnancy for the development of the fetus, and disruptions can lead to developmental issues. Switching over to glass can have a tremendous impact on thyroid function. Here are a few tips when it comes to avoiding BPA.

• Look for products labeled “BPA-free,” especially for food storage and drinking containers.
• Use glass, stainless steel, or BPA-free plastics when possible, particularly for food and beverage containers.
• Avoid microwaving plastic containers, as heat can increase the leaching of BPA into food.
• Some canned foods use liners that contain BPA.
• Whenever possible, choose fresh or frozen foods to avoid exposure.

10. MTHFR, Low Thyroid and Fertility

Folate is essential for women who are pregnant for many reasons and in the intricate world of miscarriage, genetics, and health, few connections are as compelling as those between the MTHFR gene, fertility, and thyroid disease. As research continues to unfold, understanding this triad can offer new insights into reproductive health and thyroid function, paving the way for more personalized healthcare approaches. Key terms like folate, MTHFR, thyroid, and fertility frequently arise in these discussions, highlighting their central role in these conditions.

The MTHFR (methylenetetrahydrofolate reductase) gene plays a vital role in processing amino acids, which are crucial for building proteins. Specifically, MTHFR is involved in the conversion of folate (vitamin B9) into its active form (5-methyltetrahydrofolate), which is essential for DNA synthesis, repair, and methylation — processes critical for normal cellular function.

MTHFR and Folate

Folate is a key player in cell division and growth. Adequate folate levels are especially important during periods of rapid growth, such as pregnancy, to prevent birth defects and support fetal development. Variations or mutations in the MTHFR gene, such as C677T and A1298C, can affect the body’s ability to process folate effectively. This can lead to conditions like elevated homocysteine levels, which are associated with cardiovascular problems and complications during pregnancy. Variations in this gene also mean that you need a methylated (activated) form of folate better known as methylfolate. Learn more about testing these genes here

MTHFR and Fertility

The connection between MTHFR mutations and fertility is a growing area of interest. Women with these mutations might experience challenges related to:

1. Recurrent pregnancy loss: High homocysteine levels, due to inefficient folate metabolism, can lead to issues with blood flow and clotting, increasing the risk of miscarriage.(*) Watch this video if you have high homocysteine levels, have thyroid disease and you are pregnant.
2. Egg Quality: Proper methylation influenced by MTHFR and folate levels is crucial for maintaining egg quality and viability. (*)

MTHFR and Thyroid Disease

Thyroid function is another vital aspect influenced by the MTHFR gene, given the thyroid’s role in metabolism and hormonal balance. There is a notable incidence of autoimmune thyroid diseases in individuals with MTHFR mutations. The link may partly arise from folate’s role in immune function and inflammation control, both crucial for maintaining thyroid health. Effective detoxification, influenced by proper folate metabolism, supports overall endocrine health, including the thyroid gland. MTHFR mutations can impair detoxification pathways, potentially affecting thyroid function.

I recommend this test when considering MTHFR mutations. This test looks at not only the MTHFR mutation but also the other genes involved in the methylation pathway. It is not enough to just look at MTHFR. If you are + for the MTHFR mutation I recommend you take this supplement.

Understanding the interplay between the MTHFR gene, fertility, and thyroid disease underlines the importance of an integrated approach to health.

1.  Order Your Comprehensive Thyroid Panel here
2. Order Your Methylation Pathway Profile Including MTHFR testing here
3. B12 Deficiency, Thyroid Disease, and The MTHFR Connection
4. The Vicious Cycle of Inflammation and How It Affects Your Thyroid Part I
5. Tips to Improve Low T3
6. Understanding your Thyroid lab ranges