The role of thyroid function in female and male infertility: a narrative review

However, your levothyroxine treatment should be adjusted to normalise your thyroid function as soon as possible. Review of the literature examining effects of hypo- and hyperthyroidism on sexual function. Thyroid hormones and hormone receptors also regulate the endometrium receptivity, which is the stage where all the actors, including thyroid hormones, cooperate to prepare and allow the implantation window of the blastocyst, with variations during the menstrual cycle 19, 20. If you have had postpartum thyroiditis, even though you have made a full recovery initially, it is recommended that you have your thyroid function checked before you try to conceive again and at the start of your next pregnancy to ensure that you have not developed hypothyroidism. There is an up to 50% risk that you develop a recurrence of postpartum thyroiditis in subsequent pregnancies.

The role of thyroid function in female and male infertility: a narrative review

• Finally, one study noted a 69% reduction of preterm birth 57, results confirmed by Negro et al. who showed that thyroid hormone replacement reduced both miscarriage and preterm delivery rates in euthyroid women with TAI 83.
• Hypothyroidism may also decrease the total sperm number and motility as well as lead to an impairment in acrosome integrity and mitochondrial activity 108, with improved motility upon hormone replacement 89, 109 (Fig. 2).
• The study concluded that hypothyroidism adversely affected semen quality by compromising semen volume and progressive sperm motility.

However, more research is needed to determine exactly how normalization of thyroid hormone levels affects other aspects of sexual functioning. Thyroid hormones and their impacts on male reproduction have been reported in numerous studies in past few decades. They are the crucial players in the regulation of male gonadal developments and reproductive functions. An excess or deficit of thyroid hormones not only alter the testicular functions but also interrupts neuroendocrine axis through the crosstalk between hypothalamic-pituitary-thyroid (HPT) axis synthroid purchase and hypothalamic-pituitary-gonadal (HPG) axis. These changes result in decreased testosterone level and altered seminal plasma components which affect semen quality.

Antithyroid drug therapy to treat hyperthyroidism

These hormones influence several organs, including the testis, and are crucial for sperm production. A healthy thyroid gland supports overall male reproductive health by ensuring normal sperm count and sperm motility. When thyroid dysfunction occurs, whether it’s an overactive thyroid (hyperthyroidism) or an underactive thyroid gland (hypothyroidism), it can negatively impact semen parameters, leading to lower sperm quality and fertility outcomes. In hyperthyroidism, increased T4 levels, altered LH and FSH responsiveness, disrupt the endocrine regulation upon development and functioning of male reproductive tissues and germ cells resulting in distortions in tissues such as the reduced diameter of seminiferous tubule and impaired or delayed spermatogenesis.

Sexual Dysfunction Outcomes After Normalization of Hormone Levels in Hyperthyroid Men

It is likely that you will require higher doses of levothyroxine during pregnancy, especially during the first 20 weeks, to provide sufficient supply of thyroid hormones to the baby. As soon as you know you are pregnant, it is generally recommended that your levothyroxine is increased immediately, usually by mcg daily. We recommend that you double your current dose on two days each week (e.g. every Saturday and Sunday). ​You should then contact your GP and arrange to have a thyroid blood test so that more targeted adjustments can be made if required. Women who have previously had Graves’ disease (but not had thyroid surgery or radioiodine) may relapse at any stage, but the risk rises after giving birth and remains high for one year.

They calculated a decrease in free testosterone to free estradiol ratio suggesting an increased aromatization of testosterone. However, we66 reported an increase in calculated bioT and an unaltered total estradiol to testosterone ratio in hyperthyroid patients. Thus, there is conflicting information on whether hyperthyroidism affects female sexual function, with two studies finding a relationship and one failing to find a relationship (Table 5). Several studies have investigated the relationship between male sexual dysfunction and hyperthyroidism. Researchers have sought to examine this relationship both by looking for sexual dysfunction in hyperthyroid men as well as looking for hyperthyroidism in men with sexual dysfunction. To investigate the associations between thyroid hormones and sexual dysfunction in women and men.

• There is an up to 50% risk that you develop a recurrence of postpartum thyroiditis in subsequent pregnancies.
• Besides these, we carry out correlative tests such as Blood Tests (hormone assays and serology tests), Semen Culture, ROS Test, Karyotyping, Sperm Aneuploidy Test and Y-chromosome Microdeletion.
• Nutrients such as iodine, zinc and selenium can benefit thyroid function, but it’s important to consult a doctor before starting supplements.
• If you require higher doses of antithyroid drugs to control hyperthyroidism then your baby can have a blood test to check whether its thyroid is being affected.
• However, current evidence supports thyroid derangements rather than autoantibodies as the causative factor in men, while autoantibodies appear to play a more prominent role in women.

As research continues, scientists are discovering more about the link between the endocrine system, thyroid health and male fertility. While current treatments for thyroid-related fertility issues are effective, future studies may reveal new ways to enhance fertility outcomes. Ongoing research will likely focus on how specific thyroid-related interventions improve sperm production, and whether routine thyroid function tests should be included in the diagnostic workup for male infertility. Around 1 in 1,000 men experience hyperthyroidism, and hypothyroidism affects about 1 in 100.

Last, the use of ICSI for male factor infertility and the number of embryos transferred could affect the outcomes. Thus, all these factors may have influenced the interpretation of the results, making the final medical decision often challenging to make. Thyroid disorders are mainly categorized into two groups; hypothyroidism and hyperthyroidism. As explained earlier thyroid hormones are important regulator of male reproductive function so any alterations in their serum levels have profound effects on male reproduction. The importance of thyroid hormones in the female reproductive system has been highlighted since the evidence of TSH and thyroid hormone receptors (TR-a1 and TR-b1) on ovarian and oocytes surface 15, so its role in folliculogenesis, fertilization, embryogenesis, and in implantation, and maintaining pregnancy is inevitable. In this regard, in vitro studies suggest that thyroid hormones promote FSH-induced preantral follicle growth, activating the protein kinase B (Akt) pathway 16.

Antithyroid drugs alert card

Reduction in sperm vitality may result from increased oxidative stress and reduced antioxidant capacity in reduced thyroid hormone actions. The primary study examining sexual dysfunction in women after thyroid hormone normalization is by Oppo et al. The authors found that after 3 months of treatment, desire, satisfaction and pain domain scores of the FSFI increased to control group levels in both hypo and hyperthyroid women. However, the hypothyroid group had a significant increase from baseline while the hyperthyroid group did not. Notably, the lack of orgasm remained an issue in both hypo- and hyperthyroid groups, suggesting lack of reversibility of this symptom of FSD. Most studies demonstrate that hypothyroid and hyperthyroid men have increased rates of sexual dysfunction, including erectile dysfunction (ED) in hypothyroid men.

Thus, in patients with hypothyroidism, increased testicular size is observed along with a significant drop in mature germ cells within the seminiferous tubules (22, 23). Fortunately, hypothyroidism is very rare in males with an occurrence rate of only 0.1% in the general population (21). Among the studies on human subjects, Corrales Hernandez et al. (24) analyzed blood and semen samples of patients with primary hypothyroidism (24).

Additionally, studies disagree on whether there is a relationship between the severity of ED and the severity of hormone derangement. Other sexual dysfunctions such as DE and HSD are less researched and require further investigation to reach a meaningful consensus on their relationship with hyperthyroidism. Thyroid hormones increase hepatic SHBG production, which is also regulated by hepatocyte nuclear factor-4a (HNF-4a) in response to changes in the metabolic state of the liver 23.