Why your Fertility Tests may not be ‘Normal’

Hi, welcome to episode 51 of the Fertility Rewire podcast and, in this episode, I'm going to talk to you about why you must not accept normal and you must not accept unexplained from the fertility tests that you have.

So that's quite a bold statement, isn't it?

I'm working with clients as you know, as I've talked about before, and one of the things when we're working together if they haven't already had tests, they haven't already had blood tests, hormone profiles, then this is something that I actively encourage them to have.

And then often, what happens when they get the results back is they say, Oh, the doctor said everything's normal. So, it's unexplained. The Doctor said there's nothing that they can do with that.  I always ask at this point for them to get a copy of themselves so we can have a look at the results together. Now, what this shows us, more often than not, is if you think, for example, Thyroid Stimulating Hormone: and I would encourage you to always have this tested, if you are experiencing fertility issues or even if you're just starting to think about trying for a family, look at the thyroid stimulating hormone TSH.

Thyroid Function

The way the thyroid stimulating hormone works is that the higher the level of thyroid stimulating hormone in your blood, the lower thyroid activity is. So a high TSH would show us that your thyroid is functioning below par, that it is an underactive thyroid. And the reason for that is that your body is producing this stimulating hormone to stimulate the thyroid to produce thyroid hormones and the more stimulation it needs, the poorer it's working without it. Does that make sense? So if you have a low TSH result, a low thyroid stimulating hormone, the thyroid isn't needing any help, it's functioning well and maybe it's functioning too much. And that's when we get into a hyperactive thyroid issue.

When we look at these guidelines for thyroid, generally, you're looking at a normal range being between, 0.27 – 4.9 mu/L, and this is in the UK and also in the NHS Trust, that a recent client is positioned in, the Primary Care Trust here in the part of Nottingham. There is a slight change in some parts of the country.

I'm talking to you about: the reference range, so that is the range of the low and below that the medical profession needs to give you treatment and high and above that the medical profession needs to give you treatment. These ranges are set out in clinical guidelines that Doctors follow.

The range is 0.27 – 4.9 mu/L, Okay? so below that you've got overactive thyroid, you're demonstrating ill health. above that, you've got an underactive thyroid that will need something doing you're demonstrating ill health and what we have to realise is that our medical model of health care, which I adore and we are so blessed to have but our medical model of healthcare is to treat ill health. It is to treat at the point that health is affected. It is not about " you're a little bit on the low side, so perhaps you might want to look into different ways to support your thyroid" that doesn’t happen, it’s very cut and dried.

So, a client this week had her results back and her TSH is 4.2. That's not far off. 4.9 Is it ? Her GP said  it's 'normal'. Now, in terms of pregnancy and fertility, if you Google, what's the optimal TSH for fertility you will find research articles suggesting that less than or equal to 2.5 is where you want to be, and this lady's is 4.2. So, we're working together looking at ways we can support her thyroid through other methods to try and bring that function of the thyroid more into balance.

Cortisol massively affects the thyroid function. So if you have stress, if you have cortisol at significant levels, your thyroid function will be affected. So that's one aspect that we need to look at.

When you look at recommended thyroid stimulating hormone levels in pregnancy, the first trimester of pregnancy it is recommended that the TSH be between 2 and 2.5. So, here's the thing. Your thyroid could be 4.2 while you're trying to get pregnant, a week later if pregnant, the medical advice is that they want that at 2.5. Doesn't it make sense that it would be at 2.5 or less ideally when trying to conceive?

Some fertility clinics will look at this and will support that thyroid function you know, to give you medication perhaps to support that. But I don't think widely, certainly not in the UK in the U.S. absolutely. When I'm working with clients based in the U.S. if they have a thyroid of above 2.5 They are getting treatment for that. I also have a client in Europe who's also had treatment when her thyroid function was suboptimal.

This is what I want us to think about. Let’s forget the normal. If you are out of the range, it is unhealthy. Okay. If it is within the range, the lower side or the upper side, it is sub optimal. If it's in the middle, we're looking more optimal. So get your test results and have a look at them.

Ferritin

When it comes to ferritin. Now you may not routinely have been tested for ferritin but a client that I have been working with, ferritin is something that we talked about and that she requested to be tested by her GP.  Her ferritin has come back as 19, (edit correction 14 ug/L). Now, the ferritin reference range is huge, it's something like and I don't have this to hand but I think it's 5 as the lowest to 265  (edit correction 204). Now ferritin represents your iron stores. It doesn't represent the iron in your body, that's in your haemoglobin, your red blood cells. It represents your iron stores, and you can be symptomatic as a woman generally if your ferritin is below 50. so 19 is classed as"normal". I'm doing little inverted commas in the air here, if you're watching on YouTube, you'll see that.

So at 19 I would say we can do more than that. That’s sub optimal, and we can improve that, we have room for improvement there.  And when you google Ferritin levels,  in Australia and USA certainly, the recommended ferritin level for women is no lower than 30 or 50.

So 14 I would say that's a little on the low side when you're looking at getting pregnant.

Why are fertility levels lower than pregnancy levels?

If this client were pregnant and her ferritin was tested, the medical profession would want to support that with some iron supplements. So, there's a window between trying to get pregnant and being pregnant. Fertility is about trying to get pregnant and you could be pregnant within that cycle of trying and then when your pregnancy is confirmed are we then going to look at these test results? So it makes no sense to me at all. No sense that the fertility levels are lower than the pregnancy levels

Thyroid Antibodies

I also have clients who have tested positive for thyroid antibodies. Thyroid antibodies represent an autoimmune element in that you have antibodies working at your thyroid and in the UK. If you have thyroid antibodies, then actually what that means within our guidelines is that you will get low thyroid at some point and so they will monitor you and when you do they will give you medication. Some clients with thyroid antibodies found out through private home testing and we have taken measures, they have used different sorts of support and although it’s not going to change the antibodies necessarily, we can see their thyroid function, you can see the temperature on their basal body temperature chart, the different symptoms that had led us to look to thyroid.

It’s not just about getting pregnant

You will have heard me talk about 'normal' in semen analysis, in that we accept 4% normal sperm as 'fine' which means we are accepting 96% abnormal sperm as fine also. Are you happy with that? Are you honestly happy with 'just OK?' or do you want to make this as best as you possibly can? Because remember this isn't just about getting pregnant, this is about getting pregnant with a healthy baby that will go to full term. It’s not just about getting pregnant.
So when we are looking at risk factors of low ferritin, Iron deficiency, related to pregnancy they include low birth weight, miscarriage and also preterm delivery.
And there's very similar risk factors when you're looking at Thyroid dysfunction as well.
Okay, so that’s just Thyroid and Ferritin, when we get onto further aspects, if you're just inside for your follicle stimulating just inside for your progesterone, let's make it better, let’s not accept normal as Okay, let's make it better , because normal means you're not unhealthy or the high level of the range. It doesn’t mean that you’re at your optimum health for fertility
Another one before I go, to think about is Vitamin D. And I would suggest always get your Vitamin D tested. I think I've mentioned podcast but I worked with a client who was working with a clinic in Leeds, in Yorkshire here in the UK and it was brilliant because they wouldn't start IVF until Vitamin D levels for both partners were at optimal levels
It does happen in some fertility clinics. It's not going to happen at your family doctor level. So this is where you need to inform yourself and look into ways to improve your results because it's possible. It is possible.
And if you want to know any more about that, if you want to have a chat with me about that, if you've got a question you want to ask, drop me a line at kat@fertilityrewire.com. or I'm on Instagram at @fertilityrewire.com or post comments on here or youtube.
I hope that makes sense and has given you something to start to look a bit further, and that you can start to look at optimal health, not just for you but for your future baby.