Cycle+thyroid issues - anything to try before IVF?

[kettleson]

Hello all, first post here, though been lurking for a while.

A potted history: 33, TTC #1. Two years ago we conceived almost immediately after we started trying, but it turned out to be a molar pregnancy. Fortunately I didn’t need chemotherapy, but it took 9 months to be signed off to TTC again. Since then, no sign of a BFP in 18 months of trying, though several months I have felt what might have been implantation pains. I was diagnosed with slight hypothyroidism (TSH 3.7 but rising) and TPO antibodies 6 months ago (my mum has it too, so not a great surprise), which I suspect may have been a problem for about the last year – my luteal phase has fluctuated from 23-26 days for the last year when previously it was a steady 28, and AF has been much lighter/shorter. Since starting on levothyroxine things seem to have improved, luteal phase 26/27 days for the last 3 months (though with a bit of spotting for a couple of days first) and AF more like normal. TSH now back where it should be for TTC. I’m definitely ovulating on day 14/15 (feel it every month, plus +ve OPK) and day 3 FSH/LH normal. My day 21 progesterone was 38 which GP said was just about okay, though it was day 21 of a 25 day cycle. DH’s tests were all normal.

So, just sorting out referral to fertility services, but don’t know what to expect. My thinking is that my problem seems to be with implantation, perhaps related to a short luteal phase, or immune issues related to hypothyroidism. I’d really appreciate any thoughts on what I should be asking, or what might be the suggested plan of action. Are clinics willing to try other things first, or on the NHS is it likely to be straight to IVF (I’m really reluctant to do this until all other avenues have been exhausted)? Is it possible that trying progesterone support (for the cycle length issues) or steroids (for possible thyroid-related immune issues) might be suggested first? Or, should we be waiting for a few more months to give everything a chance to hopefully get back more to normal after starting thyroid treatment?

Sorry for the long post, thanks for reading! Any advice much appreciated x

[DaftOne]

Hi kettleson, I don't have any answers for you I'm afraid but I am in exactly the same boat and have exactly the same suspicions about luteal phase and/or immune issues. I'm also reluctant to be rushed into IVF until the other avenues have been exhausted, as you say. It can be hard to get taken seriously by a GP but in my experience fertility services are better and do acknowledge hypothyroidism as a potential issue. Have you seen an endocrinologist? I'm awaiting a referral. Feel free to PM me and we can compare notes. And good luck!

[Woobeedoo]

I was reluctant to jump straight to IVF so instead asked (against the doctors advice) to please please let me try Clomid. I wish I hadn't bothered. I know it works for some but for me it didn't, so I wasted 3 months on the low dose, 3 months on the higher dose then 2 months waiting for an assessment appointment then be re-referred for IVF and have all the necessary pre-tests done again. Due to this I feel I wasted over a year when I could have had my little boy sooner.

[kettleson]

Hi Woobeedoo. Sorry to hear you had a wasted year but really pleased you got your little boy in the end :-) Do you mind if I ask - was the clomid in an attempt to increase your progesterone levels (I'm right in thinking it can be used for this, aren't I?) or was it because you weren't ovulating? Congrats again!

[Woobeedoo]

Hi, after the day 21 test confirmed I was ovulating I stupidly pushed for Clomid - I simply couldn't get my head round needing IVF straight-off and did that grabbing at straws thing plus at the time I believed the hype about IVF being 'tough, gruelling, emotional roller coaster, etc, etc'. I foolishly hoped that itd be the magic pill for me and that I wasn't as defective as the consultant was saying (but in nicer words obviously!).

Just realised I sound very bitter, I'm not, I just wish I wasn't so stubborn at times! (Thank you btw).