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Article’s Title: Higher TSH Levels Within the Normal Range Are Associated With Unexplained Infertility

Studies showed that ~10%-30% of couples that have unprotected intercourse over one year and do not succeed to conceive have unexplained or idiopathic interfertility. Hyperprolactinemia and thyroid dysfunction or thyrotropin are the known causes of infertility. Both of them are associated with irregular menstrual in women, but sometimes the normal levels of them associated with unexplained infertility, which the reasons are unknown. The main aim of this study is to compare the level of prolactin and TSH in women with normal fertility and women with unexplained infertility and with the exception of those women who have an oligospermic male partner. The treatment infertility is so expensive for couples.

The researchers hypothesized that unexplained infertility in women caused by a higher level of prolactin and TSH compare to a controlled group of women who have normal fertility, but their partners are severely oligospermic. Understanding the mechanisms that underlie unexplained infertility will help couples to have less costly treatment.

The cross-sectional studies were used to obtain the data. Researchers studied a total of 239 female patients. The female patients were between the age of eighteen and thirty-nine that were diagnosed with infertility and without any irregular menstruation. They included 187 women in this study who did not conceive over one year of unprotected intercourse (unexplained infertility group), and 52 women that their husband had oligospermia. They exclude women who had hypothyroidism and hyperthyroidism.

Even though the researchers supported their findings from previous studies, but their research was different from those earlier studies. The other studies included various factors that cause the level of TSH to be high or elevate and leads to infertility. These researchers used a strict method to ensure their findings, and the purpose of their method was to show that even a mild difference in thyroid function can cause infertility or unexplained infertility.

Thus, about 75% of the patients’ prolactin and TSH levels were measured in the laboratory of Partners HealthCare, and the rest were measured in an outside laboratory. They included only the patients that had TSH ≤5 mIU/L. These two groups of women were studied within the 13-year study period, and their characteristics were compared. The unexplained infertility group was older than the other group that their husbands had male factor problems.

The results show that the unexplained infertility group had a higher TSH level than the severe male factor even the researchers excluded the UI (unexplained infertility) group that their partners had low morphology still the results were the same. About 27% of UI group women had ≥2.5 mIU/L TSH, which twice the percentage of the severe male factor group (13% mIU/L). The data showed that the prolactin level was similar in both groups. Since the prolactin level is different during the menstrual, the researchers performed another analysis on only women that their prolactin level was measured during day 3 of their menstrual, but the results were the same. There were no significant differences between the groups.

The limitations of this study were that the researchers only relied on the health records in a span of 13 years with the exclusion of less severe male factors infertility. These limitations caused to get different results; not what expected. Thus, they were not able to measure the thyroid antibody levels or the thyroid hormones in those two groups of women. But 19 of the 239 women were checked with the thyroid peroxidase antibody (TPO). There were 3 elevated thyroid peroxidase antibodies in the unexplained group and 3 in severe male factors of those 19. When compared these two groups, the TPO median was higher in severe male factors than the UI group, but when the researchers removed these 6 individuals that had positive TPO, the level of TSH got more elevated in the UI group compare to severe male factors group. Therefore, the researchers were not able to measure the level of thyroid hormone on their subjects, which causes infertility in women. The researchers were limited to the laboratory tests and health records that were previously taken.

The interesting part of the discussion was that the previous studies had been indicated that women who had a higher level of prolactin and also had unknown infertility were treated with a dopamine agonist. This treatment resulted in the conception of 16 women out of 40 with the 10 months follow-up. But it raised the question about the treatment of thyroid hormone replacement whether women should be treated or not, and it is maybe a good step to treat a UI woman. Therefore, the researchers of this article believed that further research is needed to figure out that the treatment of a high TSH level will decrease the time of conception in UI couples.

The researchers’ hypothesis was halfway supported by this article and half not because the findings did not show that a high level of prolactin can cause UI, but the article supported that a higher level of TSH could lead to UI. The article suggests that mild variation in thyroid function is problematic in getting pregnant or conceiving naturally, but there are other factors too that are associated with unexplained infertility.

Note:

UI = Unexplained Infertility

Work Cited

Tahereh Orouji Jokar, Lindsay T. Fourman, Hang Lee, Katherine Mentzinger, Pouneh K. Fazeli

J Clin Endocrinol Metab. 2018 Feb; 103(2): 632–639. Published online 2017 Dec 19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800836/#s17title