The question
Hi Dr. Sher,
I listened to the podcast on IUI with you and Dr. Aimee, the egg whisperer and I wanted to reach out to you in hopes of seeking your advice. I am a 34 year old who is “unexplained” and I normally ovulate on my own. All blood work has been normal for me except for high TPO antibodies which the doctor has had me on a low dose of levothyroxine for a while now. My husband has a normal semen analysis. We have been trying for 2 years and the first time we conceived back in October 2022, I was on letrozole for “superovulation” and ended up having two mature follicles one on each ovary and we just did timed intercourse that cycle, but I ended up having a missed miscarriage at 7 weeks. We decided to try on our own for several months after without taking letrozole and we were not having any luck. In August 2023 we decided to try IUI so we did letrozole and the trigger shot and it actually worked until it ended in a chemical miscarriage. We did two more rounds of IUI after that and have not had success.
Do you feel IUI is even worth pursuing a couple more times given that I ovulate on my own and my husband’s SA is normal? Did the letrozole help us conceive, could it have caused the miscarriages? Would it be the same success rate as if we just tried on our own without even taking letrozole? I am so confused and at a loss on what to try and how long I should keep trying before considering IVF. Thank you in advance for taking the time to read this.
Thank you,
Mallory
Answer from Dr. Geoffrey Sher
My bigger concern is that you might have an immunologic inmmplantation dysfunction and if so , IUI alone wont bve effective. This could explain your losses too.
Between 2% and 5% of women in their childbearing years deal with hypothyroidism, a condition that affects women more than men. This issue with the thyroid often leads to difficulties in getting pregnant or maintaining a pregnancy.
Hypothyroidism in women often happens because the immune system attacks the thyroid gland. The condition is known as Autoimmune Hypothyroidism or Hashimoto’s disease. Specific antibodies, like antithyroglobulin and thyroid peroxidase (TPO) antibodies, slowly reduce thyroid hormone production. Genetics, estrogen effects, and X chromosome abnormalities also contribute to its prevalence among women.
Here's a surprising fact: Even women who don't show obvious thyroid problems might have thyroid antibodies linked to trouble conceiving or experiencing recurrent pregnancy loss (RPL). These sneaky antibodies can linger without clear signs of hypothyroidism in clinical or lab tests. And commonly, even after treating hypothyroidism with hormone supplements, these antibodies stick around.
More than two decades ago, I performed a study and reported on the fact that almost 50% of women with thyroid antibodies, regardless of thyroid function, had overactive uterine natural killer cells (NKa) and activated cytotoxic lymphocytes (CTLa) that are capable of attacking the embryo’s “root system” (trophoblast) and compromising implantation. The result was often total implantation failure (often erroneously diagnosed as infertility) or early pregnancy loss. Testing for NKa and CTLa requires access to few highly specialized Reproductive Immunology Reference laboratories. We demonstrated that treating these women with immune therapies like Intralipid or immunoglobulin-G, along with a sprinkle of low-dose steroids, significantly boosted their chances of successful reproduction.
For example, let's take a peek at the journey of a one of my patients, a 42-year-old Australian physician. She faced a whopping 23 unsuccessful IVF attempts due to Hashimoto's disease. We rapidly identified underlying NKa/CTLa and after a single cycle of tailored immune therapy ( as above) she conceived and gave birth to a healthy baby boy—an incredible glimmer of hope in her life.
It's important to note that not every woman with thyroid antibodies experiences an immune cell party in her body. However, understanding this unique relationship and providing the right treatments can reverse immunologic implantation dysfunction (IID) caused by NKa/CTLa. This knowledge offers renewed hope, making the journey to successful reproduction a brighter and more achievable adventure.
In the end, remember this: Even when your body throws a curveball like autoimmune thyroid IID the game isn't over. With the right strategies, a sprinkle of hope, and a dash of persistence, victory is within each. So, chin up and keep moving forward.
PLEASE SHARE THIS WITH OTHERS AND HELP SPREAD THE WORD!!
Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)....... for your reading pleasure:
- From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf
- Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\
General information only, not medical advice for your own situation. For that, book a consultation.