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Check Your Gas Tank Meter…It Might Be Time to Refuel: The Thyroid

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In many ways, the thyroid is like the man behind the curtain. You have never seen him and are not really sure what he does, but you know he’s there. You’ve heard about him, blamed him for your weight gain and for sleeping through your alarm clock, and considered that errors in his way are keeping you from getting pregnant. But how he is masterminding all of this remains unclear.

While the intricacies of the thyroid are more delicate than a lace shirt, the basics come down to a simple Goldilocks type of situation: the thyroid is working too fast, too slow, or just right. When it’s really off, you usually feel really off. Simply stated, when your thyroid is running on empty or very close to it (think flashing red light telling you to pull over ASAP), you will feel like a car without gas, putt putt puttering through your day, being tired, cold, and constipated, with dry skin and hair loss, to name a few.

On the flip side when your tank has been topped off just a bit too much, you feel like you had one too many shots of espresso. You experience insomnia, diarrhea, palpitations, hot flashes/sweating, anxiety…

However, sometimes the deviations are subtle, and your thyroid is just slightly off (medically termed subclinical). But you may not know it unless a doctor checks. While the subclinical part will usually not cause you any noticeable symptoms, it can increase your risk of miscarriage and infertility and lead to negative pregnancy outcomes. Bottom line: if your thyroid is off, it’s not only your bottom line that will suffer but also your plus one.

As a result, fertility MDs are somewhat fixated on hitting the thyroid hormone level sweet spot! We check it on nearly all of our patients pre-pregnancy and then again during pregnancy. We are somewhat OCD in getting it to the perfect point and will labor over when to start some additional medication, when to increase or decrease it, and when to stop it.

What and where is this elusive “gas producer”? The thyroid is a small butterfly-shaped gland that sits at the base of the neck. In most women who are free from thyroid disease, the thyroid is small and cannot be felt. The thyroid produces thyroid hormones (T4 and T3); these hormones travel through the blood throughout the body to target organs. Almost all of your vital organs are target organs in desperate need of a little thyroid juice! The ovaries and the uterus are also quite “thirsty.”

Thyroid hormone plays a role in regular ovulation, pregnancy implantation, and miscarriage. Additionally, babies don’t start to produce their own thyroid hormone until about 13 weeks of age (in utero). Therefore, for the first trimester of pregnancy, babies rely exclusively on their mothers. If you are borderline low making thyroid hormone, they will be super low. And given that thyroid hormone is essential for brain development, this is not an area you want to be lacking in! It is for this reason that doctors will frequently start a thyroid supplement early before the situation hits rock bottom.

While your thyroid may not be to blame for all of your problems, it’s under (termed hypothyroidism) or over production (hyperthyroidisim) may be the cause of some serious ailments. And like most autoimmune conditions (where the body basically attacks itself), women are about six times more likely to be diagnosed with thyroid disease; most of those diagnoses will be made in the reproductive years (30s and 40s).

Not only is the thyroid important for pregnancy and fertility, but the start of it’s decline often occurs during the reproductive years.  So while your tank may be running on empty because you’re burning the candle at both ends, it is always a good idea to have your thyroid level checked, particularly when contemplating pregnancy. Who knows? You may just need a little refueling to help put an end to those annoying symptoms!

Lighting up Will Make You Lose Your Eggs!

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There are not many things in this world you can be sure of. In the words of Ben Franklin (shout out to all our fellow Penn alums), “In this world, nothing can be said to be certain except death and taxes.” And while we love you, Mr. American, we would like to add a third: cigarettes are bad for you! Despite the Marlboro Man’s best efforts, we all know nothing good can come out of lighting up. The litany of negatives when it comes to tobacco is so long, it couldn’t even fit on one page! Brain, lungs, heart, blood vessels, esophagus, stomach, hands, and feet are all victimized by the tar and tobacco filling that little white stick. While this may have been obvious to you, you may not have known how bad smoking is for your reproductive system.

Simply stated, smoking sucks for your reproductive system. Years of data have shown that smoking can lead to infertility and early menopause. In fact, women who smoke will go through menopause one to four years earlier than nonsmoking women. (Who wants hot flashes, headaches, and vaginal dryness before you need them?) And it seems that, the more you smoke, the more damage you do; with every puff you take, you are not only burning out your lungs but also your egg supply. Additionally, women who smoke are more likely to miscarry once pregnant. The chemicals in cigarettes can damage the DNA (genetic information) inside your egg and lead to a miscarriage. But it’s not only eggs that fizzle in the face of cigarettes; the fallopian tubes also sustain damage. Think of the tubes as tunnels. Their job (most of us have two!) is to transport the sperm to the egg and the fertilized embryo to the uterus. If blocked or damaged, the sperm or egg either never get together, or if they do, the embryo is more likely to get stuck on its way to the uterus. That’s called an ectopic pregnancy (pregnancy located outside of the uterus). Ectopics can be life threatening if not treated appropriately. How and why does this happen? Well, there are little hairs called cilia (we have them in our nose as well) that line the inside of our tubes. Imagine a car wash; think of the wipers that come beating down on the car when the wash first starts. That’s sort of like what the cilia look like, but rather than beating the dirt off your car, they are propelling the sperm to the egg and the embryo to the uterus. If they don’t work, you have a problem.

But get this. Even if you don’t smoke but your partner does, you are also in trouble. There are significant effects on a woman’s fertility from passive smoking (a.k.a. second-hand smoke). The effects of smoking on male infertility are less clear. Sperm function tests are poorer in smokers. There is not clear, conclusive evidence that men who smoke are more likely to be infertile, but given the impact it has on your female partner, guys, we urge you to put it out!

So let’s say you can’t quit and you find yourself pregnant and smoking. Then what? What impact is your habit having on your unborn child? If you have ever taken biology, you probably guessed it: not a very positive one! Babies born to women who smoked are at risk for growth restriction (stunted growth) inside the uterus, small birth weight, early/preterm delivery, stillbirth, and problems with the placenta.

But we get it. Despite all that, going cold turkey can be hard. Habits, no matter how bad, are hard to break. And because of all the “yuck” that is inhaled, it is actually not only okay but preferable to start nicotine replacement therapies (the patch, the gum, etc.) during pregnancy and when trying to conceive rather than continuing to smoke. Yes, they have their effects and are no prenatal vitamins, but they are way better than the tar and tobacco that you are inhaling. There are no ifs, ands, or buts about it, butts are bad for your lungs, bad for your heart, bad for your brain, bad for your skin, bad for your ovaries, and unbelievably bad for your unborn baby. You will burn through your wallet, your lungs, and your eggs. So take it from us. Put out that cigarette, and never pick one up again!