by Margaret Wertheim MS RD

When it comes to fertility and pregnancy, folic acid, iron and calcium are the vitamins and minerals that tend to get much of the attention. We would argue that there are quite a few other nutrients that don’t get nearly enough attention, and one of these is choline. Choline is an essential nutrient that your body can synthesize in small amounts, but the majority must be obtained in your diet. While you may constantly hear about the importance of folic acid for the prevention of neural tube defects like spina bifida, research indicates that higher choline intake during pregnancy is associated with lower risk of neural tube defects as well. In addition, choline is converted to betaine in your body, which assists in the conversion of homocysteine to methionine, thus preventing homocysteine levels from becoming elevated. Elevated homocysteine is associated with increased risk for cardiovascular disease and miscarriage, and in one study was associated with poorer egg and embryo quality in women with PCOS undergoing IVF. Furthermore, choline is a precursor to the neurotransmitter, acetylcholine, which is involved in memory and muscle control. In a study in rodents, when mothers consumed higher levels of choline, their offspring had significantly better memory throughout their lives. Thus choline intake during pregnancy may have a very long-term impact on memory and brain function from infancy into adulthood.

According to the National Health and Nutrition Examination Survey, the average choline intake in pregnant women is only about 338 mg/day, while the daily requirement during pregnancy is 450 mg. Daily choline needs increase to 550 mg while breastfeeding, as breast milk is a rich source of choline. Good food sources of choline include eggs, meat and fish, dairy, legumes, and certain whole grains, nuts and seeds. Vegans and vegetarians with limited intake of eggs and dairy products are at increased risk of having a choline-deficient diet. Very few prenatal vitamins contain any choline at all, and those that do usually contain only very small amounts. Luckily, Prenate Pro and Prenatal Plus both contain 200 mg choline, which can give you the extra boost you need to ensure you’re meeting your daily choline requirement. That being said, it’s also absolutely essential to include choline-rich foods in your diet on a daily basis.

References:
Linus Pauling Institute at Oregon State University: Choline

Caudill, et al. Pre- and Postnatal Health: Evidence of Increased Choline Needs. J Am Diet Assoc. 2010; 110:1198-1206

Berker, et al. Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction. Reproductive Endocrinology. 2009; 24(9):2293-2302.

Zeisel, et al. Importance of methyl donors during reproduction. Am J Clin Nutr. 2009; 89( suppl):673S-677S.

Embrace and enhance your fertility journey with our Fully Fertile Holiday Package! This gift includes Pulling Down the Moon’s own book Fully Fertile, our new Fully Fertile Companion Yoga DVD, a Universal Fertility Intention Bracelet from SheBeads, our Nourish ARTea blend and one box of 100 tea filters.

Fully Fertile  &  Companion DVD

Pulling Down the Moon Co-Founders Tami Quinn and Beth Heller created a holistic 12-week program for optimal fertility. Newly revised and updated.

After writing our book, Fully Fertile, we had lots of requests for a companion DVD that would allow the reader to move with ease from the written text and photographs into the yoga practice. All you’ll need is your yoga mat to begin this 12-week do-it-yourself in home fertility program that includes both the book and the companion yoga DVD.

ARTeas Nourish with 100 Hemp Fiber, Biodegradable Tea Filters

What better way to nurture yourself than with a warm, comforting cup of herbal tea? Pulling Down the Moon’s exclusive ARTeas are caffeine-free, fertility-friendly, and absolutely delicious.

Nourish is a fortifying blend of partridge berry, raspberry leaves and blueberry may help strengthen and support a woman’s reproductive system.Nourish tea is recommended prior to stimulation.

Universal Fertility Intention Bracelet

Pulling Down the Moon announces a special partnership with renown bead maker and founder of She Beads, Sandy Rueve. She Beads are individually hand-rolled, clay bead jewelry sold at high end retailers all over the world.  Sandy has now birthed a new line of jewelry called, “Intention Beads.”  Working with nationally acclaimed astrologist, Barbara Schermer, Sandy has created give Fertility Intention Bracelets, all created during an astrologically auspicious time to conceive.

Each bracelet is unique, colorful and adorned with silver and Swarovski crystals making it not only meaningful as a good luck charm but also an elegant part of your jewelry collection long after you’ve manifested your intention.
Since bracelets are hand crafted and meant to be unique, colors will vary by bracelet.  Be surprised by receiving the bracelet you are meant to have.  You won’t be disappointed.

Click here for more information.

Karisa Grudi, one of our licensed acupuncturists at Pulling Down the Moon Shady Grove, sat down with us to discuss a little bit about the German Protocol and why it is so important for women who have embryo transfers:

Q. Karisa, can you give us an idea of what the German Protocol is?

A. The German Protocol is a series of two acupuncture treatments that are performed on the day of IVF transfer.  The treatments are scheduled before and after the embryo transfer on the same day.  The German Protocol is based off of a study that was performed in Germany, 2006.  In the study of 160 participants, one group received IVF transfer only while the second group received IVF transfer with two acupuncture treatments (before and after transfer).  The pregnancy results showed 42% in the acupuncture group compared to 26% in the control group.

Q. How does this particular type of acupuncture help increase a couple’s chances of conceiving?

A. In the German study, a select number of acupuncture points were used to help with the efficacy of pregnancy.   Those same points from the study are used in the clinic.  Certain points on the leg have a direct connection to the uterus and ovaries.  Those points help to bring blood flow locally to the uterus to help lessen contractions associated with the actual implantation of the embryo.  Points are also selected to decrease stress and help relax the body and mind.  In addition, points are selected on the ear to further help with relaxation, uterine blood flow and endocrine functioning.

Q. Is it helpful for all types of cycles in which an embryo transfer is taking place?

A. Yes, it is definitely helpful for all IVF cycles, including those with donor egg and/or donor sperm.  Again, the focus is the same on the day of IVF transfer – to bring blood flow locally to the uterus, to help relax the body and mind, and to help with endocrine functioning.

At Pulling Down the Moon Shady Grove, Karisa and our other licensed acupuncturists strive to provide everyone with individualized care, whatever their circumstances may be. The German Protocol is just one of the many ways acupuncture can help you on your journey. We hope you will join us!

Featured Products and Services:

Pregnancy Prep Program

Click here to learn more about our Pregnancy Prep Program, supplements to support optimal nutrition for women who are trying to conceive.

Pregnancy Prep Program

by Beth Heller, MS

In a previous post (A New Understanding of Ovarian Reserve) we outlined an emerging debate in the medical fertility community about ovarian aging.  To recap, the question is whether a woman’s eggs age with her, or whether her eggs rest in a dormant state until they are recruited for ovulation.  In the second scenario, it is hypothesized that it is the “aging environment” in which the oocyte develops that negatively affects development and subsequent oocyte quality rather than the age of the oocyte itself.

Neither perspective denies the link between age and fertility – the chances of pregnancy each month do decline with age.   The second scenario, however, suggests that changes in the internal environment in response to age and lifestyle may be an avenue for therapeutic fertility intervention.  The process of recruitment and maturation from a primordial oocyte to a mature oocyte starts almost a year prior to ovulation and gains steam during the final 120 days prior to maturation.   Normal physiological changes associated with aging include a decline in antioxidant capacity, increased levels of chronic inflammation and changes in blood sugar regulation.  All of these changes, as well as lifestyle factors like exposure to chronic stress and environmental toxins, can conceivably impact the oocyte during the maturation phase and play a greater role in our fertility than previously accepted.

In light of this new perspective, Pulling Down the Moon has developed the Pregnancy Prep Program a pre-conception nutrition program for women that addresses the essential needs of prenatal nutrition as well as the reproductive environment.  We have added  a dairy-free probiotic power for optimal digestion/elimination  and immune function as well as an organic fruits & veg blend to bolster our body’s defense against oxidative stress.   The Pregnancy Prep Program is perfect for any woman who is trying to conceive and optimal for the woman who has been using a basic prenatal and would now like to try a more comprehensive approach.

Prenatal Plus

Prenatal Plus* **

Our enhanced prenatal vitamin provides optimal prenatal nutrition including:

• 1000 mcg of folic acid to support fetal neurological development
• 30 mg of iron glycinate, a highly digestible form of iron
• 200 mg of calcium citrate and 150 mg of magnesium for bone support
• 1500 IU of pre-formed vitamin A in the form of retinol and 4000 IU  of  beta-carotene.
• 580 mg of DHA (Docosahexaenoic Acid) to support fetal brain development

Enhancements:

• 860 mg of the omega-3 EPA (Eicosapentaenoic Acid) to support the body’s anti-inflammatory response, healthy cell membranes and mood.
• 1000 IU of Vitamin D, levels of which have found to be sub-optimal in infertile populations and which may protect against the development of fibroids.
• 100 mg of high-potency CoQ10 to support cellular metabolism.
• Extra B-vitamins for women vulnerable B-depleting conditions like birth control pill use and emotional stress.
• 200 mg of choline to support fetal brain development.  Choline may also play an important role in healthy genetic expression in early embryo development.

Pregnancy-Prep Probiotic Powder* **

Powder Probiotic

This high quality, dairy-free powdered probiotic formula provides 15 billion live, colony-forming organisms per serving and supports optimal digestive health.   Probiotics have been shown to improve digestive problems like constipation and diarrhea and bolster the immune system.  Good digestion and elimination help us get optimal nutrients from the food we eat.  Poor digestion can lead to “leaky gut syndrome,” where bacteria and other toxic substances leak from the gut and permeate other tissues causing infection and inflammation.

Pregnancy Prep Organic Superfood * **

Organic Superfood

One scoop of vegetable and fruit drink per day bolsters the nutritional quality of a woman’s diet and provides antioxidants in their most effective form – that of whole food.  Because free radical damage is currently under scrutiny for its potential role in both male and female fertility, our Organic Superfood is a convenient way to support our body’s defense against the ravages of oxidative stress.

The Pregnancy Prep Program is available exclusively on-line or in our Pulling Down the Moon Centers in Chicago, Arlington Heights and Rockville, MD.  Click here to learn more or order online.

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* Produced in a triple-certified Good Manufacturing Practices (GMP) facility.  A GMP manufacturer is one that exceeded a specific set of standards laid out by the Food and Drug Administration and indicates this manufacturer has the facilities to manufacture supplements safely, but also to package, label and store them safely.

**These statements have not been evaluated by the Food and Drug Administration.  These products are not intended to diagnose, treat, cure or prevent any disease or condition.

by Beth Heller, M.S.

Nutrition was a big topic at this year’s American Society for Reproductive Medicine conference.  Concepts under discussion included the potential role of inflammation in both male and female fertility and the possible value of antioxidants like resveratrol and omega-3 fatty acids in reversing damage done by environmental toxins.  Another very simple yet compelling idea was presented by Dr. Gil Wilshire from Missouri.  Dr. Wilshire contends that many women, even obese women, are not getting sufficient nutrition for good fertility.  Put simply, the typical low-fat, USDA Food Guide diet that we have all been programmed to eat, is low in essential nutrients like omega-3 fatty acids and fat-soluble vitamins that are essential for our body’s health and reproduction.

Dr. Wilshire was preaching to the choir on this one.  That the poor quality of our modern diet – from the over consumption of fast foods and overly processed meals, to the belief that “low-fat means healthy” – puts all of us at risk for less than optimal nutritional status  is a cornerstone of our fertility nutrition programming at Pulling Down the Moon.  What was especially compelling, though, was Dr. Gil’s use of the concept of “feeding up” in his discussion.  This idea is old as the hills but almost universally accepted in the medical community:  women get pregnant when they are “feeding up” rather than paring down.

The female body is keenly aware of “energy balance,” an evolutionary mechanism that ensures the survival of the human species.  When calories are scarce, bodies begin to shut down non-essential body functions…like reproduction.  Food, however, is much more than calories.  It is also the way our body gets essential nutrients like vitamins, minerals and fats needed for healthy body function.  If a woman is consuming a diet rich in calories but poor in nutrients, she can become malnourished.  Hence an obese woman who lives on processed foods can have plenty of calories but still be “starving.”  And the slender woman who has been told by her fertility doctor to gain some weight in order to conceive may benefit more from shifting to a highly nutritious diet and lowering the intensity of her activity than from simply packing on pounds.

Rather than “feeding up,” we like to say that women get pregnant when they are “nourishing up.”  Importantly, the process of nourishing up can take place without the gain or loss of a single pound.  It begins with a very healthy diet and  good digestion so that essential nutrients are not only present, they are being absorbed and assimilated.  Calorie counting is secondary to this objective, even for the obese woman who needs to lose weight.  In general we believe that certain nutritional supplements  (including a high-quality prenatal vitamin, a probiotic to support digestion and omega-3 fats) can help support the objective of “nourishing up” but the focus should be a diet rich in fruits, vegetables, lean protein, minimally processed grains and healthy fats.

We also know that nourishment can come in many ways – including the nourishment of true relaxation that comes with yoga practice, nourishment through channeling chi throughout the body during an acupuncture session or the healing touch of massage and reiki.  Changing the intensity and intention of our exercise program from “burning and racing” to “energizing and strengthening” can also make a difference.

At a high-tech conference like ASRM it was encouraging to see nutrition on the table, so to speak.  It was clear, however, that nutrition will never get the attention of research dollars.  Many more people attended the class on Pre-Implantation Genetic Diagnosis (PGD) than the class about nutrition.  Doing nutrition research is complicated and funding is scarce because unlike drug research, where there’s potential to patent and produce a pharmaceutical drug that will make billions of dollars, a healthy diet can’t be patented and won’t make anyone rich.  Conflicts of interest are everywhere.   Governmental agencies that are charged with making nutritional recommendations are also charged with protecting the economic interests of food manufacturers.   Our national nutrition association, the American Dietetic Association, is partnering with companies like Coca Cola to get women to drink more Diet Coke in order to prevent heart disease.  Yikes!

So what are we to do?  In the face of misinformation we must begin to live the truth and spread the word.  Have you made changes to your diet that fly in the face of the Dietary Guidelines for America?  Have you switched to full fat dairy and sworn off fat-free yogurt?  Have you switched to a more nourishing lifestyle through yoga, acupuncture or other practice?  If you have, please share your stories and we will feature them in our blog and on via social media.  Send your storied to beth@pullingdownthemoon.com subject line:  Nourishing Up.  You can include your name or let me know that you’d like to remain anonymous.

by Beth Heller, MS RYT

Yoga poses are a mystery in my book.  We go to yoga class, stand on a mat in our bare feet and proceed to bend and twist our bodies until we take on a completely different shape.  What are these shapes?  Why on earth do they make us feel so good?  Why are they such a gift when we are experiencing life and health challenges such as infertility?

There is a lot of information about the physiological benefits of yoga.  Clearly, yoga postures are good for our bodies.  Stretching tight musculature improves our posture, strengthens our digestion and makes our muscles strong and supple.  Hip opening postures feed blood to the uterus and ovaries, backbends stimulate our nervous system and free our respiratory system from chronic tension, and twists “wring out” toxins and stale fluid from body tissues.  But aren’t postures just physical exercise?  The answer is yes, and no.

In his master work Light on Yoga, renowned yogi B.K.S. Iyengar explains that names of yoga poses are significant and symbolize the process of evolution.  There are poses named for plants (tree, lotus), poses named for insects (locust, scorpion), poses named for fish, reptiles and higher mammals like dog and camel.  Some are even named for legendary Hindu heroes and even gods.  The point is, Iyengar says, that while we perform yoga asana we assume many different forms, from the lowliest to the most exalted, and recognize the Universal Spirit that runs through them all.   Mr. Iyengar asserts that it is this unspoken presence of the divine that begins to work on the body of the yogi, causing new discipline and spontaneous healing to occur in diet, cleanliness and character.  What a fascinating thought – and how nice to think that tapping into something greater than ourselves is just a down dog away?

Over tea last week, Joyce, a fellow yoga teacher and friend was discussing her yoga practice when she added another dimension to my musing.

“The postures,” she said, “are the constant and I am the variable.  When I move into a yoga pose that I practice regularly, the pose is the same but depending on my state of mind, what I ate for dinner the night before and my present mood it’s a unique experience every time.  When I am tense, my down dog is rigid.  When I am sad I am reluctant to do backbends.  Because the postures encourage me to breathe and reflect, I see how my life affects my body. “

So, while in some ways these insights make the mystery even deeper, my appreciation of yoga asana is ever expanding.  These insights remind me that while yoga for fertility is trendy and hip openers are indeed great for fertility, the roots of this practice run far deeper than we will ever imagine.  And for this I am truly grateful.

Check out our brand new video companion to our book, Fully Fertile. This easy to use practice is great for any level, designed to support your body’s fertility and, with faithful practice, connect you to this universal healing awareness.

by Beth Heller MS, RYT

No, this isn’t another chirpy post about the power of positive thinking or the law of attraction.  While there are potential fertility benefits to both of those things, the positive I’m talking about here is the little plus on the pee stick or the positive lilt in the nurse’s voice when she gives you the news that your beta hCG has just doubled.  This post is also about the apprehension I’ve seen behind the eyes of my yoga students when they share their good news.  One hurdle cleared – “I’m pregnant!” – but another looms ahead…that tenuous first trimester.   This anxiety is magnified if their journey has been a long one or if a previous “positive” ended in a negative.

Having experienced multiple miscarriages and other assorted disappointments, that odd mix of joy and terror during the first twelve weeks of pregnancy is something I know way too well.  I spent most of the waking hours of my first trimesters taking my basal temperature incessantly to make sure it hadn’t dropped, bracing myself to see blood on the toilet paper every time I went to the bathroom and subjecting every ping I felt in my abdomen to a thorough Google search.  Is there anything we can do to make this time bearable?

Absolutely.  I’m assuming that you’ve been taking pretty good care of yourself on the road to pregnancy, so now is definitely not the time to pull off that road.  Keep on doing what you’ve been doing to stay happy, healthy and balanced.  In case you’re so freaked out that you can’t remember what those things were, here is a checklist for staying positive, figuratively and literally, during the first trimester:

1. Practice your yoga and meditation.   When a woman becomes pregnant during our six week Yoga for Fertility class, which I am happy to report happens quite frequently, we encourage her to stay with the class and the practice during her early weeks of pregnancy.   Researchers hypothesize that stress may contribute to early pregnancy loss, a phenomenon they are calling Pregnancy Stress Syndrome.  The immune/endocrine imbalances that result from stress may be a trigger for pregnancy loss.  The good news is that population studies show that “tender-loving-care” interventions that focus on reducing stress and helping women feel supported are associated with positive pregnancy outcomes in women with history of miscarriage. As long as the yoga is gentle and the teacher is knowledgeable about what’s verboten during very early pregnancy, you’re good to go.  If you don’t feel comfortable doing yoga, find a meditation or other relaxation class to attend to keep the “ritual of relaxation” going during this time
2. Exercise.  Yes, I did say exercise.  Note that I did not say go for a run or start power lifting, but I did say exercise.  Early pregnancy is a time to stroll and smell the flowers or stretch in leisurely manner.  Gentle (stress again gentle) movement will help to relieve anxiety, mediate the fatigue that often comes along with the first trimester and promote a sense of well-being.  Just keep it gentle (did I stress gentle?).
3. Keep eating right.  You may not feel ready for the full-on prenatal nutrition consult, but it is time to contact your nutritionist and make sure that any herbal or nutritional supplements you have been taking are still appropriate during the first trimester.   If you’ve discontinued dairy, wheat or other potential allergens, this is not the time to add them back in without the support of a skilled nutritionist, but it is time to ensure that any eliminations you have made have not created nutritional “holes” in your nutritional status.
4. Keep getting your acupuncture.  Traditional Chinese Medicine is very useful and has specific protocols for miscarriage prevention.  At Pulling Down the Moon we recommend women receive treatment weekly during the first trimester and then continue monthly or on an as-needed basis for the remainder of the pregnancy.
5. Hands on work like massage and reiki can also help you stay calm and centered.  Think about how your dog or cat melts under your touch when they are anxious.  Make sure, though, that your massage therapist knows that you are newly pregnant and is aware of any contraindicated techniques or points on the body that should not be manipulated during pregnancy.
6. Finally, keep breathing.  When the anxiety starts to creep up, take a deep inhale through your nose and let it out slowly through mouth saying silently to yourself “I’m happy, I’m healthy, I’m whole.”  The instinct is to hold the breath and count the days until week twelve but the reality is that staying in the flow of life will help you focus on something other than your fears.   The breath is a reminder of that flow and brings you back to center.

Stay present, stay peaceful, stay positive.  It will be trimester-two before you know it!   Beth

Note:  Before applying any techniques described in this or any other nutrition, exercise or holistic program an individual should always consult and obtain professional medical advice, including from their doctor.

Lisa Espinosa, Reiki Master

By: Lisa Espinosa, M.Ed., Reiki Master

“I took this class to help me find peace and relaxation during my fertility,” commented Martha*, a student in my meditation class. “It helped me find both, but even more importantly, helped me realize how important it was to not lose myself on this journey.”

Martha’s comment reflects one of the main purpose’s of the meditation class I teach: to help women re-connect with themselves, and “not loose themselves on this journey.”  In this class I help you experience an hour of peace and relaxation. And I share tools that you can integrate into your everyday life to help you navigate the stress that is common during the fertility journey.

During the class, I guide women through an hour of relaxing and nurturing meditation, integrated with Reiki healing energy.  The combination of meditation and Reiki really enhances the experience for my students. As one of my students, Jill, shared:

“I got so much from the class. It is wonderful for learning ways to release stress and take care of yourself whether you are going through treatments or taking a break. Lisa’s guidance through the meditations were gentle and helped me get the most of each meditation. The Reiki was a great bonus. I could feel the energy each time. It was fantastic!”

During the class I play soothing music as I guide my students to shift from rushing, stress, and worry to a place of peace, and centeredness. I use different meditation techniques, such as visualization and mantra. I also incorporate a chakra meditation, in which students connect with each chakra (the seven energy centers of our body which can often get clogged and congested) and begin to notice which of their chakras might need some balancing. Throughout the class I gently do Reiki by laying my hands on different areas of my students’ bodies, such as tight shoulders, or achy backs, as well as any chakras students identified that need some balancing. During the last meditation, women lie down as I spend a few moments on each student doing Reiki on an area that is in need of more healing. My clients enjoy having this hour to themselves. As Sharron, wrote:

“I enjoyed the hour to focus on myself without disruptions, to think about the week ahead and focus on what I want to achieve and (sometimes) reflect on the past week. It has been a wonderful prep for a stressful IVF cycle. It calms me during the period and keeps me busy at the same time.”

For the next few weeks this class will be a drop-in class, and will return to a 5-week enrollment class in November.  I invite all of you to take this opportunity to give it a try. There is no experience necessary, and both fertility and pre-natal clients are welcome.  If you have any questions please contact me at lisae@pullingdownthemoon.com.

* all names have been changed

by Breea Johnson, MS RD LDN

When someone is dealing with infertility, they often scour the world for answers. For a lot of women, they never figure out why they have unexplained infertility or experienced a miscarriage. But for some women, the answer may lie in a simple blood test to measure thyroid function as low thyroid function and thyroid autoimmunity are both associated with infertility and miscarriage.

Consider Pulling Down the Moon nutrition client, Ann*, a 32 year old, normal weight woman who had two miscarriages with no explanation. After going to a miscarriage specialist, she was found to have hypothyroidism (low thyroid function) and with thyroid medication was successfully able to get pregnant and carry the baby to full term.

The thyroid gland, one of the largest endocrine glands in the body, is shaped like a butterfly and is located on the front of the neck below the Adam’s apple. While it is very small (only 2 inches across), it affects our entire body, as the hormones it produces and secretes regulate metabolism, growth and development.

A well-functioning thyroid gland is pivotal for a healthy body and to conceive a healthy child. There is a direct interaction between the thyroid gland and the reproductive organs (the testes in men and ovaries in women). Hypothyroidism (low thyroid function) influences ovarian function by decreasing levels of sex-hormone-binding-globulin (SHBG) and increasing the secretion of prolactin. Prolactin, the hormone which stimulates milk production for breastfeeding, also affects ovulation and menstrual cycles. Prolactin inhibits Follicle-Stimulating Hormone (FSH) and gonadotropin releasing hormone (GnRH). With high levels of prolactin, which can be caused by hypothyroidism, ovulation is not triggered and a woman cannot get pregnant. Additionally, in men, low FSH and GnRH caused by elevated levels of prolactin can prevent the maturation of sperm.

Another common disorder affecting fertility is Thyroid Autoimmune (TAI) disease (Graves Disease and Hashimoto’s Disease). It’s the most common autoimmune disorder and affects between 5-20% of women of childbearing age (Poppe, 2008). This group of disorders involves both the endocrine and immune systems. Interestingly, there is double the rate of miscarriages in TAI-positive women and TAI has also been found to be increased in women with endometriosis. In one study, researchers found a 75% reduction in miscarriage among TAI-positive women who received levothyroxine (a drug used to treat low thyroid function) during gestation and pregnancy. Subclinical hypothyroidism also may be an issue, as women with TAI show moderately high TSH (Thyroid-Stimulating Hormone) levels before pregnancy, although often within the normal reference range. There has been discussion among endocrinologists to move the limits of TSH (used to measure TAI) to 2.5mIU/l but that is not in effect yet.

We asked Dr. Christopher Sipe, a Reproductive Endocrinologist and one of our doctor partners at Fertility Centers of Illinois, whether he thinks thyroid disorders go undiagnosed early in the fertility journey when a woman is still with her OB.

“Because thyroid disorders are so common,” says Dr. Sipe “there are many women walking around who are undiagnosed. Thyroid hormone levels fluctuate in our daily lives and can be affected by diet, exercise, supplements, weight changes, medical conditions and seasonal changes. Therefore, a woman can be normal once but 6-12 months later have an abnormal level. Pregnancy also causes a shift in the normal range of thyroid hormones, further making diagnosis of a thyroid disorder more difficult. It is for this reason that diagnosis pre-pregnancy is ideal and screening should be recommended to any woman considering pregnancy.”

Dr. Sipe recommends woman have her TSH checked when she is considering becoming pregnant, when she has an irregular menstrual cycle, if she has a family history of thyroid disorder or if she exhibits symptoms of a thyroid disorder. Symptoms of thyroid disorder include inability to lose weight, dry skin, dry hair, depression, fatigue, constipation or muscle aches and pains.

In the case of a woman who is trying to conceive, testing the thyroid early may save valuable time.

“Treatment can take three to six months before a steady hormone level is achieved, and then pregnancy can be attempted,” concludes Dr. Sipe.

*Name withheld for confidentiality reasons.