By Breea Johnson, MS RD
In a previous blog posting, I recommended that women with PCOS (Polycystic Ovary Syndrome) get screened for autoimmune thyroid disease as research has shown that women with PCOS are three times as likely to also have an autoimmune thyroid disease. The autoimmune thyroid diseases are Graves Disease and Hashimoto’s Thyroiditis. In both cases, immune system antibodies attack the cells of the thyroid gland which can lead to the gland’s eventual destruction – producing symptoms which can include weight gain or loss, depression, anxiety, rapid heart rate, and in some cases infertility. While most Reproductive Endocrinologists routinely test for Thyroid Stimulating Hormone (TSH) which can determine an over-active thyroid gland (hyperthyroidism) or under-active thyroid gland (hypothyroidism), autoimmune thyroid disease needs to be tested by determining levels of antibodies that the immune system is producing such as anti-thyroid peroxidase antibodies (anti-TPO) or anti-thyroglobulin (anti-TG)antibodies.
In addition to the higher incidence of autoimmune thyroid disease in women with PCOS, a recent study showed that infertile women suffering from PCOS with anti-TPO values that exceeded the upper level of normal were significantly more likely to be resistant to Clomid compared to Clomid responders and Metformin responders. They went on to conclude that elevated anti-TPO levels (an indicator of autoimmune thyroid disease) are associated with poor treatment response in infertile women who suffer from PCOS.
So, why is it so common to see PCOS and Thyroid Disease together? There is no definitive answer, but there are connections. Both the thyroid gland and the ovaries are part of the endocrine system. Insulin resistance, which is very common in women with PCOS, is also associated with thyroid function as studies have found that increased levels of TSH correlate with an increase in insulin resistance (read more about the insulin resistance and PCOS connection in a previous blog). There also may be specific nutritional deficiencies that PCOS and thyroid disease have in common.
While the research is still limited in the area of infertility, thyroid disease and PCOS, there is a link between all of them and getting tested and screened for both PCOS and thyroid disease may be beneficial in your fertility journey. Nutrition also plays a large role in the treatment of PCOS and thyroid disease including helping to lessen insulin resistance. To book a nutrition consultation at Pulling Down the Moon, call (312) 321-0004 or visit www.pullingdownthemoon.com.
By Breea Johnson, MS RD
Women with PCOS (polycystic ovary syndrome) may endure a lot to get pregnant – from utilizing medications to induce ovulation to undergoing IVF – all while experiencing the typical PCOS symptoms. But, does PCOS also impact miscarriage rates? Pregnancy loss rates amongst women with PCOS have been reported to be as high as 30% to 50%, but some research has shown that information to be conflicting. In a recent study, women with PCOS were found to have a 2-fold increase of miscarriage loss after undergoing ART (IVF or IUI) (Chason et al, 2010). While not the 30-50% reported previously, the rate found by Chason et al. is pretty substantial considering the general reproductive population has about an 11% miscarriage rate. PCOS has also been found in approximately 40% to 80% of women with recurrent miscarriages (Palomba et al, 2009).
Insulin levels also seem to play a factor in miscarriage, as studies have shown that Metformin has positive effects on reducing miscarriage rates in women with PCOS. In a study comparing three groups of women with PCOS on Metformin, all rates of miscarriage decreased while on Metformin but the groups that stopped at 8 weeks and 12 weeks had a statistically significant drop in miscarriage rates while the group that stopped immediately after a positive pregnancy diagnosis did not have a statistically significant drop (from roughly 20-40% down to 4-8%). However, a meta-analysis of randomized controlled trials showed that preconception intake of Metformin did not have a beneficial effect on reducing miscarriage rates in women with PCOS (Palomba et al, 2009). The research is still very limited in this area.
Factors in women with PCOS that may be contributing to increased miscarriage rates include higher Lutenizing Hormone (LH) levels which can be increased by elevated insulin. Elevated testosterone levels, obesity, insulin levels and infertility treatments are also factors that may be involved (Palomba et al, 2009). Many of these altered hormone levels seen frequently with PCOS are greatly affected by diet and lifestyle and may be improved through working with a nutritionist. Acupuncture has also been used to minimize the chance of miscarriage. Please call Pulling Down the Moon at (312) 321-0004 or visit our website at www.pullingdownthemoon.com for more information.
Chason et al. A Diagnosis of Polycsytic Ovary Syndrome (PCOS) is associated with an increased likelihood of pregnancy loss with Assisted Reproduction. October 2010.
Palomba et al. Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertility Sterility. 2009.