Thyroid and Infertility in Male and Female

In scientific terms "infertility" means the inability of a couple to have a child (regardless of cause) after one year of unprotected sexual intercourse. When looking at the statistical data it was found that infertility problem is on the rise, where one in every six couple is suffering from it. There are many different reasons for the infertility, that it becomes difficult sometimes to pinpoint the exact cause of it. One factor that many of the people may not have on their radar is the possibility of the undiagnosed thyroid problem, which over the past few years is being recognized as an entity in a wide variety of gynecological disorders.

The thyroid hormones triiodothyronine and thyroxine target each and every cell in our body, by taking over the charge of their Metabolic activities. The hormones help in increasing the metabolism of the body by enhancing the uptake of oxygen and ATP hydrolysis, leading to profound effect on the physiological processes like physical growth and development, and sexual maturation. Overall in simple terms it can be said that thyroid hormones are akin to blowing on the smouldering fire.

Any sort of disturbance in the thyroid functioning, gets reflected first through the reproductive system, which being sensitive to the hormone levels gets turned off. Women's are more prone to the reproductive problem, caused by the thyroid hormone imbalance than men. This is because the thyroid problem due to its non severity of the symptoms fails to show up in the standard blood tests.

The thyroid dysfunction condition like hypothyroidism (low level of T3 and T4) and hyperthyroidism (high level of T3 and T4) in women, disturbs various aspects of the women reproduction cycle, which can be taken into account in three phases before pregnancy, at time of pregnancy and post-pregnancy. The disturbance in phases of before and at time of pregnancy leads to the infertility condition. The imbalance levels of the thyroid hormone in the body alters the menstrual cycle, shortens the luteal phase and delays ovulation in women. In pregnancy the thyroid hormones complicate the process of getting or staying pregnant. It is not that the thyroid hormones affect the fertility only in women, the male fertility also get affected by decrease in the sperm count, viability of the sperm and sex drive.

The women in reproductive age group are mostly affected by the hypothyroidism state of the thyroid dysfunction, which is marked by the increase in level of Thyroid stimulating hormone(TSH). This condi- tion alters the metabolism of the steroid hormones involved in the reproduction process, mainly the estradiol and testosterone.

The problems seen in the women due to the thyroid hormones imbalance are .
MENSTRUAL IRREGULARITIES
The thyroid problem affects the ability of the body to produce reproductive hormones, thereby causing the menstrual irregularities. The increase in the level of TSH in hypothyroidism brings about changes in the cycle length and the blood flow of the men- strual cycle, where heavy flow is observed in the women with hypothyroid condition. Women who fail to get pregnant have a common problem of the irregular menstrual cycles or absence of it.
REPRODUCTIVE HORMONES
Conception is not possible if the women do not ovulate. The thyroid hormones are also known to prevent ovulation, the monthly process where the egg is released to be fertilized. As the thyroid hormone receptors are expressed on the surfaces of the human oocytes, cumulus cells and granulosa cells, the thyroid hormone along with the follicle stimulating hormone exert a direct stimulatory effects on the granulosa cell functions, including the morphological differentiation. Thyroid hormone facilitate FSH mediated LH/hCG receptor induction and progester- one secretion which signals the body of the false pregnancy state and prevents the secretion of the ovum. The hypothyroidism can cause formation of _the cysts in the ovaries affecting the release of the ovum. Another possible effect of the hypothyroidism is, it shortens the luteal phase. The luteal phase in the menstrual cycle is the period in between ovulation and the onset of the menstruation. A normal luteal phase is between 13 to 15 days and it is long enough to the nurture a fertilized egg until it is settled in the uterus. A shortened luteal phase can be the cause of failure in sustaining the fertilized egg for long enough to implant. It causes loss of pregnancy in the early phase.
IMPACT OF ESTROGEN
The women who are diagnosed with the thyroid problem and are taking birth control pills with estrogen and stop them immediately in order to conceive, suffer from infertility problem. This is because of the abnormal rise in the TSH. The birth control pills affect the liver, leading to increased production of the thyroxine binding proteins that attach to the thyroid hormone circulating in the blood.
OTHER CAUSES
The imbalances of the other hormones also affect the woman's fertility. Hypothyroidism condition where there is increase in the level of the thyroid stimulating hormone, raises the level of the prolactin in the body through the increase in the production of the Thyroid releasing hormone (TRH). Prolactin is the hormone controlling milk production in the preg nant women. Too much of prolactin (hyperprolactinemia - Excess of Prolactin and Fertility) interferes with the secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH) produced from the pituitary gland. The decrease in these hormones prevents the maturation of the follicles thereby causing ovulatory dysfunction. When thyroid gland is not functioning properly, it can also led to the formation of the cysts in the ovaries affecting the releases of the ovum, decreasing fertility and also the chance of becoming pregnant. Thyroid hormone dysfunction reduces sperm motility in males. In case of the males, the thyroid hormone is known to play an important role in the proliferation and proper functioning of the sertoli and leydig cell in the testis, also spermatogenesis, sperm motility and ultimately fertility. Any disturbances in the levels of the thyroid hormones affect the morphological and functional development of the testis, ultimately the sperm viability is affected. Next time if you are experiencing any gynecological related problem, the first thing you must do, is to get your thyroid check up.

Diseases that leads to Infertility
If one were to trace back in time, the moment when they first realised that they truly want a child, what would that moment look like? Maybe the sight of pure innocence as it shines through a face so serene to look up to its life-giver in unadulterated love... maybe it would be the moment when one hears the squeal of joy when a toddler sees its mother... Few would care to have these moments until much later when they give serious thought to starting a family. Until then, most go on living our lives without a single thought to how something like a disease could influence our ability to begin a new phase of life. And yet there are diseases that do just that - if left unmanaged, their complications could influence fertility in both men and women. Infertility can be defined as the inability to conceive after 12 months of sexual intercourse without contraception. The most common causes of infertility are environmental or acquired. In females, these are irregular menstruation and problems for ovulation (discharge of ova or egg from the ovaries). In males, semen abnormalities and defective genes could be responsible for infertility.

Some of the diseases that could lead to infertility are mentioned below.

1. DIABETES Complications of diabetes include dysfunctions and failures of various organs. It also causes disturbances in the male reproductive system. This is because correct utilisation of glucose is essential for formation of sperms. It is also required by the sperm for motility and fertilisation with the egg. In male diabetic patients, the sperms also have structural defects and this affects their fertility. As per some studies, women with diabetes may also have menstrual irregularities and delayed ovulation.

Management of the complications associated with diabetes and keeping blood glucose levels as close to normal as possible can improve fertility rates in diabetics.

2. SEXUALLY TRANSMITTED DISEASES Sexually transmitted infections are a common cause of infertility. Many of these cause infertility simply through infection of the reproductive tract and causing damage to the surrounding tissues. For example, the bacteria that causes Gonorrhea destroys the ciliated cells that are responsible for transporting the egg after fertilisation to get implanted in the uterus. Chlamydia is one of the most common sexually transmitted diseases, and is linked to increased risk of a miscarriage. Both infections are also believed to increase the risk of ectopic pregnancy (where fertilised egg implants itself outside the uterus, in the fallopian tube). Further, a condition called as pelvic inflammatory disease occurs due to sexually transmitted infections. In this condition, an inflammatory reaction develops which damages tissues of the reproductive system.

The complications of these diseases can be prevented by their timely diagnosis and treating them effectively

3. IMMUNE FACTORS AND OTHER INFECTIONS The seminal fluid that contains the sperm is complex and also contains many other components that can sensitise the female genital tract. This may result in the development of antibodies (proteins) in the female after intercourse. These antibodies may eliminate the sperm or otherwise impair its ability to fertilise with the egg. In addition, bacterial, fungal, viral as well as parasitic infections interfere with conceiving as they may damage the reproductive system. Urinary tract infections and tuberculosis are examples of such diseases

4. AUTOIMMUNE ASSOCIATED INFERTILITY Endometriosis (where the tissue that normally line the uterus, called endometrium, grows outside it), premature ovarian failure (POF) and polycystic ovarian syndrome (PCOS), all these are disorders of the female reproductive system that affect fertility. These disorders may develop due to an autoimmune reaction in which the body targets healthy cells of ovaries. In case of PCOS, the woman may suffer from dysfunction of ovulation, or its complete absence. In certain conditions, the woman's immune system also mistakenly considers the sperm as a foreign invader and attempts to destroy it.

Managing infertility in these patients can be done by medications for inducing ovulation. This is done in addition to the management of these underlying conditions.

Fibroids are a type of non-cancer tumours that can occur in the uterus and may cause infertility in women. If the size of tumour increases too much, it can obstruct the transport of sperms, egg, or the embryo, depending upon its location. They can also cause inflammation in the uterus and affect the ability of the uterus to contract, because of which, the fertilised egg will not be able to implant in the uterus. Fibroids can be detected using ultrasound scan. It can also help determining the size, location and nature of fibroids. Fibroids of the uterus are usually removed through a surgical procedure called as myom ectomy.

How many of us really stop to think about the long-term consequences of any disease or disorder? Most people only look to control the immediate signs and symptoms that they observe. However, like most other problems, a disease also gets worse the longer it is ignored, or if it is not properly managed. The outcome of this disregard can very often be significant, appearing as something as serious as infertility. Most disease conditions that may lead to infertility can be managed and/or treated if recognised early in time.

Recognise the hidden aspect of any disease - stop it in its tracks before it wreaks major havoc