The Specialist: Thyroid Disorders and Infertility

Dr. Sapna ShahDr. Sapna Shah

When Dr. Sapna Shah was in medical school, she wasn’t sure that she would become an endocrinologist — but she fell in love with the practice, earning board certification in internal medicine and endocrinology. 

Today at her practice, Paloma Health, she offers her patients a unique, dual focus on both hypothyroidism and infertility. It’s not often you meet a specialist who has dealt with the conditions they treat — but Dr. Shah is open about her experience and generous with her insight into her patients' struggles. 

“That feeling of coming into a room, sitting across from a doctor, and not knowing what kind of news you're going to receive, that's not something you learn a ton about in medical school. That feeling of vulnerability, like you're in the hands of someone else — it was challenging.

She met her husband in her thirties while traveling abroad and busy with work. After trying to conceive, they were met with recurrent pregnancy losses. Before that point, Dr. Shah was a person who’d never had any health issues. Dealing with her own infertility journey gave her a deeper understanding of her patients’ experiences. “That feeling of coming into a room, sitting across from a doctor, and not knowing what kind of news you're going to receive, that's not something you learn a ton about in medical school. That feeling of vulnerability, like you're in the hands of someone else — it was challenging.”

After going through several cycles of IVF, she started feeling much more fatigued than usual, which prompted her husband to suggest she get her thyroid checked. She was sure it was nothing. “I’d previously tested it myself, and it was fine,” she said. “But it was off. And it turned out to be a thyroid issue.”

Fatigue was her main symptom, though she also had dry hair and dry skin. It was winter, and she was stressed due to work and IVF treatments — which made her symptoms easy to confuse with other issues, even as an endocrinologist. Soon after her diagnosis, she started synthetic hormones to balance her thyroid hormone levels. She was able to become pregnant with her first child and is currently pregnant a second time.

Her suggestion for treating patients experiencing infertility is to make sure to run a full panel of thyroid tests. “If patients don't get tested for thyroid issues when dealing with infertility, it's because they don't know that it can be a cause.” Plus, the tests are available and usually fairly inexpensive.

Thyroid conditions affect fertility — from conception to carrying to term. As Dr. Shah learned through her own experience, the presence of thyroid antibodies, whether you have a thyroid condition or not, is also associated with infertility.

Thyroid conditions affect fertility — from conception to carrying to term. As Dr. Shah learned through her own experience, the presence of thyroid antibodies, whether you have a thyroid condition or not, is also associated with infertility.

According to a 2020 study published in Thyroid, “There is continued evidence supporting an important role of thyroid hormone in regulation of reproductive tissues at many levels.”

Dysregulated TSH levels can interfere with fertility in multiple ways. They can cause anovulatory cycles (skipped ovulation), luteal phase disruption (which is the disruption of the last half of your cycle after ovulation), hyperprolactinemia (high levels of prolactin, which is associated with infertility), and sex hormone imbalances.

The American Thyroid Association agrees. “Pregnant women with undiagnosed or inadequately treated hypothyroidism have an increased risk of miscarriage, preterm delivery, and severe developmental problems in their children.” Because hypothyroidism is much more prevalent in women, it may go undiagnosed or untreated in many women, especially women of color, who are often overlooked in medical care. It’s important that endocrinologists and other health professionals pay close attention to the signs and resist the urge to chalk up any noticeable symptoms to everyday issues. 

As an endocrinologist herself, Dr. Shah acknowledges and is grateful for her level of access to care. She didn’t have to endure long appointment wait times and was able to work with excellent specialists, like her reproductive endocrinologist — who didn’t give up on her after other doctors told her she’d never be able to conceive.

“Access to specialists is a big problem, especially wait times,” Dr. Shah says. When it comes to fertility, that's an even greater issue. “Women and particularly women of color's symptoms are underplayed, and infertility isn't talked about enough because it's not considered an emergency."

She is all too aware this is not the case for most patients. “Access to specialists is a big problem, especially wait times,” Dr. Shah says. When it comes to fertility, that's an even greater issue. “Women and particularly women of color's symptoms are underplayed, and infertility isn't talked about enough because it's not considered an emergency," she says. Health care practitioners should be aware of this and do a full panel of thyroid tests for patients who are struggling to conceive in addition to the usual fertility assessments.

Dr. Shah also recommends telemedicine as a way to increase accessibility and has incorporated it into her own practice at Paloma Health with this in mind.

For some patients, at-home thyroid test kits may also help, particularly now when many are still wary of in-person appointments, she says. These tests typically measure three main hormone levels (TSH, T3, and T4) as well as thyroid antibodies.

Remember, many patients might be scared of seeing a doctor or beginning a new health journey, whether because of a thyroid condition or problems getting pregnant — or both. “In general, recurrent pregnancy loss is not discussed enough. And you feel shame. You feel like you're failing as a woman. There's a lot of pain and stigma attached to it,” Dr. Shah says. "As health care practitioners, we can help."

Dr. Shah is board-certified in internal medicine and endocrinology. On day one of her endocrinology rotation after medical school, Dr. Shah knew that endocrinology was for her. Over time, she has developed a special interest and passion for patients with hypothyroidism who are pregnant, trying to conceive, or who struggle with infertility. She herself has struggled with infertility and hypothyroidism, and greatly empathizes with patients who manage these conditions. She now has a beautiful boy who is her world. Outside of her endocrine practice, Dr. Shah loves to travel, experience new cultures, read, and try new foods.

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