Antibodies – A potential problem in fertility…. And a bit of a personal ramble.

As a person who has been tested and diagnosed with Hashimotos (aka antithyroid peroxidase antibodies), I am aware how little is known about antibodies and NOTHING is known about the treatment of it.

I know, I know…. go gluten free, dairy free, sugar free. I did the everything free diet – my thyroid antibodies never went down and in fact went up. Compounding this huge diet change, my eating life become stressful and barren.

Yes, many people find this diet change a big benefit. If you feel better on a gluten free diet, stick to it. For me I never noticed a single shift in my physical being. The biggest change – feeling deprived when I went out to eat and tired of eating a clean protein with veggies. I was sick of fish and chicken with veggies. Some days I thought I would turn into a fish or at least zucchini.

Yes, I did every supplement under the sun. No change in antibodies.

After a year and half of eating this way, my thyroid antibodies never lowered. In fact, they went up even more. Finally, as my dad was dying I threw in the whole diet thing. I went to Dunkin Donuts and had THE BEST chocolate chip muffin. I never looked back. In fact, never saw my health get worse. I kept thinking today will be the day I feel like shit…I’m eating this “crappy” food. Nope. Nothing.

It was after my marriage dissolved, my thyroid antibodies went way down into normal range. My “ah” moment, stress was my trigger.

What was my big lesson? As health practitioners we make big generalizations and the topic is as multi-faceted as the people who have the antibodies.

Yes, this topic is blurry, fuzzy and ambiguous. Which brings us to the impact of antibodies on fertility and implantation.

I am aware there are IVF doctors who treat autoimmune disorders with experimental modalities (mostly IV treatment). My experience with clients who have under gone treatment – poor results.

Generally, the majority of doctors don’t recognize the topic and believe there is no tie in with antibodies and fertility. Yet, from my personal experience, I became aware of how antibodies can change your health. It left me wondering what is the tie in with fertility.

Below are two current studies:

1) Found a strong correlation between thyroid antibodies and miscarriage. It appears women with antibodies have a 43% chance of miscarriage compared to non-antibodies women (25%).

2) Autoimmune factors could be a factor in failed implantation of genetically viable, tested embryos.

Clearly, there is some sort of correlation between antibodies and conceiving. What kind of treatment should you start if you have thyroid antibodies?

First: There are no FDA approved Western medicine treatments to target fertility issues.

Personal belief: Avoid anything extreme: like experimental IV treatments, being prescribed dozens of supplements and expensive bloodwork delving into the nooks and crannies of your immune system.

Do: Explore different modalities and pay attention to how your body responds. Do your physical symptoms improve with treatment changes? As your physical symptoms change, the potential for improved fertility increases. If something doesn’t work for you, ditch it and move on.

 

Preconceptional antithyroid peroxidase antibodies, but not thyroid-stimulating hormone, are associated with decreased live birth rates in infertile women

Presented as an oral paper (O-92) at the Annual Meeting of the American Society of Reproductive Medicine in Baltimore, Maryland, October 17–21, 2015.

Aimee Seungdamrong, M.D., Anne Z. Steiner, M.D., M.P.H., Clarisa R. Gracia, M.D., M.S.C.E., Richard S. Legro, M.D., Michael P. Diamond, M.D., Christos Coutifaris, M.D., Ph.D., William D. Schlaff, M.D., Peter Casson, M.D., Gregory M. Christman, M.D., Randal D. Robinson, M.D., Hao Huang, M.D., M.P.H., Ruben Alvero, M.D., Karl R. Hansen, M.D., Ph.D., Susan Jin, M.P.H., Esther Eisenberg, M.D., M.P.H., Heping Zhang, Ph.D., Nanette Santoro, M.D.

Fertility and Sterility Nov 2017

Objective
To study whether preconceptual thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) antibodies are associated with poor reproductive outcomes in infertile women.

Design
Secondary analysis of data from two multicenter, randomized, controlled trials conducted by the Reproductive Medicine Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Multivariable logistic regression analyses were performed to assess the association between preconceptual TSH levels and anti-TPO antibodies.

Setting
Not applicable.

Patient(s)
Serum samples from 1,468 infertile women were utilized.

Intervention(s)
None.

Main Outcome Measure(s)
Cumulative conception, clinical pregnancy, miscarriage, and live birth rates were calculated.

Result(s)
Conception, clinical pregnancy, miscarriage, and live birth rates did not differ between patients with TSH ≥2.5 mIU/L vs. TSH < 2.5 mIU/L. Women with anti-TPO antibodies had similar conception rates (33.3% vs. 36.3%) but higher miscarriage rates (43.9% vs. 25.3%) and lower live birth rates (17.1% vs. 25.4%) than those without anti-TPO antibodies. Adjusted, multivariable logistic regression models confirmed elevated odds of miscarriage (odds ratio 2.17, 95% confidence interval 1.12–4.22) and lower odds of live birth (oddr ratio 0.58, 95% confidence interval 0.35–0.96) in patients with anti-TPO antibodies.

Conclusion(s)
In infertile women, preconceptional TSH ≥2.5 mIU/L is not associated with adverse reproductive outcomes; however, anti-TPO antibodies are associated with increased risk of miscarriage and decreased probability of live birth.

 

Contribution of immunology to implantation failure of euploid embryos

Jason M. Fantasia, M.D., T.S., Richard T. Scott. MD, H.C.L.D./A.L.D. (A.B.B.)

Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey; and Thomas Jefferson University, Philadelphia, Pennsylvania

Outcomes in assisted reproduction have seen marked improvement. With increased ability in the embryology laboratory to use extended embryo culture which in turn enables other selective techniques, such as trophectoderm biopsy and comprehensive chromosome screening, the chance of success per embryo transfer is increased. However, even the selection of a euploid blastocyst, which selects out many embryonic factors, does not yield successful implantation and ultimately delivery in all cases. Among the factors that affect implantation failure of apparently reproductively competent embryos, the immune system has been perhaps both the most plausible and the most debated. There are data on T-helper cells, in particular the TH1-TH2 balance, peripheral and uterine natural killer cells, and autoantibodies, all of which have been shown to have variable effects on implantation. Many investigators have developed and used a wide range of immune tests and treatments aimed at manipulating the milieu to favor implantation. Although it is certain that the immune system plays a role in implantation, our understanding of the physiology, let alone the pathophysiology, remains incomplete. It is imperative that we gain more clear evidence of causes and test and implement treatment paradigms. In the meantime, immune testing or empirical treatment with the use of immune modulators must be approached with caution.