Subclinical hypothyroidism and infertility: what’s the link?
Mario Montanino (IT)
[Montanino] .
Context: In recent years, the scientific interest has been deeply focused on the relation between fertility status in women and thyroid function. Nevertheless, this link is not yet fully understood and, today, there are no guidelines recommending the thyroid function check in asymptomatic infertile women. In particular, subclinical hypothyroidism (SH) seems to be strictly related to the fertility of these patients. Objective: To clarify the link between SH and infertility, and investigate alternative approaches for these patients. Methods: Review of literature and evidence regarding a new approach for infertility and altered thyroid function. Patients: Infertile women with SH. Interventions: Management of these patients with new therapeuthical approaches, such as supplementation of myo-inositol (MI). Main outcome measure(s): New tools for improving fertility in parallel to a TSH normalization. Results: The altered value of TSH is linked to subfertility, indirectly influencing the LH-FSH release and the causing alteration in the ovulatory cycle. It would be necessary to find new alternatives to hormones, in order to: maintain the TSH title in a normal range; improve the reproductive outcome of subfertile women, especially those undergoing ART. Myo-inositol, as a new approach, seems to be able to reduce the TSH title, acting as TSH-sensitizing agent without side effects. Conclusions: Existing data give support to the notion that MI is involved in several hormonal pathways, including TSH signaling. The evidence on MI indicates that its supply could improve TSH title of women with SH. This alternative approach could represent a useful tool for TSH normalization in subfertile women undergoing an ART protocol.