Prevalence of Subclinical&Overt Hypothyroidism in Infertile Women&Evaluation of Outcome Following Treatment of Hypothyroidism

Introduction- The thyroid gland plays a key role in the growth& development, also controls the rate of metabolic processes throughout the body. Thyroid dysfunction is an important contributing factor in female infertility, affecting 2-4 % of the population in the reproductive age group. Hypothyroidism affects fertility as it causes hormonal imbalance, anovulation& luteal phase defect. Also, it is often associated with increased prolactin levels. Estimation of thyroid levels is simple& cost effective. It is recommended that estimation of thyroid hormones& serum prolactin levels should be a part of initial workup in an infertility case. Also, hypothyroidism should be managed initially before evaluating other causes of raised prolactin levels. Aim 1. To estimate the prevalence of hypothyroidism in infertility.2. To find a correlation between hypothyroidism& raised S. prolactin in infertility.3. To assess the outcome of infertility after treatment of hypothyroidism. Methodology A prospective study was conducted on 360 women in the age group of 18-45 years, with primary& secondary infertility, in the Department of Obstetrics& Gynaecology, MGM MCH, a tertiary care hospital. The cases were divided into two groups comprising of 180 subjects each on the basis of type of infertility. Group I consisted of cases of primary infertility, while group II consisted of cases of secondary infertility. Both the groups were further subdivided into three groups respectively. Subgroup A comprised of euthyroid cases, subgroup B comprised of cases of subclinical hypothyroidism, subgroup C comprised of cases of overt hypothyroidism. The study was carried out over a period of one year from May 2017. Cases with hypothyroidism& raised S. prolactin were treated with thyroxine (25-150ug/day)& the response to treatment as well as effect on infertility was evaluated. The results were statistically analysed. Results The prevalence of hypothyroidism in infertile women is 15 %. Prevalence of hyperprolactinemia in infertility is 22.7 %,& associated with hypothyroidism is 89.1 %. Menstrual dysfunction was seen in 85 % of total cases. Altered lipid profile was observed in 25.5 % of total cases. Out of 360 cases, 258 cases conceived (71.6 %) in a period of one year. Conclusion Thyroid hormones not only regulate metabolism but also influence the hypothalamo-pituitary-ovarian axis& is an important etiology of female factor infertility. It may remain asymptomatic in many cases& even euthyroid cases may screen positive for thyroid autoantibodies. Hence early screening improves the prospects of conception. Hypothyroidism, Infertility, Anovulation, Luteal Phase Defect, Thyroxine.