Connecting The Dots: The Impact Of Subclinical Hypothyroidism On Female Subfertility And Obesity
Authors: Ashfaq Naila , Hussain Warda , Hussain Mugheera , Saba Neelam , Muddasir Asma , Liaqat Jawairiah 
Published: February 2025

Objective: To find the frequency of subclinical hypothyroidism in females with subfertility
Methods: This was a descriptive cross-sectional study Department of Obstetrics and Gynecology, CMH Hospital Kharan, for 6 months (1st Jan 2023 to 30th June 2023).
A total of 159 females meeting inclusion criteria were included after taking informed consent. Females were enquired about infertility status and their thyroid status was measured in terms of thyroid stimulating hormone (TSH) and free thyroxine (FT4). Mean and Standard Deviation were used for quantitative variables whereas frequency and percentages were used for categorical variables.
Results: The mean age of females in this study was 27.86±7.58 years. The mean weight, height and BMI were 72.87 ± 13.31 kg, 1.64 ± 0.06 m, and 27.23 ± 4.90 respectively.
Fifty-three (33.33%) females were obese and 106(66.67%) females were non-obese. The mean level of TSH was found to be 2.51 ± 2.29 mIU/mL with huge variation as the minimum TSH level was 0.1 and the maximum was 7.90 mIU/mL. The mean FT4 was 1.29±0.4 ng/dl with a minimum and maximum FT4 level of 0.70 and 1.90 ng/dl respectively. There were 43 (27%) females with subclinical hypothyroidism whereas, 116 (73%) did not have subclinical hypothyroidism. There was an association between subclinical hypothyroidism and obesity, p-value < 0.05.
Conclusion: This study concludes that the prevalence of subclinical hypothyroidism was found to be greater in infertile women and hence routine screening of subclinical hypothyroidism among females with subfertility should be practiced. We also found an association of SCH with obesity in these females.

REFERENCES:

Abangah G, Rashidian T, Nasirkandy MP, Azami M. A meta-analysis of the prevalence and etiology of infertility in Iran. International Journal of Fertility & Sterility. 2023;17(3):160-73.
Carrell DT, Peterson CM. Reproductive endocrinology and infertility. Springer Sci+ Busin Med. 2010;345.
Bala R, Singh V, Rajender S, Singh K. Environment, lifestyle, and female infertility. Reproductive sciences. 2021;28:617-38.
World Health Organization. Infertility prevalence estimates: 1990–2021. 2023 [Online available from]: https://www.who.int/publications/i/item/978920068315. Retrieved from 18th Sep 2023
Shafierizi S, Basirat Z, Nasiri-Amiri F, Kheirkhah F, Chehrazi M, Pasha H, et al. The prevalence of adjustment disorder and predisposing factors in infertile women. BMC psychology. 2023;11(1):142.
Maaherra Armstrong P, Augustin H, Bärebring L, Osmancevic A, Bullarbo M, Thurin-Kjellberg A, et al. Prevalence of Vitamin D Insufficiency and Its Determinants among Women Undergoing In Vitro Fertilization Treatment for Infertility in Sweden. Nutrients. 2023;15(12):2820.
Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. International journal of applied and basic medical research. 2012;2(1):17-9.
Priya DM, Akhtar N, Ahmad J. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Indian journal of endocrinology and metabolism. 2015;19(4):504-6.
Cooper DS. Subclinical hypothyroidism. New England Journal of Medicine. 2001;345(4):260-5.
Biradar SM, Poornima R, Sonagra AD, Jayaprakash Murthy D. Thyroid dysfunction in infertile women. Int J Pharm Bio Sci. 2012;2:53-8.
Mahadik K, Choudhary P, Roy P. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC pregnancy and childbirth. 2020;20(1):1-7.
Ratnaparkhe V, Shah H, Upadhyay K. Link between infertility, overweight and subclinical hypothyroidism. Int J Health Sci Res. 2020;10(2):10-7.
Sadbhawna D, Sonia S, Nitin G. Prevalence of subclinical hypothyroidism among females with menstrual disorders. International Journal of Health Sciences & Research. 2019;9(8):110-5.
Ali T, Bahadur A, Bashir B, Hassan T, Ishaq B, Qasim M. Prevalence of Hypothyroidism in Pregnancies and its Obstetric Outcomes. Pakistan Journal of Medical & Health Sciences. 2022;16(03):1184-6.
Onwubuariri M, Bassey G, Kasso T, Nyengidiki T. A-Case Control Analysis of Thyroid Disorders in Infertile Women at the University of Port Harcourt Teaching Hospital, Nigeria. Asian Journal of Pregnancy and Childbirth. 2020;3(1):1-9.
Mohadure DS, Fating L. Case Report on Hypothyroidism in Infertile Woman with IVF Conception. Journal of Pharmaceutical Research International. 2021;33(35B):148-51.
Jagun OE, Andu BA, Olawale OO. Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria. Afr Health Sci. 2022;22(2):444-50.
So S, Tawara F. Risk factors of subclinical hypothyroidism and the potential contribution to miscarriage: A review. Reproductive medicine and biology. 2020;19(3):232-42.
Kant R, Barnwal S, Yadav P, Tendulkar P, Bairwa M. Subclinical hypothyroidism in community perspective: Treat or not to treat? J Prevent Med Holistic Health 2023; 7(1): 19-22
Kaur G, Kaur S, Mahajan M, Kaur A. To Study Prevalence of Infertility in Patients of Hypothyroidism. Indian Journal of Clinical Biochemistry. 2022;30(S1):S63-S.
Amer MH, Thuwain MM, AL-Snafi A. Investigation of thyroids dysfunction among infertile women in Nasiriyah city. Int J Curr Pharm Res. 2020;12(5):31-4.
Dhillon-Smith RK, Tobias A, Smith PP, Middleton LJ, Sunner KK, Baker K, et al. The prevalence of thyroid dysfunction and autoimmunity in women with history of miscarriage or subfertility. The Journal of Clinical Endocrinology & Metabolism. 2020;105(8):2667-77.
Bendary AA, El Hodiby ME. Study of thyroid immunological and functional disorders in women with unexplained infertility 2022; 2(63): 1-6
Wali AA-E-D, Abdelfattah W, Abd-El-Fatah SM. Prevalence of thyroid dysfunction and thyroid autoimmunity in infertile women. Evidence Based Women's Health Journal. 2020;10(4):308-15.
Jagun OE, Andu BA, Olawale OO. Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria. African Health Sciences. 2022;22(2):444-50.
Zhang Y, Wu W, Liu Y, Wang X, Guan Y, Jia L. Analysis of basal serum TSH, FT3, and FT4 levels based on age, sampling time in women with infertility. BMC Women's Health. 2021;21(1):317.
Zhang B, Wang J, Shen S, Liu J, Sun J, Gu T, et al. Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age. Gynecol Endocrinol. 2018;34(10):875-9.
Ratnaparkhe V, Shah H, Upadhyay K. Link between infertility, overweight and subclinical hypothyroidism. Int J Health Sci Res. 2020;10(2):10-7.