need some advice

[ajourney]

hello doctor
I am 30yrs old and have been diagnosed with unexplained IF (never been pregnant/no miscarriage). All my tests are normal except for one on antithyroid antibody (ATA) which is positive. My TSH is normal between 1-2. I feel fine healthwise and have not felt symptoms of hypothyroidism. In such a case I am trying to determine if I must undergo immune testing before IVF.

Please let me know if you have answers for the following:

1)What percentage of ATA positive woman have activated NK cells ?
2) what percentage of woman with ATA positive and activated NKcells have infertility or related problems?
3)What percentage of woman with ATA positive and normal NK cells have infertility?
4)I understand having ATA puts one at risk for hypothyroidism in the future. Does having ATA also contribute independent of hypothyroididm to infertility and related problems?
5) What are the consequences of having positive ATA but normal TSH? I know of a risk for hypothyroidism...anything else?
6)Once ATA's are positive how long does it take for one to develop hypothyroidism?
7) If ATA is positive but TSH is between1-2, does a patient then need medication for thyroid hormone..probably a low dose?
8)Do all patients with ATA positive develop hypothyroidism in the future? If not then what percentage does develop hypothyroidism?
9)Is there anyway to reduce the level of ATA in the body ...like I have heard selenium helps. ..anything else?
10)What percentage of the population has ATA positive?
11)Would you suggest going in for immune testing prior to IVF when ATA is positive but TSH is normal between1-2?

I have asked you quite a few questions and will really appreciate your input. In case you are not very sure on the percentage, a rough estimate will also do.
Thanks a lot

[Scott Roseff MD]

Hi,

Peripheral (blood) NK cells have essentially been proven to be meaningless when it comes to fertility. NK cells in the uterus, on the other hand, may be meaningful but we don't have good ways at measuring them. In addition, if/when they are meaningful, it's usually in light of recurrent pregnancy loss, which doesn't pertain to you as you described.

Having said that, to answer your questions:

1)What percentage of ATA positive woman have activated NK cells ?
==> Don't know.
2) what percentage of woman with ATA positive and activated NKcells have infertility or related problems?
==> Don't know.
3)What percentage of woman with ATA positive and normal NK cells have infertility?
==> Don't know.
4)I understand having ATA puts one at risk for hypothyroidism in the future. Does having ATA also contribute independent of hypothyroididm to infertility and related problems?
==> No, it doesn't. Controversially, some believe it may increase the risk of miscarriage.
5) What are the consequences of having positive ATA but normal TSH? I know of a risk for hypothyroidism...anything else?
==> No. Some women with one autoimmune issue, however, may be at an increased risk for developing others in the future.
6)Once ATA's are positive how long does it take for one to develop hypothyroidism?
==> First, it doesn't necessarily mean one will indeed develop hypothyroidism. Second, no one know the answer to this as far as I know.
7) If ATA is positive but TSH is between1-2, does a patient then need medication for thyroid hormone..probably a low dose?
==> No, not with your history.
8)Do all patients with ATA positive develop hypothyroidism in the future? If not then what percentage does develop hypothyroidism?
==> No, not all will develop the disease. Don't know what % will.
9)Is there anyway to reduce the level of ATA in the body ...like I have heard selenium helps. ..anything else?
==> Some use baby aspirin, but overall nothing seems to help.
10)What percentage of the population has ATA positive?
==> Don't know. In order to know this, one would need to draw blood on 100,000 people and check for ATA -- Hasn't been done.
11)Would you suggest going in for immune testing prior to IVF when ATA is positive but TSH is normal between1-2?
==> No.

Take care,
Dr. Roseff in Florida