At Shady Grove Fertility (SGF), we are committed to providing evidence-based care that prioritizes the best outcomes for our patients. Recently, the American Society for Reproductive Medicine (ASRM) released updated guidelines regarding subclinical hypothyroidism. These recommendations mark a pivotal shift in how we approach thyroid health during the fertility journey, and we want to explain why this is significant and how it impacts our approach at SGF.
What is subclinical hypothyroidism?
Subclinical hypothyroidism is defined as an elevated thyroid-stimulating hormone (TSH) level with normal thyroid hormone levels (free T4). It has often been debated whether this condition affects fertility or pregnancy outcomes. Past practices routinely included thyroid testing as part of baseline fertility evaluations, as abnormal TSH levels were thought to potentially impair conception or pregnancy.
What do the new ASRM guidelines say?
The new ASRM guidelines provide clear evidence that routine thyroid testing in asymptomatic individuals — those without a personal or family history of thyroid disease or clinical signs — is not necessary. Here are the key takeaways:
- Limited evidence of impact on fertility: The data do not support that mild elevations in TSH adversely affect the chances of conception or pregnancy outcomes in most infertile individuals.
- Targeted testing is more effective: Testing should be reserved for individuals with symptoms of thyroid dysfunction, a known history of thyroid disease, or specific risk factors.
- Reducing unnecessary interventions: Treating mild TSH elevations in patients without symptoms has not been shown to improve fertility outcomes and may lead to unnecessary treatment or stress.
How will this change fertility care at SGF?
In alignment with the research, SGF will no longer include routine thyroid testing as part of baseline fertility evaluations for asymptomatic patients. Instead, we will adopt a more targeted approach to ensure that testing is performed only when there are clinical indications, such as a personal or family history of thyroid disease, symptoms of thyroid dysfunction (e.g., fatigue, weight changes, or sensitivity to cold), or other risk factors, such as autoimmune conditions.
What does this mean for you?
If you’re beginning your fertility journey at SGF, this change underscores our commitment to personalized, evidence-based care. Here’s how it benefits you:
- Streamlined testing: By avoiding unnecessary tests, we simplify the evaluation process, saving time and resources.
- Reduced anxiety: For many patients, an elevated TSH result can cause unnecessary worry. With this change, we focus only on clinically significant findings.
- Improved outcomes: By adhering to guidelines grounded in robust research, we ensure that your care is optimized for the best possible results.
A focus on what matters most
“We understand that fertility care is deeply personal, and every decision matters. By adopting the latest ASRM guidelines, we reaffirm our commitment to delivering care that is not only cutting-edge but also compassionate and patient-focused,” shares Micah J. Hill, D.O. “These updates ensure that your journey with SGF is rooted in the most current scientific understanding, free from unnecessary interventions, and tailored to individual needs.”
If you have questions about these changes or your specific care plan, our team is here to help. We encourage you to reach out to your SGF physician or care team to discuss any concerns or next steps.
Medical contribution by Micah J. Hill, D.O.
Micah J. Hill, D.O., is board certified in Obstetrics and Gynecology (OB/GYN) as well as Reproductive Endocrinology and Infertility (REI). Dr. Hill completed his residency in OB/GYN at Tripler Army Medical Center, Honolulu, Hawaii. He then completed his fellowship in REI at the National Institutes of Health in Bethesda, Maryland.
