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Thyroid disorders and female infertility
David Unuane1, Brigitte Velkeniers1, Kris Gustave Poppe2
1Department of Endocrinology, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels 1090, Belgium.
The Journal of Clinical Endocrinology and Metabolism
|February 3, 2026
Summary
Thyroid disorders impact female fertility and assisted reproductive technology (ART) outcomes. Current evidence on subclinical hypothyroidism and thyroid autoimmunity treatment is debated, prompting individualized care for women
Area of Science:
- Reproductive Endocrinology
- Immunology
- Endocrinology
Background:
- Thyroid disorders are common in women of reproductive age, potentially affecting fertility via hormonal and immune pathways.
- Overt thyroid dysfunction significantly impacts reproductive health, but the roles of subclinical hypothyroidism (SCH) and euthyroid thyroid autoimmunity (TAI) are debated.
- Levothyroxine (LT4) is frequently used for SCH, often initiated at TSH levels of 2.5 mIU/L, despite limited supporting evidence for improved fertility.
Purpose of the Study:
- To review current evidence on the effects of thyroid dysfunction and TAI on female fertility and ART outcomes.
- To explore the underlying hormonal and immune mechanisms involved.
- To discuss the controversies surrounding diagnosis and treatment thresholds for SCH and TAI in the preconception setting.
Main Methods:
- Systematic review of existing literature on thyroid disorders, female fertility, and assisted reproductive technology (ART).
- Analysis of hormonal and immune-mediated mechanisms linking thyroid status to reproductive outcomes.
- Evaluation of current clinical practices and emerging data regarding treatment guidelines.
Main Results:
- Overt hypothyroidism clearly impairs reproductive physiology.
- The impact of subclinical hypothyroidism and euthyroid TAI on fertility remains controversial, with limited evidence supporting current treatment thresholds.
- Thyroid status and autoimmunity may influence ART outcomes, including ovarian response, embryo quality, and pregnancy rates.
Conclusions:
- Treatment decisions for thyroid dysfunction and TAI in women of reproductive age should be individualized, considering thyroid function, antibody status, and reproductive context.
- Higher TSH cut-offs are increasingly considered for diagnosis and treatment in the preconception setting.
- Further research is needed to clarify the role of SCH and TAI in fertility and ART, and to establish evidence-based treatment guidelines.
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