PREVALENCE OF HYPOTHYROIDISM IN INFERTILE WOMEN POPULATION - A PROSPECTIVE OBSERVATIONAL STUDY.pptx

PREVALENCE OF HYPOTHYROIDISM IN
INFERTILE WOMEN – A PROSPECTIVE
OBSERVATIONAL STUDY
SUBMITTED BY:
Mohammad Areef Uddin (05)
Sara Khan (06)
Sana Fathima (07)
Ayesha Siddiqua (08)
UNDER THE ESTEEMED GUIDANCE OF:
Dr. Syed Aseem
Pharm.D, PhD
Associate Professor of Pharmacy Practice
SHADAN COLLEGE OF PHARMACY

● INFERTILITY:
Infertility is the inability to conceive even after a year of unprotected sexual intercourse. Infertility is
a complex disorder with significant medical, psychosocial, and economic aspects. The unique quality
of this medical condition involves affecting both the patient and the patient's partner as a couple.
PRIMARY
INFERTILITY
•Primary infertility is when a pregnancy has never been
achieved by a person, and can’t conceive after one year (if
you’re 35 or older) of regular, unprotected sexual
intercourse.
SECONDARY
INFERTILITY
•Secondary infertility is defined as the inability to conceive or
carry a baby to term after previously giving birth or having at
least one successful pregnancy.
UNEXPLAINED
INFERTILITY
•Fertility testing hasn’t found a reason that a person or
couple is unable to get pregnant..
INTRODUCTION
TYPES OF INFERTILITY

HYPOTHYROIDISM
The thyroid is a highly vascular organ regulated by TSH
from the anterior pituitary. Iodine is essential for the
synthesis of thyroid hormones.
Thyroid hormones do not have any discrete target
organ. They affect cells of almost all the tissues of the
body.
 The two thyroid hormones, thyroxine (T4) and tri-
iodothyronine (T3) help in the growth and
development of the body, sexual development,
increase basal metabolic rate and modulate
reproductive functions.
 When the thyroid gland cannot produce and release
enough thyroid hormones (i.e. T3 and T4) into the
bloodstream, it causes hypothyroidism.
 According to the hormone levels and symptoms,
hypothyroidism is divided into subclinical
hypothyroidism and clinical hypothyroidism.
•An increase in the TSH levels
with T4 and T3 suggests
subclinical hypothyroidism.
SUBCLINICAL
•An increase in TSH levels with
low T4 and T3 levels suggests
clinical hypothyroidism.
CLINICAL
TYPES OF HYPOTHYROIDISM

ASSOCIATION OF HYPOTHYROIDISM WITH INFERTILITY

PREVALENCE OF HYPOTHYROIDISM IN INFERTILITY
PREVALENCE
The prevalence of
hypothyroidism in
the reproductive
age group ranges
from 2 - 4 %.
WHO estimates the
overall prevalence
of primary infertility
in India to be 3.9 %
- 16.8 %.
The prevalence of
SCH has been
reported to be 0.7
% - 2.3 % in a
large series of
unselected infertile
women.
The prevalence of
hypothyroidism in
infertile women is
much higher than in
women in reproductive
age group. Subclinical
hypothyroidism is more
prevalent than overt
hypothyroidism.

NEED FOR STUDY
Infertility is a condition of the male or female reproductive system characterized by infertility after
12 months or more of persistent, unprotected sexual activity. The major risk factors involving
infertility include age, endometriosis, chronic diseases, hormonal imbalance, environmental
factors, too much body fat, fibroids, abnormalities in the uterus, STDs, and fallopian tube disease.
• Infertility is generally associated with hypothyroidism as Infertility is a common consequence of
ovulatory dysfunction in women, and it is often associated with endocrine issues. Hence the study
is conducted pertaining to the following evaluations:
 Assessing the thyroid status is necessary for infertile women.
 To examine hypothyroidism as a significant factor contributing to infertility.
 To determine the occurrence of hypothyroidism among women experiencing primary and
secondary infertility.
• The prevalence of hypothyroidism is significantly higher in infertile women than in women of
reproductive age. This research provides aid by:
 Bringing awareness among infertile women regarding hypothyroidism as among the primary
preventable causes of infertility.
 Also, to counsel patients about other factors that can lead to infertility.

LITERATURE REVIEW
Hasibul Hasan Shirazee et.al., conducted a prospective observational study on the
Prevalence of Hypothyroidism in Infertile Women Attending a Tertiary care Centre in
West Bengal, India. A total of 314 women were recruited. The study shows that the
overall prevalence of hypothyroidism among infertile patients attending tertiary care
centers was 21.9%. In the primary and secondary infertility groups, it is 19.2% and
38.6% respectively. Thus Hypothyroidism is an emerging cause of infertility (both
primary and secondary). SCH is more prevalent than clinical hypothyroidism in
infertile women.

Kamal A Ahmed et.al., a cross-sectional, case-control study on the Assessment of
Thyroid Functions Test among Hyperprolactinemic Sudanese Infertile Females. The
study subjects consisted of 150 patients. 100 samples were collected from
hyperprolactinemic patients. 50 normal prolactin patients in the same age group (16-
42) were used as controls. The control group included infertile patients with normal
prolactin levels. The prevalence of thyroid dysfunction and its association with
hyperprolactinemia was found in 17 women with hypothyroidism (17%), all of them in
the study group and no subject had a thyroid dysfunction in the control group. The
present study concluded that hyperprolactinemia and hypothyroidism are important
and widely prevalent causes of infertility.

AIM & OBJECTIVES
AIM:
To evaluate the % prevalence of hypothyroidism in primary and secondary infertile
women.
OBJECTIVES:
This study is required to determine the prevalence of hypothyroidism in women who
are infertile.
 It is aimed to assess the occurrence of hypothyroidism in women suffering from
infertility and visiting the outpatient department.

 Calculating the percentage of hypothyroidism in women who are experiencing
infertility.
 Assessing hypothyroidism is necessary for determining its impact on primary and
secondary infertility.
 To examine hypothyroidism as a significant factor contributing to infertility.
 Evaluate the frequency of both subclinical and clinical hypothyroidism in women
who are infertile.
 To evaluate the other risk factors like PCOD, uterine fibroids, stress, along with
hypothyroidism causing infertility.

METHODOLOGY
STUDY DESIGN
• Prospective Observational Study
INCLUSION CRTIERIA
• Age group: 18-45 years
• Every woman who is infertile in the age range mentioned above (primary and
secondary)
• Infertile women with clinical and subclinical hypothyroidism
EXCLUSION CRITERIA
• Pregnant women
• Women below the age of 18 and above 45
• The study does not include patients who are unwilling to participate.
• Chronic systemic diseases, liver disease, renal disease or cardiac disease.

STATISTICAL ANALYSIS
• MS EXCEL
DURATION OF STUDY & SAMPLE SIZE
• 6 months, 100 patients
Place of Study
Study Population
Shadan Teaching & General Hospital, Peerancheru, Hyderabad
Out Patients

MATERIAL AND METHODS
• The protocol for approval was submitted to the ethics committee of Shadan
Hospital. After receiving the approval, a prospective observational study was
carried out. Data was collected from the out patient department (OPD) of Shadan
Institute of Medical Sciences.
• Patient demographic information (age, weight, BP, etc.), presenting complaints,
Gynecological history (past history, LMP, menstrual history, coital history, surgical
history, etc.), and laboratory investigations (CBP, Thyroid Profile, Prolactin, Blood
sugar) were gathered.
• Patients were also encouraged to fill up proforma for gathering complete
information.

PREVALENCE OF HYPOTHYROIDISM IN INFERTILE WOMEN POPULATION - A PROSPECTIVE OBSERVATIONAL STUDY.pptx

RESULTS
Table 1: % Prevalence of hypothyroidism in infertile women
A pie diagram & 3-D chart representing % prevalence of hypothyroidism in
infertile women

As per our research, we discovered that 17 out of 100 infertile women suffer from
hypothyroidism, while the remaining 83 out of 100 have normal TSH levels
(euthyroid).
Table 2: Categorization of infertile women
CATEGORY OF INFERTILITY NUMBER OF PATIENTS
PRIMARY 73
SECONDARY 27
A pie diagram & an area chart representing the categorization of infertility

In the study we conducted, we found that 73 women had primary infertility, meaning
they had never been able to conceive. Additionally, we found that 27 women had
secondary infertility, indicating that they had been able to conceive in the past but
were currently experiencing difficulty.
TABLE 3: A table representing the categorization of hypothyroidism in infertile
women (17 hypothyroid patients)
TYPES OF HYPOTHYROIDISM NUMBER OF PATIENTS
SUBCLINICAL 10
CLINICAL 7

A bar diagram representing the categorization of hypothyroidism in infertile women
In our study, we analyzed that 10 infertile women had subclinical
hypothyroidism (mildly elevated TSH levels and normal T3 T4 levels) and 7
infertile women had clinical hypothyroidism (elevated TSH, and T3 T4 levels)
among 100 infertile women.

Table 4: % Prevalence of Hypothyroidism in Primary and Secondary Infertile Women
INFERTILE WOMEN No. of Patients % Hypothyroidism
Primary 73 15%
Secondary 27 2%
Bar diagrams representing % Prevalence of Hypothyroidism in Primary and Secondary
Infertile Women

From our study, we found that the primary infertile category had more hypothyroid
patients ( i.e.,15%) compared to the secondary infertile category ((i.e., 2%).
Table 5: Prevalence of Hypothyroidism concerning the age range of infertile women
Age Range of Patients Number of patients % Prevalence of
Hypothyroidism
18-20 5 1
20-25 28 1
25-30 37 8
30-35 19 2
35-40 9 5
40-45 2 0

A pie diagram representing the age range of infertile women
In our study, we grouped the infertile patients based on their age, and the
highest number of infertile patients were found in the age group of 25-30 i.e.,
37 patients.

A bar diagram representing Prevalence of Hypothyroidism concerning the age range
of infertile women
After comparing the different age groups of infertile women, the highest prevalence
of hypothyroid patients was found in the age group of 25-30 (8%) which also had the
highest number of infertile women followed by the age group of 35-40 (5%), then 30-
35 (2%), and lastly 18-20, 20-25 had 1% prevalence. No hypothyroid patients were
found in the age group of 40-45.

Table 6: A table representing the overall mean age of infertile women along with the
mean age of primary and secondary infertile women.
AGE RANGE NUMBER OF
INFERTILE WOMEN
PRIMARY
INFERTILE
WOMEN
SECONDARY
INFERTILE
WOMEN
18-20 5 5 0
20-25 28 21 7
25-30 37 28 9
30-35 19 11 8
35-40 9 8 1
40-45 2 0 2
MEAN AGE 27.2 26.6 28.9

Bar diagrams representing the mean age of primary and secondary infertile women
The average age of women who are unable to conceive was computed and
found to be 27.2. In women with primary infertility, the mean age was 26.6,
while in those with secondary infertility, it was 28.9.

Table 7: A table representing % composition of infertile women identified with the
following factors
VARIOUS FACTORS LEADING TO INFERTILITY % COMPOSITION OF INFERTILE WOMEN
HYPOTHYROID 17
PCOD 40
FIBROID 15
ENDOMETRIAL CYST 7
PSYCHOSIS 1
UNKNOWN 20

After the complete analysis of our study that was conducted on 100 infertile
women, 17 had hypothyroidism but a higher number was seen in the PCOD
category (40) and 20 patients were infertile due to unknown reasons. Few infertile
women had fibroids (15), endometrial cysts (7) and only one infertile woman had
psychosis.
Bar diagrams representing % composition of infertile women identified with the
following factors

DISCUSSION
Our Prospective Observational study consisted of 100 women who were experiencing
infertility. We collected and tabulated the results of the study, and used the data to create pie
charts and graphs.
We have classified women who are unable to conceive into two groups based on their
medical history - primary and secondary infertility. As per the data presented in Table 2, out of
the total number of infertile women, 73 were identified as primary infertile, while the remaining
27 were categorized as secondary infertile. It is noteworthy that a majority of the participants
in the study belong to the primary infertility category.
We calculated the percentage of infertile women with Hypothyroidism attending the OPD of
Obstetrics and Gynecology Department of Shadan Institute of Medical Sciences, Teaching
Hospital, and Research Centre and found it to be 17%. The remaining 83% of the population
were euthyroid, as shown in Table 1. Our findings are consistent with the studies of Kamal A
Ahmed et al. and Priyanka Gupta et al., but contradict the study of Mohana Priya et al. The
prevalence of Hypothyroidism in the studies of Hasibul Hasan Shirazee et al. and Indu Verma
et al. is 21.9% and 23.9%, respectively.

This discrepancy could be explained by the higher sample sizes in the previously described
research.
The data presented in Table 3 highlights that among 17 patients diagnosed with
hypothyroidism, 10 had subclinical hypothyroidism and 7 had clinical hypothyroidism. By
analyzing Table 4, we can infer that out of 73 women who were diagnosed with primary
infertility, 15 suffered from hypothyroidism. Similarly, out of the 27 women with secondary
infertility, 2 were diagnosed with hypothyroidism. This suggests that a greater proportion of
primary infertile women are affected by hypothyroidism compared to those with secondary
infertility. These findings contradict the results of studies conducted by A A Akande et.al. and
N Akter et.al.
The age group of 25-30 has the highest number of infertile women, accounting for 37% as
shown in Table 5. Our study reveals that the age group of 25-30 has the highest occurrence
of hypothyroidism, with a prevalence rate of 8%.
The average age for primary infertility was found to be 26.6 years, while for secondary
infertility it was 28.9 years. The overall mean age was calculated to be 27.2 years, as per the
data presented in Table 6.

After conducting a thorough analysis of our study, we discovered that there were additional
factors contributing to infertility. These included conditions such as PCOD, Uterine Fibroids,
Endometrial cysts, Psychosis, and some cases where the root cause was unknown. Of all
the factors examined, PCOD was found to have the most significant impact on infertility.
(Table 7)
Infertility in women is often linked to hypothyroidism based on the results of assessments.
Nonetheless, the primary cause of infertility is PCOD.
As part of the standard infertility examination, it is recommended that thyroid screening
tests are conducted. Additionally, a routine Abdominal Ultrasound should be performed to
diagnose PCOD in infertile women. We highly recommend this investigation as a necessary
step for detecting infertility.

CONCLUSION
In a group of 100 women who had been experiencing infertility for at least a year, the
incidence of Hypothyroidism was found to be 17%. It has been observed that hypothyroidism
can play a significant role in infertility. Infertile women were found to have a higher prevalence
of subclinical hypothyroidism in contrast to clinical hypothyroidism.
The number of women suffering from primary infertility is greater than those facing secondary
infertility. The prevalence of hypothyroidism is higher in the primary infertile group in contrast
to the secondary infertile group. The group of women between the ages of 25 and 30 have a
higher rate of infertility in contrast to other age groups. Additionally, this same age group also
has a greater number of patients with hypothyroidism.
Infertile women frequently suffer from hypothyroidism, which can be a contributing factor to
their infertility. However, PCOD is the primary cause responsible for infertility according to the
results of the assessment. A further research study must be done on the impact of PCOD on
infertility.

Since hypothyroidism is commonly found in women who are struggling with infertility, it is
recommended to conduct a basic thyroid profile test early on in the investigation process. It is
advisable for every woman to undergo a thyroid test as a part of their regular check-up. By
treating hypothyroidism-induced infertility, one can avoid undergoing costly investigations and
invasive procedures to overcome infertility.
Our study has a few limitations:
• Less sample size
• As it was just 6 months long, study time was not sufficient to conduct follow-ups.
• Few lab parameters were not available to conduct efficient data collection and analysis.
• The study was conducted only at a single site.
• The major limitation is that we thought Hypothyroidism was a major cause of infertility but
after analyzing the results we found PCOD is the major cause of infertility.

BIBLIOGRAPHY
https://www.ncbi.nlm.nih.gov/books/NBK556033/
https://www.icliniq.com/articles/womens-health/prevalence-of-hypothyroidism
https://my.clevelandclinic.org/health/diseases/23187-unexplained-infertility
https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308
https://www.nhs.uk/conditions/infertility/treatment/
https://medlineplus.gov/hypothyroidism.html
https://www.verywellhealth.com/infertility-and-thyroid-disease-4019413
Shirazee HH, Pradhan M, Mondal T, et al. Prevalence of hypothyroidism in infertile women attending a
tertiary care centre in West Bengal, India - a prospective observational study. J Evid Based Med Healthc
2021;8(10):556-561. DOI: 10.18410/jebmh/2021/109
https://www.itmedicalteam.pl/health-science/citation-index.html

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