BP Disorder & Planning for a Pregnancy
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Q:  BP Disorder & Planning for a Pregnancy

i was dxed in 92 and put directly on lithium causing me hypothyroidism or what ever its called and gained alot of weight. since then ive delt with weight problems. but my question doesnt deal with the weight its self but the thyroid. does this disorder dissapear and can it cause infertility? ive been pregnate once with a miscarrage. i didnt tell my family about it because i didnt want to hurt them or have them look down on me. it was only a month in to the pregnacy and i delt with it. but ive been in past relationships where it felt like the right time to try with no luck. right now im at a point in my life where i dont need to be pregnate so i dont plan on it. but what about the future. should i see a specialist instead of putting it off till im actualy ready only to find out that too much damage had been done? this question has been bothering me for months. the only thing ive ever wanted to be is a mother and am working my way to give my future children a life with less chaos and turmoil than mine was and as best of a life with every thing they could ever want like my parents did for me. so i have a long ways to go before i get to that point but i dont want to find out then that i could have prevented my self from infertitility..that would be the most devistating thing i could ever experiance and would have hit my last brick wall head on faster than 100mph and would give up...carying a child means more to me than my own life. but like i said im not ready now. but would like to know the awnser to my question above..okay enough rambling. an awnser would be greatly apprecieated.

dear jennifer -- 
Presuming your diagnosis was bipolar disorder, now would be a good time to prepare a plan for how pregnancy is going to be handled as far as what medications you should be on at the time you conceive, and then what medications you'll be on during the pregnancy and during breastfeeding.  As you've figured, it makes sense to have this worked out in advance.  There are some choices, when you're preparing in advance, that you just wouldn't have if you wait until you're pregnant.  In particular you need a plan for the very beginning of pregnancy, the "first trimester", which is when the brain and other organs first form -- in general, most of the routine medications we use should be avoided at that time and there needs to be some other approach already in place for that trimester before you conceive (because if you wait until you're sure you're pregnant, you're well into that trimester already!).  

So you can see, there's some planning to be done.  However, successful pregnancies are not only possible, they're the usual outcome.  In some respects the bigger challenges come after that, like having enough supportive "alloparents" -- people who can give good quality child care and substitute for you in the "mom" role -- so that you can get rest, especially sleep, especially early in the post-partum phase where there is substantial risk to you of a post-partum mood problem if you're exhausted or sleep-deprived.  So planning out who's involved raising this child besides you deserves as much thought, in my opinion, as what med's you'll be taking at what stages.  

Finally, as regards the thyroid bit.  There are simple ways to address lithium-induced hypothyroidism, as you've probably learned already.  Getting your thyroid status straight is important before pregnancy, but as far as I know (perhaps an ob-gyn doc' could tell you more) there is no barrier, especially no permanent one, from the hypothyroidism (e.g I wouldn't count on being hypothyroid as effective birth control!).  There may be some role for thyroid replacement as a treatment for bipolar disorder, so look into that.  

If this new approach gets studied, perhaps it might even be a new tool in the management of bipolar disorder during pregnancy! -- as there's not much reason to think that if you're on thyroid hormone (but not hyperthyroid from too much replacement) that there would be any risk to a fetus (although this won't really be known for another decade or so, if it becomes a routine treatment option, i.e. until lots of women have had pregnancies on thyroid hormone for treatment, and we see that they and their babies do okay)

Lastly, there is potentially a relationship between weight gain and infertility.  You might need to ask your ob-gyn, if you have one, about polycystic ovarian syndrome, if you're really having trouble getting pregnant.  

Good luck with all those important steps.

Dr. Phelps

Published February, 2002


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