Infertility Treatment When You Have Diabetes or Thyroid Disease: What the Team Adjusts

The appointment was supposed to be about egg counts and cycle timing. Instead, the first question was about a thyroid test from eighteen months ago, and the second was about the last A1C result. For many people, this is the moment they learn that infertility treatment with diabetes or thyroid disease looks a little different from the version their friends describe.

It is rarely a closed door. More often it is a reordering. The endocrine system and the reproductive system share so much wiring that a fertility specialist cannot sensibly stimulate ovaries, time insemination or transfer an embryo without knowing how the thyroid and the pancreas are behaving that month.

What follows is an honest account of what the team actually checks, what tends to be adjusted, who is usually asked to wait and for how long, and which beliefs about thyroid “fixes” and diabetes do not hold up to the evidence.

How infertility treatment with diabetes or thyroid disease actually begins

Most fertility pathways begin the same way regardless of medical history. Infertility is usually defined as not conceiving after a year of regular, unprotected sex, and the NHS notes that around one in seven couples may have difficulty conceiving within that time. The workup covers ovulation, tubal patency, semen analysis and ovarian reserve.

With diabetes or thyroid disease in the picture, two things are added before anything is prescribed. The first is a current snapshot of metabolic and thyroid control: thyroid-stimulating hormone (TSH, the pituitary signal that tells the thyroid how hard to work), free thyroxine, often thyroid peroxidase antibodies, and for diabetes an A1C (a measure of average blood glucose over roughly three months) alongside kidney function and, where relevant, a retinal check.

The second addition is a medicines review. Fertility treatment is, in effect, planned pregnancy, and some drugs that manage glucose, blood pressure or cholesterol are not considered suitable once conception is possible. Nobody is asked to stop anything on the spot; the prescribing clinician plans substitutions and timing.

Only then does the reproductive plan take shape. For some that is timed intercourse with ovulation induction, for others intrauterine insemination, for others IVF. The techniques themselves are not different. What differs is the sequencing, the extra blood draws around stimulation, and the shared decision-making between endocrinology and reproductive medicine. In practice the two specialties often agree a written plan, so that a rising TSH or a low glucose reading during stimulation has an owner and a response before it happens.

Can your thyroid cause infertility? What the gland does in a woman

Yes, it can, though more often by disrupting ovulation than by preventing conception outright. The thyroid sets the metabolic tempo of nearly every tissue, and the reproductive axis listens closely.

In a woman the thyroid influences how the hypothalamus and pituitary release the hormones that trigger follicle growth and ovulation. When the gland is underactive, the pituitary releases more thyrotropin-releasing hormone, which also nudges up prolactin, the milk hormone. Raised prolactin can suppress ovulation, lengthen cycles or stop periods entirely. Low thyroid hormone also alters sex-hormone binding globulin, shifting the balance of circulating estrogen and testosterone.

The Mayo Clinic lists heavy or irregular periods among the recognized features of hypothyroidism, and Cleveland Clinic notes that untreated thyroid disease can make conception harder and raise early pregnancy risks. The reverse pattern, an overactive gland, tends to produce lighter, shorter or absent periods, and the resulting weight loss and high metabolic demand can further disturb cycles.

Men are not exempt. Thyroid dysfunction in either direction has been linked in clinical studies to reduced libido, erectile difficulties and changes in sperm motility, which is one reason a thyroid test sometimes appears on a male partner’s panel.

The encouraging part is that these effects are largely reversible once thyroid hormone levels normalize. Ovulation often returns on its own when an underactive thyroid is replaced, which is why guidelines place thyroid assessment early in the fertility workup rather than treating it as an afterthought.

When “normal” thyroid levels still matter: TSH levels for fertility and antibodies

A result stamped “within range” is not always the end of the conversation. Standard laboratory ranges describe the general population, and pregnancy changes the goalposts.

The 2017 guideline of the American Thyroid Association on thyroid disease in pregnancy recommends that women already taking thyroid hormone keep TSH in the lower half of the trimester-specific range, and where that range is not available, below about 2.5 mIU/L. Many fertility teams apply the same target when planning treatment, because the first weeks after conception are exactly when the embryo depends entirely on maternal thyroid hormone.

Two further results shape decisions. Subclinical hypothyroidism means TSH is raised while free thyroxine is still normal; the gland is straining but coping. The ATA guideline recommends treating this in women undergoing IVF or ICSI. The other result is thyroid peroxidase antibodies, immune markers that signal the thyroid may be under attack even when hormone levels are fine. Antibody-positive women have a higher chance of their TSH drifting upward during stimulation and pregnancy, so they are watched more closely.

Here the evidence is more sobering than the internet suggests. A large UK randomized trial of thyroid hormone in antibody-positive women with normal TSH found no improvement in live birth rates, and the ATA guideline does not recommend routine treatment for that group. In other words: a raised TSH is worth correcting; positive antibodies alone are a reason to monitor, not automatically to medicate. The judgment about which side of that line a person falls on belongs to the endocrinologist reading the full picture.

Can people with diabetes be infertile? Diabetes and infertility in women and men

Diabetes does not make a person infertile by definition, but both type 1 and type 2 can make conception harder and make early pregnancy riskier, which is why the two are managed together.

In women, the mechanisms differ by type. Type 2 diabetes frequently travels with insulin resistance and polycystic ovary syndrome (PCOS, a condition of irregular ovulation, excess androgens and often multiple small ovarian follicles). High insulin levels push the ovaries to make more androgen and disturb the pulse of ovulation signals, so cycles become infrequent or absent. Type 1 diabetes, especially when glucose control has been difficult over years, is associated with later menarche, more cycle irregularity and earlier menopause in observational studies.

In men, the National Institute of Diabetes and Digestive and Kidney Diseases and the Mayo Clinic both list erectile dysfunction and retrograde ejaculation (semen entering the bladder rather than leaving the body) among diabetes-related complications caused by nerve and blood-vessel damage. Research also points to higher rates of sperm DNA fragmentation with poorly controlled glucose.

Then there is the pregnancy itself. NIDDK explains that high blood glucose in the first weeks, often before a test turns positive, raises the risk of miscarriage and of birth defects affecting the heart, spine and brain. That single fact drives most of what fertility teams adjust: they want glucose as steady as it can safely be before an embryo exists, not after.

None of this means conception is unlikely. It means the preparation is deliberate, and that a diabetes team becomes part of the fertility team.

What the team adjusts first: the preconception window

Think of the weeks before treatment as the part of the pathway with the most leverage. Nothing in the IVF lab can undo a glucose spike in week five of pregnancy; a good preconception plan can prevent it.

For diabetes, the shared target is an A1C as close to the non-diabetic range as can be achieved without frequent hypoglycemia. NIDDK describes this as the central preconception goal and recommends that eye, kidney and blood pressure checks happen before pregnancy, because retinopathy can progress during gestation and some kidney changes influence how a pregnancy is monitored. Insulin remains the standard glucose-lowering therapy in pregnancy, and people on oral or injectable agents are often transitioned ahead of time under their diabetes team.

For the thyroid, the first adjustment is confirming that TSH sits where the endocrinologist wants it, not merely within the lab range. People on replacement are often told to expect a repeat test and possible adjustment; those with untreated subclinical hypothyroidism may begin treatment before stimulation.

Across both conditions, the team reviews:

• Medicines not suited to pregnancy, such as certain blood pressure drugs (ACE inhibitors and angiotensin receptor blockers) and statins, which are typically replaced or paused by the prescriber.
• Folic acid, started before conception; people with diabetes are often prescribed a higher-strength version, a decision made by the clinician.
• Smoking, alcohol and sleep, each of which affects both glucose and reproductive hormones.

This window can feel like a delay. Clinically it is the opposite: it is the part of treatment most likely to change the outcome of the pregnancy that follows.

Thyroid medicines during fertility care: underactive and overactive glands

Two very different thyroid problems lead to two very different adjustments.

An underactive thyroid is managed with levothyroxine, a synthetic version of the hormone the gland would normally make. It does not stimulate the thyroid; it simply replaces what is missing, and the body converts it to the active form. Because the hormone has a long half-life, blood levels change slowly, and the Mayo Clinic notes that TSH is usually rechecked around 6 to 8 weeks after a change. Fertility teams build that lag into their calendar, which is why a thyroid adjustment can push a planned cycle back by one or two months. The ATA guideline adds that thyroid hormone requirements rise soon after conception, so treated women are typically asked to retest as soon as pregnancy is confirmed and roughly every four weeks through mid-pregnancy.

An overactive thyroid, most often from Graves’ disease (an autoimmune condition in which antibodies switch the gland on), is handled with more caution. Antithyroid drugs block hormone production, but the two generic agents in this class carry different safety profiles at different stages of pregnancy, so the endocrinologist may switch between them around conception. Untreated hyperthyroidism in pregnancy is linked to miscarriage, preterm birth and growth restriction, so teams generally want the condition quiet and stable before fertility treatment starts.

People who have had radioactive iodine treatment are usually asked to wait; the ATA guideline advises deferring conception for at least six months afterward and confirming stable thyroid hormone levels first. In every scenario, changes are made by the prescribing clinician, never by the patient adjusting a bottle at home.

Diabetes medicines during infertility treatment: what changes and what doesn't

The honest summary is that insulin usually stays, several newer agents usually go, and one older tablet occupies a gray zone.

Insulin does not cross the placenta in meaningful amounts and remains the reference treatment for glucose control in pregnancy, so people with type 1 diabetes continue it throughout fertility treatment. What changes is the intensity of monitoring. Ovarian stimulation raises estrogen sharply, and progesterone support after transfer adds a hormone known to reduce insulin sensitivity, so glucose readings may drift upward within a cycle. Continuous glucose monitoring, where available, makes those shifts visible in real time.

Metformin, which lowers hepatic glucose output and improves insulin sensitivity, sits in the gray zone. The NHS lists it among options used to help ovulation in women with PCOS who have not responded to first-line treatment, and some teams continue it into early pregnancy while others stop it once a pregnancy is confirmed. The evidence on continuing it through pregnancy is mixed, and the decision is individualized.

GLP-1 receptor agonists, the injectable class that slows gastric emptying and reduces appetite, and SGLT2 inhibitors, which make the kidneys excrete glucose, are not recommended in pregnancy. Manufacturers’ labelling for GLP-1 agents advises stopping before a planned pregnancy, with the exact interval set by the prescriber. People switched off these drugs often see glucose and weight change, which is another reason the switch is planned weeks ahead rather than mid-cycle.

A practical point patients rarely hear: the fertility clinic and the diabetes clinic may each assume the other is watching the glucose. Ask who owns that number during your cycle.

Hypothyroidism and IVF: how ovarian stimulation shifts the thyroid

IVF adds a wrinkle that routine fertility care does not: the hormone surge of controlled ovarian stimulation can change thyroid results within days.

During stimulation, estrogen can climb to many times its usual level. Estrogen increases thyroxine-binding globulin, the protein that carries thyroid hormone in the blood. More of the hormone becomes bound and inactive, free hormone dips, and the pituitary responds by raising TSH. In a healthy thyroid the gland simply makes more hormone and the system rebalances. In a thyroid already working at its limit, or one being fully replaced by tablets, that compensation is weaker, and TSH may rise above the planned target.

The ATA guideline notes this effect and advises caution about interpreting TSH drawn during or immediately after stimulation; it suggests that where retesting is needed, waiting a week or two after stimulation gives a more reliable value. Teams handle this in one of several ways: checking TSH before the cycle starts and ensuring it sits comfortably below target, retesting after egg retrieval, or planning a frozen embryo transfer in a later, calmer cycle so that the thyroid can be reassessed first.

Hyperthyroidism poses a different IVF concern. Stimulation itself is well tolerated when the condition is controlled, but ovarian hyperstimulation syndrome (OHSS, a complication in which fluid shifts out of blood vessels after stimulation) places extra strain on the heart and circulation, systems already working harder in an overactive thyroid state. Stable thyroid function before stimulation is therefore a safety matter, not only a success matter.

None of this makes IVF unsuitable with thyroid disease. It makes the pre-cycle thyroid check non-negotiable.

Who is usually treated now, and who is usually asked to wait

Guidelines do not publish a rigid list, but clinical practice follows a fairly consistent logic: proceed when the endocrine condition is stable and safe for pregnancy, pause when it is not.

People who usually proceed without delay include those with well-replaced hypothyroidism whose TSH is already in the target range, those with type 1 or type 2 diabetes whose A1C is near goal with no untreated retinopathy or significant kidney disease, and those with PCOS-related insulin resistance where ovulation induction is itself part of the treatment plan.

People who are usually asked to wait, typically for a defined and explained period, include:

• Anyone whose TSH is above target and needs replacement started or adjusted; the retest interval alone is around 6 to 8 weeks, per Mayo Clinic guidance on hypothyroidism.
• Anyone with active, uncontrolled hyperthyroidism, until hormone levels are stable on treatment.
• Anyone who has recently had radioactive iodine; the ATA guideline advises at least six months before conception.
• Anyone with an A1C well above goal, until glucose control has improved and pregnancy-unsuitable medicines have been replaced.
• Anyone with proliferative retinopathy that has not yet been treated, since pregnancy can accelerate it.

Age complicates these pauses. A delay of two months matters differently at 28 than at 40, and fertility specialists weigh declining ovarian reserve against the benefit of stabilizing a condition. Sometimes the compromise is to collect and freeze eggs or embryos while the endocrine work continues, then transfer later. That is a decision for the treating team, taken with the patient’s priorities on the table.

Infertility treatment with diabetes or thyroid disease at a glance: what gets checked and why

Patients often leave consultations with a list of tests and no sense of how they fit together. This table lays out the usual pre-treatment checks, what each one tells the team, and when it tends to be repeated. Exact timing varies by clinic and by individual.

Test	What it shows	Why it matters before treatment	Typical repeat point
TSH and free thyroxine	How hard the pituitary is pushing and how much hormone is circulating	Sets the baseline; guideline target for treated women is TSH below about 2.5 mIU/L	6–8 weeks after any change; soon after positive pregnancy test; about every 4 weeks to mid-pregnancy
Thyroid peroxidase antibodies	Autoimmune activity against the thyroid	Flags people whose TSH may rise during stimulation or pregnancy	Usually once; monitoring is by TSH thereafter
A1C	Average glucose over roughly three months	High early-pregnancy glucose raises miscarriage and birth defect risk	Every 3 months during planning; more often in pregnancy
Kidney function and urine protein	Early diabetic kidney changes	Influences blood pressure management and pregnancy monitoring	Before treatment, then per diabetes team
Retinal examination	Diabetic eye disease	Pregnancy can accelerate retinopathy; treatment is safer beforehand	Before conception and during pregnancy
Semen analysis (partner)	Count, motility, shape	Diabetes and thyroid disease can affect sperm and ejaculation	Repeated if abnormal or after lifestyle or glucose changes

The timing intervals above are drawn from the Mayo Clinic, the American Thyroid Association pregnancy guideline and NIDDK; they are typical ranges rather than fixed rules. What the table makes visible is the rhythm of this kind of care. The thyroid is checked at the points where hormones shift fastest, and glucose is checked continuously because the window of greatest fetal vulnerability opens before most people know they are pregnant.

What the following weeks usually look like

Once the team is satisfied with baseline results, the cycle itself follows a familiar shape, with a few extra appointments threaded through it.

In a medicated or IVF cycle, the first week involves daily or near-daily hormone injections and several ultrasound and blood checks. People with diabetes often notice glucose creeping upward as estrogen rises, and insulin plans may be adjusted mid-cycle by the diabetes clinician; this is expected, not a sign of anything going wrong. Some teams schedule a glucose review a few days into stimulation for exactly this reason.

Around egg retrieval, which is a short sedated procedure, fasting instructions need tailoring for anyone on insulin so that glucose does not fall too low. This is a conversation to have in advance, not on the morning of the procedure.

After transfer, progesterone support begins. Progesterone reduces insulin sensitivity and may leave glucose readings higher than usual for the two weeks until a pregnancy test. Thyroid-wise, the ATA guideline notes that TSH drawn immediately after stimulation can be misleading, so some teams wait a week or two before retesting.

If the test is positive, the pace quickens. The guideline recommends TSH soon after confirmation and then roughly every four weeks through the middle of pregnancy, because requirements climb early. Diabetes care also intensifies, with more frequent glucose targets and an early scan.

If the test is negative, the team typically reviews the endocrine results from the cycle alongside the embryology before planning the next attempt. Two cycles are rarely identical in this setting; each one adds information about how the thyroid and glucose behaved under hormonal load.

What people often get wrong

Some of the most common beliefs about thyroid, diabetes and fertility sound reasonable and are simply not supported.

“I can get my thyroid back to normal naturally.” For hypothyroidism caused by autoimmune damage, the gland cannot regrow lost tissue, and no diet, supplement or herb has been shown in controlled trials to restore its function. The NIH Office of Dietary Supplements notes that iodine deficiency is a cause of hypothyroidism, but in iodine-sufficient countries extra iodine does not help and excess can worsen autoimmune thyroid disease. Selenium has been studied; results are inconsistent and it is not a treatment. Replacement hormone is the evidence-based option, and it is a conversation for the prescriber.

“Normal TSH means my thyroid is fine for fertility.” As the ATA guideline makes clear, pregnancy-planning targets are narrower than population ranges, and antibodies can predict trouble ahead even when today’s number is unremarkable.

“Diabetes means I’ll be infertile, so there’s no point trying.” Diabetes affects ovulation, sperm and early pregnancy risk, but NIDDK’s guidance is built around the premise that planned, well-controlled pregnancies are achievable.

“I should stop my diabetes tablets myself before IVF so they don’t harm the baby.” Abrupt stopping can send glucose soaring in the very weeks that matter most. Substitution is planned by the clinician, usually well before treatment.

“Thyroid medicine is a fertility drug.” It restores ovulation only when low thyroid hormone was the cause. In antibody-positive women with normal TSH, a large randomized trial found no benefit for live birth.

Each of these myths shares a root: treating a complex, slow-moving endocrine system as if it had an on-off switch.

Questions to ask your care team

Good questions do more than gather information; they reveal whether the endocrine and fertility plans are actually joined up. These are the ones that tend to surface the gaps.

• What TSH target are you using for me before and during treatment, and why that number?
• Have my thyroid antibodies been tested, and how will a positive result change monitoring?
• If my thyroid medicine is adjusted now, how long before we recheck, and does that move my cycle start date?
• What A1C level are you comfortable starting treatment at, and what happens if I am above it?
• Which of my current medicines are unsuitable in pregnancy, who will change them, and when?
• During stimulation and after transfer, who is monitoring my glucose, and how do I reach them between appointments?
• How will fasting for egg retrieval be handled with my insulin?
• Would you recommend freezing embryos and transferring in a later cycle so my thyroid or glucose can be reassessed first?
• Has my partner’s semen analysis been reviewed in light of his diabetes or thyroid results?
• Have my eyes and kidneys been checked recently enough for pregnancy planning?
• Once I am pregnant, how often will thyroid and glucose be checked, and which team leads that care?

Write the answers down. The same question put to the endocrinologist and the fertility specialist occasionally produces two different answers, and noticing that early lets the two teams align before the cycle begins. If an answer is “we usually don’t check that,” it is fair to ask what the guidelines say; the ATA pregnancy guideline and NIDDK preconception guidance are both public documents your clinician will recognize.

When to call your doctor

Most of fertility care with diabetes or thyroid disease is scheduled and predictable. A few situations are not, and they warrant a same-day call rather than waiting for the next appointment.

During or after ovarian stimulation, contact the fertility team urgently for rapidly increasing abdominal swelling or pain, nausea and vomiting that stop you keeping fluids down, breathlessness, or passing much less urine than usual. These can indicate ovarian hyperstimulation syndrome, which is more serious when thyroid or glucose control is unstable.

For diabetes, seek immediate help for persistent high glucose with vomiting, abdominal pain, deep or rapid breathing or fruity-smelling breath, which can signal diabetic ketoacidosis. Repeated low glucose readings, especially around fasting for procedures or after medication changes, also need a prompt review.

For the thyroid, call if you develop a racing or irregular heartbeat, fever with agitation or confusion, or marked shaking and heat intolerance, particularly if hyperthyroidism is known or antithyroid medicine has recently changed. A sore throat with fever in someone on antithyroid drugs needs same-day blood tests, because this class can rarely suppress white blood cells.

In early pregnancy, report any bleeding, severe one-sided pelvic pain or shoulder-tip pain without delay.

Call emergency services for chest pain, fainting, a seizure, or a glucose level that will not come up despite treatment.

Everything else, from a thyroid result that looks slightly off to a glucose pattern you do not understand, belongs in a routine message to the team. In this kind of care the most useful habit is simple: when in doubt, ask, and let the people who know your results decide what it means.

Frequently asked questions

Can your thyroid cause infertility even if you have no symptoms?

Yes. Mild hypothyroidism can disturb ovulation and raise prolactin without producing the fatigue or weight change people expect, and subclinical hypothyroidism by definition has normal thyroxine with a raised TSH. The ATA guideline recommends treating subclinical hypothyroidism in women undergoing IVF. Thyroid testing is part of a standard fertility workup precisely because symptoms are an unreliable guide.

What does your thyroid do in a woman's reproductive system?

Thyroid hormone sets the pace of the hypothalamus and pituitary signals that drive follicle growth and ovulation, influences prolactin, and alters the protein that carries sex hormones in the blood. Too little hormone can lengthen cycles or stop ovulation; too much can shorten or suppress periods. After conception, the embryo relies entirely on maternal thyroid hormone for the first weeks of brain development.

Can people with diabetes be infertile?

Diabetes does not automatically cause infertility, but it can make conception harder. Insulin resistance in type 2 diabetes often coexists with PCOS and irregular ovulation, type 1 diabetes is associated with more cycle irregularity, and in men diabetes-related nerve and blood vessel damage can cause erectile dysfunction and retrograde ejaculation. With planning and good glucose control, NIDDK guidance treats pregnancy as a realistic goal.

How can I get my thyroid back to normal naturally before fertility treatment?

For autoimmune hypothyroidism, there is no diet or supplement shown in controlled trials to restore thyroid function, because damaged gland tissue does not regrow. Adequate iodine matters where deficiency exists, but extra iodine in iodine-sufficient countries can worsen autoimmune thyroid disease, according to the NIH Office of Dietary Supplements. Replacement hormone is the evidence-based route, and whether you need it is a decision for your clinician.

What TSH levels for fertility do clinics usually aim for?

Many fertility teams follow the American Thyroid Association pregnancy guideline, which recommends that treated women keep TSH in the lower half of the trimester-specific range or, where that range is unavailable, below about 2.5 mIU/L. Targets for untreated women with normal results are less standardized. Your own target should be set by your endocrinologist, taking antibodies and planned treatment into account.

Does hypothyroidism and IVF stimulation interact?

Yes. Stimulation raises estrogen, which increases the protein that binds thyroid hormone, so free hormone dips and TSH can rise. A healthy thyroid compensates; a fully replaced or struggling one may not. The ATA guideline notes that TSH drawn right after stimulation can mislead and suggests retesting a week or two later. Some teams freeze embryos and transfer in a calmer cycle once the thyroid has been rechecked.

Will I have to stop my diabetes medicines before fertility treatment?

Possibly some of them. Insulin is continued, metformin is handled case by case, and GLP-1 receptor agonists and SGLT2 inhibitors are not recommended in pregnancy and are usually stopped beforehand. Blood pressure drugs such as ACE inhibitors and statins are also typically replaced. These changes are planned weeks in advance by your prescribing clinician; stopping anything abruptly on your own can destabilize glucose.

How long does a thyroid adjustment delay fertility treatment?

Usually by one to two months. Thyroid hormone has a long half-life, and the Mayo Clinic notes that TSH is typically rechecked about 6 to 8 weeks after a change. If the result is still outside target, another adjustment and another wait may follow. Teams sometimes use that time for other parts of the workup so the delay is not wasted.

Does diabetes or thyroid disease in my male partner matter for fertility treatment?

It can. Diabetes may cause erectile dysfunction, retrograde ejaculation and higher sperm DNA fragmentation, while thyroid dysfunction has been linked to reduced libido and altered sperm motility. A semen analysis is standard, and a thyroid or glucose review may be added if results are abnormal. Improving glucose control and correcting thyroid levels can improve semen parameters in some men, though timelines vary.

Once I am pregnant after treatment, how often are thyroid and glucose checked?

More often than before. The ATA guideline recommends checking TSH as soon as pregnancy is confirmed and then roughly every four weeks through mid-pregnancy because hormone needs rise early. Glucose monitoring intensifies as well, with tighter targets and an early scan. Who leads this care, the fertility clinic, endocrinologist or maternity team, varies, so ask before the pregnancy test rather than after.

References

• Infertility, NHS
• Pregnancy if You Have Diabetes, NIDDK, National Institutes of Health
• Hypothyroidism, Cleveland Clinic

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.