High FSH

I get a lot of traffic to this site from people searching for information on high FSH. Here is my take on it.

Follicle Stimulating Hormone is secreted by the pituitary gland and stimulates the ovaries to mature follicles in preparation for ovulation. An elevated level (>10mIU/ml) on day 3 of the menstrual cycle indicates that the brain is having to work harder to stimulate the ovaries; this is thought to be related to a diminished ovarian reserve. It also means that the patient is unlikely to respond well to ovarian stimulation medication used in IUI and IVF. Doctors tend to agree that you are only as good as your worst FSH result and that a lower result one month does not cancel out a poor result another month. However, there is no consensus on whether or not a low quantity of eggs also indicates a low quality of eggs. Many reports suggest that a younger woman with high FSH has a much better chance of success than an older one with the same FSH level because her eggs are younger and therefore likely to be of better quality.

Conventional thinking suggests that patients with high FSH have a very reduced chance of pregnancy, either with or without assistance. However, we do not know the FSH levels of those with no fertility problems so it is not possible to say that those who conceive easily always have low FSH levels. It is possible that an elevated FSH level in itself does not predict pregnancy outcome but that coupled with poor egg quality and/or other fertility problems, it may seriously reduce the chance of pregnancy.

Traditional Chinese Medicine believes that FSH and related egg quality can vary extensively from month to month and that this can be improved with the help of acupuncture and Chinese herbs. Practitioners believe that stress can play a big part in raising FSH levels and that this does not necessarily indicate lower egg quantity or quality.

A real life friend recently started trying for a baby. She conceived after a few months but sadly miscarried. She had had day 3 and 7dpo bloodwork done early on, mainly to make sure she was ovulating. Her GP had told her that all the results were normal and she hadn’t questioned it any further. After her miscarriage she asked me advice on a few things and I asked about her FSH level, just to rule that out as a problem. She looked up the number and called me back straight away. It was 13.4, she was 33 years old. I recommended, as casually as I could, that she make an appointment with a fertility clinic, just in case. She did but never got to keep it as she conceived shortly afterwards and everything has gone well since. So, with an FSH level of 13.4, she conceived fairly easily twice. If I hadn’t mentioned it, she would never have known about the high level.

My first FSH test, at age 35, showed my level to be 4.6. I was happy with that and didn’t think to research it any further. We carried on with tests and treatment (we were dealing with male factor infertility) for a year and a half before falling at the first hurdle of IVF. When I went for my first follicle scan after a week of ovarian stimulation, there were only three follices. Not the 15 or so I’d been expecting. I couldn’t believe it. My FSH levels were normal so how could this have happened? The nurse checked my blood test results. Yes, my FSH level was low but my E2 (oestradiol, a form of oestrogen) was over 400 pmol/l. Normal levels are below 275. A very high E2 level can suppress a high FSH level and give a low reading. My FSH should have been retested, the nurse guessed it would have been at least 10. A further week on ovarian stimulation medication yielded no further follicles but we went ahead with egg collection. We got two eggs, miraculously both fertilised and were transferred, pregnancy resulted, miscarriage followed.

The following month, my FSH level was 17. A subsequent IVF cycle was abandoned after only one measly follicle was produced after two weeks of stimulation on the highest dose of meds possible. We triggered, tried on our own anyway. Two weeks later, two lines. Another miscarriage. Another natural cycle, another pregnancy, another miscarriage. What was going on? I wasn’t supposed to be conceiving at all with my FSH level of 17. (As for the MFI, my husband had had a varicocele ligation in the meantime and his semen analyses results were back to normal). It was retested, still 17. At this stage we reckoned IVF was a waste of time and money and invested our efforts in trying to stop the miscarriages rather than trying to conceive in the first place. I was already on Cyclogest, aspirin, Heparin, HCG shots and Prednisolone each cycle and had started Low Dose Naltrexone. I was also doing acupuncture 2 or 3 times a week, depending on the stage of my cycle.

I took a month off and took a huge dose of antibiotics, designed to combat any low grade infection in my uterus that may be hampering my pregnancies. Next cycle I took 50mg of Clomid days 3-7 and all the above meds from ovulation. It worked. At the age of 37 and with an FSH level of 17, I supposedly had a statistical probability of about 2% of conceiving and even less of carrying to term.

There was something preventing me carrying to term but I don’t think it was high FSH. I had six miscarriages in a row – what are the odds that I recruited six bad eggs in a row, that were eager and willing to be fertilised but unhappy to stay the distance?

This time around I was too chicken to test. I was just too terrified that the result would be in the twenties and that would be the end of it. We were going to try anyway so I didn’t see the point in knowing, at least not at the start. And here I am, seven weeks pregnant with a healthy heartbeat, conceived with the help of nothing but acupuncture and a HCG trigger shot on my third postpartum ovulation. I am 39.

I completely understand if my few remaining readers are reaching for the Unsubscribe button. I have done that. I’m not even sure if this post is the start or the end of something.

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