High FSH Level and Diminished Ovarian Reserve
Understanding Elevated FSH and a Diagnosis of Poor Ovarian Reserve
Dec 20, 2008
A woman is born with all the eggs she will ever have. When trying to determine how many eggs a woman has left, doctors rely on several tests. One of these is a measurement of a woman’s FSH level. FSH, or follicle-stimulating hormone, is produced by the pituitary gland. It stimulates the ovaries to produce a follicle which will contain an egg.
The Relationship between Elevated FSH and Ovarian Reserve
A high FSH level indicates that the pituitary gland must work hard to help the ovaries produce an egg, since the supply of eggs is dwindling. A woman should discuss her individual FSH level findings with a reproductive endocrinologist familiar with her case; levels of 10 - Iu/L and higher, however, are generally considered to be elevated. Although FSH levels can fluctuate from month to month, it is generally accepted by most REs that the highest FSH level found gives the most accurate indicator of ovarian reserve.
FSH levels are usually tested on day 3 in a woman’s cycle as part of an initial fertility workup. Although rare, elevated FSH levels can also be caused by lactation, familial twinning or auto-immune diseases. FSH level testing is not the only indicator of poor ovarian reserve. Additional bloodwork to test Anti-Mullerian Hormone and Inhibin B levels, or ultrasounds to determine ovarian volume or antral follicle count will provide a doctor with more information before deciding on a diagnosis of DOR.
Is a Woman with High FSH and DOR in Menopause?
PJ, a New-York area woman who was diagnosed with diminished ovarian reserve, says family doctors or OB-GYNs who tell their infertile patients that they are in menopause solely based on an elevated FSH level do them a disservice. “In actuality, the entry to menopause is much more complex and subtle than any one test can indicate,” she writes on her website, highfshinfo.com.
A woman will pass through several phases of reproductive life before arriving at menopause. These include early, peak and late reproductive years, followed by perimenopause and then menopause. The Mayo Clinic advises on their website that the actual arrival of menopause can only be proven after the fact. “Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs.”
What Causes Elevated FSH and Diminished Ovarian Reserve?
Dr. Drew Tortoriello, medical director of Sher Institutes for Reproductive Medicine’s Manhattan location, says female age is a major factor. “As more women delay their child-rearing for personal/social reasons, the proportion of women experiencing DOR is skyrocketing,” he wrote in an email.
For younger infertile women with high FSH levels and poor ovarian reserve, Dr. Tortoriello gave several possible causes:
- Familial
- Environmental exposure (cigarettes, chemotherapy, radiation therapy)
- Trauma to ovary (“Surgery to the ovary to remove cysts with endometriomas is the usual culprit,” he added.)
- Chromosomal - loss of a portion of the X-chromosome or one whole X-chromosome (Turner syndrome)
- Genetic - galactosemia or fragile X syndrome permutation
Some believe that using wheatgrass, herbs or acupuncture can lower FSH levels, although a lowered FSH level does not improve DOR. “Claims of being able to truly lower FSH (and improve ovarian reserve) are controversial,” notes PJ at her website. Some women undergoing IVF do feel alternative therapies help. “I did acupuncture, supplements and shiatsu massage,” wrote PJ in an email. “I think these may have contributed to both of my successful pregnancies.”
Can a Woman with High FSH levels and a diagnosis of DOR Get Pregnant?
Finding medical support to achieve pregnancy with a diagnosis of poor ovarian reserve can be a challenge. Even if an elevated FSH level leads to a diagnosis of diminished ovarian reserve, however, an infertile woman can still achieve pregnancy. Assisted Reproductive Technology, such as intra-uterine insemination (IUI) or in-vitro fertilization (IVF) is usually recommended in order to maximize the chances of becoming pregnant.
