High FSH Level: Its Effect on Fertility and Treatment
Speaker: Norbert Gleicher, MD
What is FSH? What is its role in the female reproductive cycle?
"FSH (follicle-stimulating hormone). This is one of the so-called gonadotropic, which is secreted by the pituitary gland and stimulates the growth of follicles. This is its physiological function, but in reproductive medicine, FSH has been, for many decades, the main diagnostic tool for determining how well the ovaries function in a woman. Virtually every gynecologist, not even specializing in the treatment of infertility, uses FSH to determine at least the first impression of the woman’s condition in terms of her reproductive health."
What level of FSH is considered high?
"The standard answer that you get from most textbooks and from an overwhelming number of colleagues is that the normal level of FSH is up to 10 international units per 1 ml (U / L), some even say up to 12. We do not share this opinion. FSH rises with the age of women and, therefore, it does not make sense to assume that the normal level of FSH for young women, say, for a 21-year-old woman, is the same as the normal level of FSH for 43-year-olds. Nevertheless, this is how our medicine and our specialization has evolved over the past thirty years. And therefore, a few years ago we established what we call age levels of FSH. And therefore, today, in our practice, we use those to determine whether a woman’s ovulation reserve is normal or not."
At what level is FSH pregnancy impossible?
"The reflection of the maximum level of FSH is relative depending on age and other determining factors. But I can say that as soon as FSH reaches 30, and, of course, if it reaches level 40, then conception becomes practically very difficult, if almost impossible, even for young patients. The younger the patient, the higher our chances of achieving pregnancy using our own eggs, even if she has high FSH."
Many doctors believe that the level of FSH should decrease before the patient tries to use the IVF cycle. Is this approach (wait and see) a convincing advice?
"FSH is not a disease, FSH is a symptom. This is a reflection of the work of the ovaries. So we, in fact, do not look at the current level of FSH. We look more comprehensively at what the ovulation reserve of the patient actually looks like. If you expect a decrease in the level of FSH, you postpone the possibility of the patient getting pregnant for several months. And we really do not believe in waiting. We trust the expectation in the case when a medicine, like DHEA, has a beneficial effect on the ovaries. But as soon as we start work, we want to move forward."
Are there effective treatments for a reduced ovulation reserve?
Many colleagues believe that reduced ovulation reserve is incurable. Our center does not share such an opinion, and did not share it for many years, basing itself in principle on our experience with DHEA. Thanks to this experience, we have come to a new understanding of the aging of the ovaries. One of the interesting observations made in treating patients with DEA with an extremely severely reduced ovulation reserve is that we not only get an unexpected number of pregnancies, but also, as soon as these women become pregnant, the level of miscarriages is surprisingly low."
Can a woman become pregnant after she was denied treatment at the artificial insemination center due to high levels of FSH? Having a high level of FSH, what is a prerequisite for them to conceive?
"Approximately one third of the patients who came to us, because they were told that their only chance of conceiving is a donor egg, and they leave us, becoming pregnant with their own. Thus, a minority, but still a fairly large proportion of patients with an overly depleted ovarian reserve and usually quite high FSH, with appropriate treatment in CHR, will still get a fairly decent chance of becoming pregnant."
What does it mean for a young woman if she has high FSH?
"This is a diagnosis and it basically means that the woman is prematurely aging the ovaries. Quite often, it is not recognized that young women may have a lower FSH level than older women, and therefore, in essence, a normal figure is perceived as undervalued. We call it testing the characteristic age-related functions of the ovaries, or the age characteristic of FSH, in this context. And this is an extremely important concept for determining the diagnosis of premature ovarian aging. Many young women beat the thresholds of countless infertility clinics for years with the so-called diagnosis of unexplained infertility because no one considered them FSH or AMG (Anti-Muller Hormone) by age characteristics. And as soon as it is established that the cause of their suffering is premature aging of the ovaries, the whole treatment regimen changes. Then we stimulate them differently and find a different approach to their situation, and suddenly, women, who have not understood for many years why they cannot become pregnant, suddenly become pregnant."
Dr. Gleicher is the founder and medical director of the Center for Human Reproduction, located in New York. He has more than 30 years of experience in reproductive endocrinology and infertility. As a doctor, he devoted himself not only to treating patients, but also to research, he published hundreds of scientific papers in the most important medical journals, and also wrote and edited a number of textbooks. Dr. Gleicher is a member of many editorial boards, and is often invited by a speaker at medical conferences around the world.
Norbert Gleicher, MD, FACOG, FACS
Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has been published online for reviewing, immunological issues and infertility.