Elevated FSH

What is FSH?

Follicle Stimulating Hormone (FSH) is one of the two “gonadotropins” secreted from the pituitary gland to regulate the function of the ovary (LH or Luteinizing Hormone being the other). FSH stimulates the ovaries’ production of estrogen and promotes development of the follicles. The estradiol produced by the ovaries signals the brain to decrease the production of FSH. Therefore if there is not enough estrogen produced by the ovary, then the brain doesn’t receive the signal and FSH production continues.

What is ovarian reserve and why is it important?

Ovarian reserve is defined as the health of the ovaries and the eggs they contain. As a women ages, the amount of eggs in reserve naturally decreases and her FSH levels increase. The amounts of eggs in reserve can only be approximated.

How is ovarian reserve tested?

FSH blood test on Day 3
Estradiol blood test on Day 3
Clomiphene Challenge Test (CCT) on Day 3 of the menstrual cycle to determine the FSH level. Then Clomiphene is given on days 5-9 and then retest the amount of FSH on day 10. If the FSH is elevated as well on day 10, then this usually is an indicator of diminished ovarian reserve.
Test for low inhibin B levels which have to do with the feedback system from the ovaries to the brain and FSH production. If this number is low, then there is low ovarian reserve.
An ultrasound can be performed to see if basal antral follicles are present.

What is High FSH?

Remember FSH levels predict low fertility when they are abnormal but they do not accurately predict high fertility when normal. Also the cut off values are very laboratory dependent and your FSH can vary from cycle to cycle. High FSH, as a general rule, can be defined as a Day 3 value of over 10 mg/dl.

What do the numbers mean?

Less than 9	A good level and you should expect an adequate response to ovarian stimulation
9-10	Fair and response is between completely normal and somewhat reduced
10-12	Reduced ovarian reserve with a reduced response to stimulation and possibly some reduction in egg and embryo quality
12-17	Marked reduction in response to stimulation and more reduction in egg and embryo quality
Over 17	Very poor response or no response to stimulation
Over 30-40	Menopause suspected and menstrual cycles will tend to stop

What are the causes of High FSH?

The underlying causes of High FSH may include extreme stress, diminished blood flow to the ovaries, or lack of ovarian response to pituitary production of FSH.

What are the symptoms of High FSH?

Typically, symptoms of High FSH may include hot flashes, night sweats, vaginal dryness, infertility, irritability, menstrual irregularity, decreased libido, and headaches.

Western Treatment options for women with elevated FSH and reduced ovarian reserve:

In vitro fertilization with assisted hatching
In vitro fertilization with coculture
In vitro fertilization with donor eggs

Chinese Medicine Treatment for High FSH:

In our clinic, we use acupuncture, herbs, Reproductive Organ Massage, dietary guidelines, and meditation to address the elevation in FSH. By implementing these methods, we will be able to increase blood flow to the ovaries, relax the body and reduce stress, regulate the Hypothalamus-Pituitary-Ovarian axis, and increase egg quality.

Serving patients in Milpitas, Fremont, Silicon Valley, and the San Francisco Bay Area