When I speak to women who have been told that they have high FSH levels, their outrage is palpable. So many women with elevated FSH levels are frustrated to the point of fury. They feel sucker-punched by Mother Nature after learning about this reduced fertility indicator—something they may never have heard about before entering a doctor’s office.
They don’t understand the meaning of having high FSH, and many are quickly forced to confront the hard reality that a genetically linked child may not be in the cards for them. It can be incredibly difficult to hear the news that the best option for building a family is through donor eggs before you ever get a chance to attempt pregnancy with your own eggs.
What does having high FSH levels mean?
An elevated FSH indicates diminished ovarian reserve. Diminished ovarian reserve is associated with a reduced number of follicles or eggs, often of questionable quality. Statistically, the chances of a successful pregnancy for women with demonstrated and consistently high FSH levels are not good.
Fertility specialists are loath to use drug-heavy, complicated therapies such as in vitro fertilization (IVF) when the likely outcome is the heartbreaking disappointment of a failed cycle. So they offer egg donation as the treatment option of choice because this increases the odds of taking home a healthy baby.
But talk of statistical evidence and the donor egg alternative only stokes the pain of women who want their shot at a genetically linked child. Infertility patients are a scarce breed. We can hear that there is a 90% pregnancy failure rate for our diagnosis, and we hear a 10 percent chance – and we want it. We are often willing to gamble.
In an atmosphere so electrified by emotion, it is often difficult for patients to discern the facts that will help them make informed decisions about infertility treatment.
High FSH levels symptoms
Follicle-stimulating hormone (FSH) is an important hormone in the human body regarding a woman’s fertility. Follicle-stimulating hormone is involved in the maturation of eggs in the ovaries in females. High levels of FSH can be symptomatic of several conditions, and the specific symptoms you might experience will depend on the underlying cause.
In women, high levels of FSH are often associated with menopause or ovarian disorders. Symptoms might include:
- Irregular or absent periods
- Hot flashes
- Night sweats
- Vaginal dryness
- Low libido
- Mood swings
- Difficulty sleeping
- Problems with memory and concentration
- Weight gain
However, having a high FSH alone don’t directly cause these symptoms. Instead, they’re usually a sign of an underlying condition that is causing both the symptoms and elevated FSH.
What causes high FSH levels?
High FSH levels can be caused by several factors, including:
- Menopause: As women approach menopause, the ovaries begin to respond less to the hormones that stimulate egg development. This can lead to higher-than-normal levels of FSH in the blood.
- Premature Ovarian Insufficiency (POI): This condition occurs when the ovaries stop functioning correctly before age 40. This can result in high FSH levels as the body tries to stimulate the ovaries.
- Polycystic Ovary Syndrome (PCOS): While women with PCOS often have higher levels of luteinizing hormone (LH), some may also have elevated FSH levels.
- Turner Syndrome: This condition, which affects females, is caused by a missing or incomplete X chromosome. One of the results can be high FSH levels.
- Ovarian Resistance Syndrome: This is a rare condition where the ovaries are resistant to FSH, leading to increased hormone levels in the blood.
- Follicle-Stimulating Hormone (FSH) stimulates estrogen production, which, in turn, jolts follicular growth. The follicle is the sac in which the egg matures until it is released into the fallopian tube during ovulation.
- During a woman’s reproductive years, as long as the ovaries function normally, FSH levels peak monthly during the middle of the menstrual cycle but are otherwise low.
- Near the end of those “reproductive” years, FSH levels begin to rise early in the cycle and eventually stay elevated at all times.
- The usual onset of menopause is at around 51 years of age. Or it can happen prematurely, beginning before age 40.
FSH Test Results
Ovarian Reserve Screening involves multiple tests to better understand the likelihood of achieving a live birth.
There is no single test that is the best predictor of live birth.
All test results should also be interpreted in the setting of age and prior performance during treatments.
Low FSH, higher AMH levels, and Antral Follicle Counts are associated with a better prognosis.
High FSH, low AMH, and Antral Follicle counts are associated with a worse prognosis.
Age is an overriding factor that must be considered in these tests. Older women will always have a more challenging time getting pregnant despite having similar levels.
TABLE: General Interpretation of Ovarian Reserve Screening
Normal FSH Levels by age
|Antral Follicle Count
|>1.2 ng/mL *
*AMH levels over 4 ng/mL and AFC over 20 may be associated with Polycystic Ovarian Syndrome
How to Lower High FSH Levels
It is possible to lower FSH levels using estrogen medication and birth control pills. However, lower FSH levels don’t change the ovarian reserve or your chances of getting pregnant.
FSH and Pregnancy
High FSH levels early in the menstrual cycle are a marker of a failing ovary. However, it’s not an all-or-nothing phenomenon. It’s a predictor of reduced fertility, which is not the same thing as sterility.
Despite high FSH levels, stimulation, and IVF attempts that didn’t pan out, a small number of patients can still walk away and conceive.
Some reproductive endocrinologists call elevated FSH levels an empiric observation that egg quality is low and synonymous with low implantation rates. That, however, is a statistical, and not an absolute, statement.
Poor-quality eggs cannot generate the cellular energy required for the seven-day sprint from ovulation to implantation. There is a lack of function; it just can’t keep up. And it’s honest to communicate this to women with high FSH levels. Brutal but honest.
And do the research. Given the sheer number of women who delay childbearing until their mid-30s and 40s when FSH levels rise, along with the associated increased risk of implantation failure and miscarriage, research focuses on treatments that will preserve maternal genetics. One crucial piece of the puzzle lies in unlocking the mystery of the aging process of the ovary.
Why does the rate of ovarian aging accelerate when women are around 37?
If we knew that, it might impact what doctors can do and see if it is possible to predict how an individual’s ova would age. Until there is a clear understanding of ovarian aging, FSH remains the benchmark for most doctors when it comes to making therapy determinations.
Want to know your likelihood of becoming pregnant at any age? Learn more about age and fertility.
How do FSH levels affect fertility treatment success rates?
While each fertility clinic uses a different assay to measure FSH, most centers say that anything above 15 is considered “abnormal.”
On average, patients in the 10-to-15 range have a 50% lower success rate of bringing home a baby than others in their age group with FSH levels of 9.5 or below.
When FSH levels are above 15, the success rate decreases to less than 5%, and there is an increased chance of chromosomal abnormality.
Elevated FSH levels also indicate diminished ovarian reserve, meaning there are fewer follicles or eggs, which are often of questionable quality.
Treatment for high fsh levels in females
Women with high levels of follicle-stimulating hormone often can indicate diminished ovarian reserve, making it more difficult to conceive. Various fertility treatments are available to help increase your likelihood of carrying a successful pregnancy.
- Fertility medications: Gonadotropins, which are injectable hormones, may be used to stimulate the ovaries to produce more eggs. Clomiphene citrate (Clomid) is another medication that can stimulate ovulation.
- In Vitro Fertilization (IVF): IVF may be recommended, particularly if other treatments like IUI have been unsuccessful. During this process, eggs are retrieved from the ovaries and fertilized in a lab. The resulting embryos are then transferred to the uterus.
- Donor eggs: For women with significantly diminished ovarian reserve, using donor eggs can be an effective way to achieve a successful pregnancy. The donor eggs are fertilized with the partner’s sperm (or donor sperm), and the resulting embryos are transferred into the recipient’s uterus.
- Lifestyle changes: While lifestyle changes alone may not significantly lower FSH levels, they can contribute to overall health and fertility. This includes maintaining a healthy weight, eating a balanced diet, exercising regularly, reducing stress, and avoiding tobacco and excessive alcohol use.
- Acupuncture: Some studies suggest that acupuncture may help balance hormone levels and improve fertility, though more research is needed in this area.
- Coenzyme Q10 (CoQ10): Some research suggests that CoQ10 may improve egg quality and ovarian response in women with diminished ovarian reserve. Learn more about vitamins and supplements that may help your fertility.
FSH and Age
So what if you are younger and your FSH is marginally elevated?
In that case, many fertility specialists think it is reasonable to stimulate the ovaries in an attempt to achieve pregnancy, either with intrauterine insemination (IUI) or in vitro fertilization (IVF). Again, it depends on the fertility clinic. Some are willing to take a chance on borderline women, and some are not. The threshold depends on the particular experience of a given laboratory and on a given couple’s willingness to gamble on stimulation.
If a woman is borderline, then depending on all the variables that come into play, it may be worth a try.
If, however, a patient is menopausal, or if repeat FSH levels are elevated to a high degree, then that is when many doctors feel that there is no point in pursuing either high or low-tech assisted reproductive technology (ART) – as the body is already at its limit. That leaves using donor eggs if experiencing pregnancy is the goal. And some women may not be ready to hear that news.
A diagnosis of a high FSH is a hard one to accept. And it is a diagnosis that way too many women hear at the very beginning of their infertility journey. They feel furious if they don’t get to try even once with their own eggs, and the doctors may feel like they don’t want to put a patient through the financial, physical, and emotional trauma of fertility treatment with the genuine possibility of no positive outcome.
Know the facts. Know that you are not alone in your feelings of frustration. If you need a support group, RMA sponsors the FertiliFriends support group on Facebook. Join the community today.