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 indicator of reduced fertility—something that they may never have heard about before entering a doctor’s office.
They don’t understand the meaning of having high FSH levels, 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 trying to build a family is donor egg before you ever get a chance to attempt pregnancy with your own eggs.
What 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 very rare breed. We can hear that there is a 90% rate of failure for pregnancy 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.
Quick FSH Facts:
- 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 are functioning 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 prior by age 40.
FSH Test Results
Ovarian Reserve Screening involves the use of multiple tests to better understand the likelihood of achieving a live birth.
There is no single test which 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 and higher AMH levels and Antral Follicle Counts are associated with a better prognosis.
High FSH and low AMH and Antral Follicle counts are associated with a worse prognosis.
Age is an overriding factor that must be taken into account when looking at these tests. Older women will always have a harder time getting pregnant even if they have similar levels.
TABLE: General Interpretation of Ovarian Reserve Screening
|AMH||FSH||Antral Follicle Count|
|Best Prognosis||>1.2 ng/mL *||<10 mIU/mL||>10 *|
|Lower Prognosis||0.5-1.2 ng/mL||10-20 mIU/mL||8-10|
|Lowest Prognosis||<0.5 ng/mL||>20 mIU/mL||<8|
*AMH levels over 4 ng/mL and AFC over 20 may be associated with Polycystic Ovarian Syndrome
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, and 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 that is synonymous with low implantation rates. That, however, is a statistical, and not an absolute, statement.
Poor quality eggs are unable to generate the cellular energy required to make 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 is focusing on treatments that will preserve the 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 have an impact on 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.
How 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 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 goes down to less than 5% and there is an increased chance of chromosomal abnormality.
Elevated FSH levels also indicate diminished ovarian reserve which means there are fewer follicles or eggs and these are often of questionable quality.
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 women who are borderline 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 very real possibility of no positive outcome.
Know the facts. Know that you are not alone in your feelings of frustration. Get support and talk with your RMA of Philadelphia doctor today.
- Ovarian Reserve (Predicting Fertility Potential in Women) – Published by the American Society for Reproductive Medicine (ASRM)
- Premature Ovarian Failure – Published by RESOLVE: The National Infertility Association
Author: Pamela Madsen, The Fertility Advocate, Guest Blogger