High FSH
Treatment for High FSH (Elevated FSH) and Low Ovarian Reserve
Success of an In Vitro Fertilization (IVF) cycle to a large degree depends on the patient's ability to produce a good number of high-quality eggs. A woman's ability to produce eggs, both in terms of quantity and quality, however, decreases naturally with age, making it harder for older women to conceive. Some women experience this decline in ovarian function much earlier in life than most. They then suffer from Premature Ovarian Aging (POA).
High FSH Explained
Dr. Gleicher discusses High FSH, its effects on fertility and treatment options.
Assessing the probability of IVF success
In attempts to predict IVF success, experts have developed a number of tools to assess patients' "ovarian reserve." They include blood tests, some drawn on the second or third day of the menstrual cycle (like FSH, follicle-stimulating hormone) and others (like AMH, anti-Müllerian hormone) that can be drawn at any time. Assessing so-called antral follicle counts (AFCs), the number of small follicles at cycle start through vaginal ultrasound, is another popular method of measuring ovarian reserve.
Contact us if you are trying to get pregnant with high FSH.
High FSH levels indicates low ovarian reserve
FSH is probably the most widely used measurement to assess a woman's ovarian function. Given FSH's role in maturing eggs, you might think that high FSH is a good thing. This is, however, not the case; high FSH, also known as elevated FSH, is indicative of low ovarian reserve, and significantly lower pregnancy chances with IVF. Similarly, abnormally low AMH and/or AFCs also denote a relatively poor prognosis, in addition to high FSH levels.
It is important to remember that FSH levels increase and AMH level as well as AFCs decline as women age. This means that normal ranges for all of these measurements change. This is often forgotten, even by fertility specialists. At CHR we, however, utilize age-specific FSH levels to determine whether a woman's ovarian reserve is normal or not. Since CHR investigators first reported the use of such age-specific values, their utilization has significantly picked up world-wide (see also below).
Should IVF be withheld from women with elevated FSH?
Many fertility centers, unfortunately, still use universal cut-off values for FSH and AMH. When a patient has high FSH or low AMH, they simply refuse treatment, irrespective of patient age and other factors. This approach may ensure higher pregnancy rates at such centers (because they reject women with smaller chances), but it leaves women with elevated FSH and/or low AMH often feeling abandoned. CHR, therefore, does not have such arbitrary cut off values.
Contact us if you are trying to get pregnant with high FSH.
FSH is only a part of the picture
While FSH levels and AMH levels are important in assessing ovarian reserve, both have limitations. Neither FSH nor AMH can, indeed, categorically determine whether a woman can or cannot conceive, unless she has very high FSH levels. AMH can be completely undetectable for a woman to get pregnant with IVF, as over 50 pregnancies so far in women with undetectable AMH at CHR clearly demonstrates. Therefore, placing too much emphasis on high FSH and low AMH can be misleading.
Age-specific FSH levels
A few years ago, CHR's research established age-specific levels of FSH and AMH. Any FSH level means different things if found at different ages. For example, a normal FSH level for a woman at 42 suggests POA if found in a 32-year old. To really assess a woman's ovarian reserve, and her IVF pregnancy chances, one really needs to look at age-specific AMH and FSH levels. The nearby figure demonstrates age-specific AMH and FSH levels for CHR's patients.
CHR offers the table for age-specific levels of baseline FSH and AMH:
| AGE SPECIFIC b-FSH and AMH LEVELS | ||
| Age | FSH | AMH |
| < 33 Years | < 7.0 mIU/mL | = 2.1 ng/mL |
| 33-37 Years | < 7.9 mIU/mL | = 1.7 ng/mL |
| 38-40 Years | < 8.4 mIU/mL | = 1.1 ng/mL |
| = 41 Years | < 8.5 mIU/mL | = 0.5 ng/mL |
Contact us if you are trying to get pregnant with high FSH.
FSH is not specific enough
The medical literature suggests that FSH is not as specific as it was thought. Indeed, a number of papers published by CHR's physicians suggest that AMH is actually more specific than FSH in assessing ovarian reserve and pregnancy chances with IVF. Better AMH specificity makes sense because AMH reflects the smaller follicles, which represent a majority of a woman's ovarian reserve. (The Figure demonstrates that ranges are narrower for AMH than FSH, suggesting that AMH is more precise in reflecting ovarian reserve.) Given the superiority of AMH, IVF treatment decisions, based on high FSH levels alone, appears outdated. The medical literature suggests that FSH is not as specific as it was thought. Indeed, a number of papers published by CHR's physicians suggest that AMH is actually more specific than FSH in assessing ovarian reserve and pregnancy chances with IVF. Better AMH specificity makes sense because AMH reflects the smaller follicles, which represent a majority of a woman's ovarian reserve. (The Figure demonstrates that ranges are narrower for AMH than FSH, suggesting that AMH is more precise in reflecting ovarian reserve.) Given the superiority of AMH, IVF treatment decisions, based on high FSH levels alone, appears outdated.
DHEA treatment for high FSH and diminished ovarian reserve
Yet, perhaps the most important reason for not refusing fertility treatment to women with high FSH levels is this: Even with high FSH, women can conceive, if given proper treatment.
Over the last 5 to 6 years, hundreds of women with diminished ovarian reserve have received high FSH treatment at CHR and ended up conceiving after all, using an IVF protocol specifically developed for women with abnormally poor ovarian reserve. A central component is supplementation with dehydroepiandrosterone (DHEA) prior to IVF. Through extensive research, CHR has been able to demonstrate that DHEA supplementation for at least 6 weeks before start of an IVF cycle can dramatically increase pregnancy chances with IVF in women with high FSH. (Recently, a small-scale clinical trial from Israel also confirmed that DHEA supplementation is an effective treatment for high FSH levels, indicative of diminished ovarian reserve.)
Contact us if you are trying to get pregnant with high FSH.
Treating the cause, not the symptom
CHR practically never refuses fertility treatment to women, as long as FSH levels aren't menopausal. To women with very high FSH, our physicians explain relatively low pregnancy chances if they tried with their own eggs (in contrast to the superior pregnancy chances with donor eggs, even in older women). However, if patients, after giving fully informed consent, still wish to "give it a try" before moving on to egg donation, CHR will not withhold IVF treatment solely based on elevated FSH levels.
Most patients come to CHR after having been turned away by other centers, or after having failed multiple IVF cycles elsewhere. We routinely hear that they were told "that their FSH needs to come down before they can try IVF." This is a somewhat silly argument, because high FSH is merely a symptom, and not the disease. For optimal results, one needs to treat the disease, which is the patient's diminished ovarian reserve. This is precisely CHR's approach in treating women with diminished ovarian reserve when placing them on DHEA supplementation. (In this sense, calling DHEA supplementation a "treatment for high FSH levels" is a misnomer.)
With this approach, CHR has been able to achieve impressive IVF pregnancy rates, despite our center's extremely adversely selected patient population with disproportionately large number of women with severely diminished ovarian reserve and high FSH. We suggest you look at our IVF pregnancy rates for the last year in this patient population, and you will be astonished!
Contact us if you are trying to get pregnant with high FSH.
Next Step
The first step is easy, simply complete the Contact Form to determine if you qualify for our DHEA Treatment Program.
Last Updated: December 29, 2011
