High FSH - High Follicle Stimulating Hormone - Fertility Implications
What is High FSH?
FSH (follicle stimulating hormone) is a hormone released by the pituitary gland. FSH stimulates the growth of follicles and has a role in the maturation of oocytes. The measurement of FSH levels in the blood is one of the most widely used tests to assess a woman's ovarian function and is typically taken on day 2 or 3 of a woman's menstrual cycle. If a woman's FSH levels are above what is expected for her age, then she is considered to have high FSH. Through years of clinical research, CHR has developed a special expertise in helping women with high FSH levels get pregnant with individualized treatment protocols that target the root causes of high FSH and not just the high FSH symptoms.
What Causes High FSH?
Follicle stimulating hormone levels can be elevated for many reasons. Though high FSH can have genetic components, not all causes of high FSH and its root cause, diminished ovarian reserve, have not been elucidated. Elevated FSH tends to indicate that a woman’s ovarian reserve is becoming depleted and no longer producing eggs at all, or producing very few, lower-quality eggs.
Symptoms of high FSH in females often mimic those of menopause, including irregular periods, hot flashes, and headaches. In couples actively trying to conceive, difficulty getting pregnant can also be a sign of high FSH. However, in early stages of diminished ovarian reserve, high FSH (and low AMH) in the blood may be the only indication of what is happening in the ovaries with no other symptoms of high FSH felt by the patient.
High FSH and Infertility
Given FSH's role in maturing eggs, you might think that high FSH is a good thing. This, however, is not the case. High FSH in females indicates low ovarian reserve, and women with high FSH have significantly lower pregnancy chances with In Vitro Fertilization (IVF) than women with normal FSH levels.
At CHR, our fertility specialists thoroughly individualize high FSH treatment for women trying to conceive with diminished ovarian reserve. This approach of personalized, proactive treatment that includes IVF with DHEA supplementation and highly individualized egg retrieval has resulted in a surprisingly robust pregnancy rates for CHR’s patients, even with high FSH. Over the years, our success in helping women with high FSH get pregnant with their own eggs has earned CHR the reputation as the IVF center of last resort.
The Relationship Between Low AMH and High FSH Levels
It is important to remember that as women age, FSH levels naturally increase, and AMHAMH levels as well as AFCs AFCs decline. This means that what should be considered a normal range for all of these measurements changes over time, with FSH going up and AMH and AFCs going down in tandem. This is often forgotten, even by fertility specialists. At CHR we 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 worldwide.
High FSH and LH in Women Explained
Like FSH, luteinizing hormone (or LH) is also released by the pituitary gland. It works in conjunction with FSH to signal the body to release a mature egg from its ovarian follicle, thus starting ovulation. If a woman is having trouble conceiving, her doctor will likely run tests to check whether she has high FSH/low LH, or high FSH/normal LH.
If the results of a test come back abnormal, the woman may need to undergo additional diagnostic testing and treatment for elevated FSH and LH to get pregnant. Elevated FSH in females combined with abnormal LH levels require prompt diagnosis and treatment to prevent further ovarian failure, but it is still possible for the patient to conceive with her own eggs.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
Last Updated: February 5, 2019