High FSH (High Follicle Stimulating Hormone): Fertility Implications
What is High FSH?
High FSH is an indicator of diminished ovarian reserve (DOR), a common and sometimes overlooked cause of female infertility. Elevated levels indicate that a woman’s ovarian reserve is becoming depleted and that her ovaries are no longer producing eggs at all, or producing very few, lower-quality eggs, which negatively affects her fertility prospects.
Because levels of follicle stimulating hormone are naturally lower in younger women and higher in older women, it is crucial to evaluate every woman's level against her age: If they are above what is expected for her age, then she should be considered to have high FSH and diagnosed with DOR. Otherwise, younger women with premature ovarian aging (POA) can be overlooked, which leads to treatment delays.
Through years of clinical research, CHR has developed a special expertise in helping women with high levels of follicle stimulating hormone get pregnant with individualized treatment protocols that target the root causes and not just the 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 DOR, indicated by high FSH, have been elucidated.
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. 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 felt by the patient.
High FSH and Infertility
Given the role of this hormone in maturing eggs, you might think that high FSH is a good thing. This, however, is not the case. High follicle stimulating hormone in females is more a reflection of how few eggs are going through the maturation process in the ovaries. Sensing that there are only few eggs developing, the pituitary gland pumps out more FSH to try to develop more eggs, which results in the abnormally high level of this hormone in the blood. As noted, women in this situation have significantly lower pregnancy chances with in vitro fertilization (IVF) than women with normal levels.
At CHR, our fertility specialists thoroughly individualize 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 surprisingly robust pregnancy rates for CHR’s patients. 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, follicle stimulating hormone levels naturally increase, and AMH levels and AFCs AFCs decline in tandem. Therefore, FSH and AMH move in opposite directions as women age. Some women, like in this case report, however, experience an exception to this combination when older: Their FSH goes up, but their AMH stays high or normal. These women also tend to have low androgen levels, leading CHR investigators to come up with a previously unrecognized diagnosis of hypoandrogenic PCOS.
High FSH and LH in Women Explained
Like follicle stimulating hormone, luteinizing hormone (or LH) is also released by the pituitary gland. The two hormones work in conjunction 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 and whether she has low or normal LH.
If the results of a test come back abnormal, the woman may need to undergo additional diagnostic testing and treatment for elevated follicle stimulating hormone and luteinizing hormone 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 often 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 specialist in reproductive endocrinology, 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.
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Last Updated: April 30, 2020