Treatment for High FSH Levels
Getting Pregnant with Your Own Eggs Is Possible
Many of our colleagues believe that DOR is untreatable. We really do not believe that.
Many women with elevated levels of FSH are told by fertility specialists that they would only have a chance of getting pregnant with donor eggs. If your fertility clinic told you this, you should consider a second opinion. Even with a high level of follicle-stimulating hormone, many women can conceive if given proper infertility treatment for high FSH.
Over the last 15 years, hundreds of women with diminished ovarian reserve have received treatment for elevated FSH levels at CHR and ended up conceiving with their own eggs through an IVF protocol specifically developed for each woman with poor ovarian reserve.
Don’t Be Discouraged By a Poor IVF Prognosis
Dr. Gleicher explains why many patients actually have better pregnancy chances than they’re told with proper treatment.
How We Approach Fertility Treatment for High FSH Levels
Abnormally high FSH on your blood test is a symptom of diminished ovarian reserve (DOR) or premature ovarian aging (POA), both of which are conditions that can make getting pregnant naturally very difficult due to reduced ovarian function and a reduced number of good quality eggs, or oocytes. FSH rises with declining ovarian reserve because the pituitary gland, where FSH is produced, doesn’t receive the normal signal from the ovaries to reduce FSH production.
The central tenet of CHR’s success in treatment for high FSH levels is the rigorous individualization of care. This individualization starts with the diagnostic work-up, where we evaluate blood test results (which include your FSH, AMH, and estradiol level and other hormones) in an age-specific fashion. It’s important to note that FSH can only be measured on a specific day of the menstrual cycle (it’s usually a day 3 blood test), and that if you are using hormonal contraception like the birth control pill, your result may be affected.
CHR has developed reference charts for both FSH and anti-Mullerian hormone (AMH) levels for different ages. (Anti-Mullerian hormone is another key fertility hormone, secreted from each antral follicle and preantral follicle in the ovaries.) For example, while an FSH test value of around 8 mIU per mL is normal for a woman in her mid to late thirties, it is high for a woman in her 20s. For a woman in her 40s, this would actually be considered low FSH. This approach of looking at hormone levels in the context of age allows our physicians to catch diminished ovarian reserve (DOR) early. You can find CHR’s normal FSH level chart by age here.
Human reproduction is complex, and fertility challenges may stem from the female partner, the male partner, or even both. Because of this, a semen analysis from the male partner is another important part of the work-up. This allows your reproductive endocrinologist to determine if you are having trouble conceiving because of male factor infertility, female factor infertility, or both. When male factor infertility due to low sperm count is involved, as well as in cases of DOR on the female side, couples may be candidates for ICSI treatment, which increases the chances of fertilizing every available egg.
When a woman is diagnosed with DOR, her reproductive endocrinologist at CHR will develop a personalized treatment protocol, often using androgen supplementation via DHEA, CoQ10 supplementation and highly individualized egg retrieval (HIER) for in vitro fertilization (IVF treatment). In the ovarian stimulation phase, our reproductive endocrinology experts tend to use higher doses of gonadotropins to best encourage the ovaries to develop multiple eggs for retrieval.
CHR also proactively treats other, often related, conditions that affect fertility prospects, such as inflammation and autoimmunity. Across the board, our tailored, patient-focused approach and reproductive medicine research are at the core of our success, not only with DOR but also with conditions like endometriosis, PCOS, and others.
Supplementation to Restore the Ovarian Environment in Cases of High Follicle-Stimulating Hormone
A central component of CHR’s successful approach to fertility treatment for women with elevated FSH levels is supplementation with dehydroepiandrosterone (DHEA) prior to IVF. This treatment approach, first developed here at CHR, is now a key strategy in reproductive medicine. Through extensive research, CHR has been able to demonstrate that supplementation for at least 6-8 weeks before the start of an IVF cycle can dramatically increase IVF pregnancy chances in this group of women. DHEA helps restore an androgen-rich ovarian environment, which in turn helps women with DOR and POA develop a larger number of healthier eggs. Learn more about this supplement here.
Egg Retrieval with Elevated FSH Levels
Highly individualized egg retrieval (HIER) is a relatively recent treatment approach, also developed at CHR based on research conducted in-house. When our embryologists noticed that eggs retrieved from women with high FSH levels often appeared “overmature,” CHR investigators conducted a study to determine whether retrieving eggs earlier than typical with an earlier hCG trigger would improve egg quality for these women. As we have reported in peer-reviewed medical journals, our study found that retrieving eggs when the lead follicles are 16-18 mm or even earlier, rather than the conventional 20 mm, improved the number and quality of eggs and embryos available in IVF cycles.
This was because luteinizing hormone receptors on the granulosa cells are up-regulated in older women, meaning that the effects of luteinizing hormone are more pronounced. This means that older women’s eggs become “overmature” faster, and they need to be retrieved before this premature luteinization occurs. By carefully timing the hCG (human chorionic gonadotropin) trigger shot to push the eggs through the very last stage of maturation, CHR’s physicians can retrieve more viable eggs than possible with a one-size-fits-all approach to egg retrieval timing.
What Not to Do: “Natural” FSH Treatments
Patients sometimes ask us about “natural” fertility treatments. Unfortunately, most nutritional supplements and other “natural” treatments usually lack scientific evidence and don’t work. Studies have also found that supposedly “natural” supplements are sometimes laced with hormones and other controlled substances. Furthermore, trying “natural” FSH treatments, and even natural IUI, can delay the start of an effective treatment that is supported by concrete scientific evidence. Since time is of the essence with DOR, trying “natural” treatments can result in significant reduction in the chances of pregnancy.
Treating the Cause, Not the Symptom
CHR practically never refuses fertility treatment to women, especially when FSH hormone levels aren't in the menopausal range. When we see a patient with very high FSH levels into the menopausal range, or with premature ovarian failure (POF), our physicians explain relatively low success rates in this situation for women who try with their own eggs, in contrast to the superior pregnancy chances with donor eggs, even in older women. 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 multiple failed 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 or an indicator, 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.
With this approach, CHR has been able to achieve impressive IVF pregnancy rates and live birth rates, despite our center's adversely selected patient population with a large number of women with severely diminished ovarian reserve. We suggest you look at our IVF pregnancy rates for the last year in this patient population, and you will be astonished!
We Give Families Choices
Getting pregnant with your own eggs is still possible at CHR. We have over 30 years of experience in treatment for high FSH levels and diminished ovarian reserve. Many of our patients have had multiple failed IVF cycles elsewhere, or have been rejected by another center due to a poor prognosis. By using individualized ovarian stimulation protocols that are tailored to each patient, we are able to offer treatment options for older patients who wish to become pregnant using their own eggs.
Egg donation is also a great option (and we maintain our own egg donor pool, both for fresh cycles and frozen donor egg cycles), but at CHR, the final decision is always up to the patient.
Find Out Whether CHR is Right for You
To learn more about science-based, individualized fertility treatment options at CHR, call us at (212) 994-4400 or (212) 933-5700, or contact us online.
Read more about High FSH
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.