Is it worthwhile trying to reduce FSH levels?

This is one of the most frequently asked questions at CHR since almost all of our center’s patients present with high FSH levels. And the answer in an overwhelming majority of cases is, no, it is not worthwhile to attempt to reduce FSH levels.

Some colleagues believe that IVF cycles with lower FSH values have better outcome chances than cycles with low values. We don’t believe this to be the case, and the principal reason is obvious: FSH is not the disease; high FSH levels are only the symptom of poor ovarian function. Lowering the FSH (which can be done easily in a few short days by raising estrogen levels) will treat the symptom and not the disease. It’s like treating the fever in an infection with aspirin, instead of treating the causative bacteria with an antibiotic.

The belief that high FSH must be lowered before an IVF cycle can be initiated, causes an additional problem: Many physicians use this argument to delay cycle starts in women in whom they don’t really want to initiate cycles (i.e., poorer prognosis patients). Since time is a significant enemy in women with low functional ovarian reserve (LFOR), any unnecessary delays in starting treatment must be avoided, including this one.

On a side note, FSH levels are also much less predictive of dehydroepiandrosterone (DHEA) positive effects than AMH levels. While AMH quite frequently improves with DHEA supplementation, FSH levels drop much more rarely. The reason is that FSH levels are also strongly influenced by estradiol levels and AMH is not.

This is a part of the November 2018 CHR VOICE.

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.