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High FSH Treatment

High FSH, also known as Elevated FSH, treatment explained by Dr. Gleicher from Center for Human Reproduction in New York NY. How High FSH affects fertility and premature ovarian aging.

FSH stands for follicle-stimulating hormone it is one of the so called gonadotropins, which is released by the pituitary and as the name says stimulates the Dr. growth of follicles. That’s its physiological function but in reproductive medicine it has been our main diagnostic tool for many decades in assessing how well ovaries are still functioning in a woman. Practically every gynecologist, even if not specializing in infertility, uses FSH to get at least a first impression of where a woman stands in terms of her reproductive to get at least a first impression of where a woman stands in terms of her reproductive capacity. The standard answer that you will get in most textbooks and from most colleagues is that an FSH up to ten milli international units per ml is considered normal, some people capacity. The standard answer that you will get in most textbooks and from most colleagues is that an FSH up to ten milli international units per ml is considered normal, some people even say up to 12. We don’t believe that. FSH increase as women get older and therefore to assume that what represents a normal FSH level for young women, lets say for a 21 year old, is the same as what represents a normal FSH level for a 43 year old, simply does not make sense. Yet, that is how medicine and our specialty has been proceeding for the last thirty years. And we therefore a few years ago established what we called, age-specific FSH levels. And we therefore, today in our practice, use those to determine whether a woman has normal ovarian reserve or not. What represents a maximum FSH level is relative depending on the age and other surrounding factors. But I can say that once an FSH of 30 is reached and definitely once an FSH level of 40 is reached, for all practical purposes becomes very difficult if not impossible, even for young patients to conceive. The younger the patient the better our chances will be to still achieve pregnancy with use of a woman’s own eggs, even if her FSH is high. The FSH is not the disease, FSH is the symptom it is a reflection of what the ovary does. So we really don’t look at the given FSH level at the particular moment. We look much more comprehensibly at what the ovarian reserve of that patient looks. If you wait until FSH comes down, you may be waiting through the last few months of a patient’s opportunity to conceive. We really do not believe in waiting. We believe in waiting while medications that we give beneficially impact the ovaries such as DHEA. But as soon as we can get going we like to get going. Many of our colleagues believe that diminished ovarian reserve is untreatable. Our center really does not believe that, hasn’t believe in that for a good number of years, principally based on our experience with DHEA. Through our DHEA. experience we have come to a new understanding of ovarian aging. One of the interesting observations that we have made in our DHEA treated patients with very very severely diminished ovarian reserve is that not only are we getting a surprising number of pregnancies but once these women get pregnant our miscarriage rates are surprisingly low. Approximately one third of women who come to us because they were told that their only chance of pregnancy is through donor eggs, leave us pregnant with the use of their own eggs. So a minority but still a quite significant portion of patients with very very poor ovarian reserve and usually quite high FSH, with appropriate treatment at CHR will still have a very decent pregnancy chance. Is a diagnosis, it basically means that that woman is prematurely aging in her ovaries. It is very frequently not recognized that young women have lower FSH levels than older women and that therefore the cut off of what is normal in them has to be set lower. We call that age specific ovarian function testing, or age specific FSH in this context. And that is a crucially important concept if one wants to make the diagnosis of premature ovarian aging. Many younger women circulate for years amongst fertility centers with a diagnosis of so called unexplained infertility, because no one has looked at their FSH or AMH values in an age specific way. And once they are recognized to suffer from premature ovarian aging than the whole treatment paradigm changes. Then you stimulate them differently, then you approach them differently and suddenly those women who for years didn’t understand why they didn’t conceive, suddenly they get pregnant.