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What is follicle stimulating hormone?
Follicle stimulating hormone (FSH) is a substance produced by the brain,
specifically from the anterior pituitary gland. In women, FSH stimulates the
maturation of follicles (eggs) and hormone production in the ovary. In men, FSH
stimulates the production of sperm and male hormones in the testes.
What is a FSH test and what can it reveal?
An FSH test is a blood test that may be used in combination with other tests to
diagnose reproductive problems in both men and women such as low sperm counts
and the absence of menses. The test also may be used to investigate pituitary
disorders, delayed or early puberty, and menopause. A low FSH level might
indicate a problem with the pituitary or hypothalamus (another area in the
brain), whereas a high FSH level indicates a problem with the testes or ovaries
themselves.
In women, the FSH level is determined from a blood sample taken on day 3 of
the menstrual period. Fertility specialists generally agree that FSH levels over
10 to 15 mIU/ml (depending on the laboratory) indicate diminished fertility,
with higher levels indicating even more difficulty becoming pregnant and
carrying a healthy baby to term.
What is "diminished ovarian reserve?"
Ovarian reserve refers to a woman’s current supply of eggs. As a woman ages,
the number of eggs gradually declines until her supply is exhausted at
menopause. In fact, a woman’s eggs have already decreased from millions before
birth to a few hundred thousand at puberty. This number still far exceeds the
number shed in the average number of menstrual cycles in a woman’s lifetime.
The greater the number of eggs remaining, the better the chance for
conception; and alternatively, a low ovarian reserve greatly decreases a woman’s
chance of conception. As a woman ages and her ovaries near their end of a
lifetime of producing eggs, the remaining eggs are of poorer quality. The day 3
FSH may be part of a Clomid Challenge test, which is more sensitive in detecting
diminished ovarian reserve than the day 3 FSH alone. Following the day 3 lab
work, the patient takes an oral medication called Clomid from cycle days 5
through 9 and has a repeat FSH checked on cycle day 10. An elevated day 10 FSH
indicated diminished ovarian reserve even if the day 3 level is normal.
What options are available if my FSH test results raise concern?
Elevated FSH levels occur normally at the beginning of the menopausal
transition, sometimes years before the woman experiences hot flushes or
irregular cycles. Unfortunately, for women interested in fertility, the
prognosis is very poor and most are advised to consider in vitro fertilization
using eggs donated from younger women.
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