What does it mean to have high FSH levels?

When you’re undergoing fertility treatments or have trouble conceiving, your doctor may order a test that reports your current FSH levels. It’s a standard test used to evaluate a patient’s current fertility and overall health status. This basic blood test doesn’t require any specific preparation on your part. It’s usually done on a certain day of your cycle because FSH levels fluctuate.

FSH stands for follicle stimulating hormone, which is the hormone the pituitary gland uses to stimulate the ovaries each month.  It is one way to help predict a patient’s fertility status. How hard your pituitary gland has to work to get eggs to develop, correlates with lower low ovarian reserves or poorer egg quality. Some patients feel angry, depressed, and anxious when they hear this news. However, high FSH levels don’t mean all hope is lost. It’s merely one indicator of your fertility status and possible fertility treatment success rate.

What is FSH?

Follicle stimulating hormone (FSH) is one of your fertility hormones. It’s created within your pituitary gland, which is located at the base of your brain. It’s sort of between your ears at nose-level.

FSH is a key hormone for proper sexual development. A normal FSH level usually means your reproductive organs are functioning as they should be. A high FSH level can mean something is amiss.

What does FSH do?

FSH stimulates egg growth. More specifically, it stimulates follicles in your ovaries. The follicle grows around an egg.  As they grow, the egg inside the follicle matures. If your FSH level is high, your body needs more FSH than normal to stimulate this growth. A lower FSH level usually means your ovaries are functioning well with average stimulation.

FSH also boosts your body’s production of estradiol. This type of estrogen helps eggs mature and release. It also helps the uterine lining thicken properly for implantation of the fertilized egg.

FSH and the Menstrual Cycle

When your period ends, estrogen levels are low.  The pituitary gland sends out FSH to tell the premature eggs in your ovaries to grow. As the eggs to grow within the follicles, estrogen is produced which causes the pituitary gland to release less FSH. This process ensures that follicles mature properly and release when timing is just right. If your eggs don’t mature properly, they won’t release enough estrogen which causes the pituitary gland to increase FSH levels. This is your body’s way of trying to produce a quality egg.

Every month, FSH starts several follicles growing. Normally, however,  your body only releases one egg at ovulation.  This is because the other follicles get starved out as FSH levels fall as the most responsive follicle continues to make more estrogen.  The other follicles and eggs won’t mature properly, and the body simply reabsorbs them. Though most women are born with more than 1 million eggs, only 300,000 or so make it to puberty, and only a few hundred actually make it to ovulation. As the number and quality of eggs drops, your FSH levels will  rise. That’s why doctors use FSH levels to estimate your chance of pregnancy via intercourse or fertility treatments.

What do high FSH levels mean?

High FSH levels are an indication that your body has to work harder than normal to create a mature egg of good quality. That’s usually because your ovarian reserves are low or you have few quality eggs left. It’s part of the aging process and usually happens with women 38 or older. If a younger woman experiences high FSH levels, she may have premature ovarian failure, which means her ovaries have fewer eggs than normal for her age.

While high FSH levels may mean lower success rates with IVF treatment, that’s not always true. Some women with high FSH levels do well with fertility medications that stimulate the follicles. But it’s important to know your FSH levels so your doctor can advise the treatment with the greatest chance of success.

What do low FSH levels mean?

FSH levels can also be too low. If your FSH and LH (luteinizing hormone) levels are both low, you may have an issue with your pituitary gland or hypothalamus. This can also create problems with ovulation.

Why are FSH levels so important?

Some patients may feel frustrated when a doctor relies on an FSH test to determine possible outcomes. But this test is essential for proper fertility testing and treatment.

First, if your levels of FSH are much higher than usual, that’s a signal that something is wrong. Your ovaries likely don’t have enough eggs or have poor quality eggs. Because you release multiple eggs each month, timing is important.

Your FSH levels also help doctors know whether IVF or IUI with injections are the best choice. If your FSH levels are above a certain level, your doctor may advise against these options because you aren’t likely to respond well to fertility medications that stimulate egg growth.

These medications act much like FSH, stimulating the ovaries to mature eggs. If FSH isn’t helping the eggs mature properly, then injectable fertility drugs may not help either.

Sometimes doctors advise an egg donor when your FSH levels are too high. However, that’s not always the only option. They may advise an alternative protocol or attempt IUI or IVF if they think your odds of success are good.

Symptoms of High FSH Levels in Women

At this point, you’re probably wondering if there are signs or symptoms that your FSH levels are high. Sometimes there are symptoms, and they’re usually similar to the symptoms of menopause.

You may notice:

• Irregular periods: They may occur less frequently, or the timing may vary (e.g. a 28 day cycle followed by a 52 day cycle). You may also experience spotting between periods.
• Hot flashes: This feels like sudden warmth over part of your body, usually your face, neck, and chest. You may also sweat profusely with hot flashes. Some women have them at night while they’re sleeping.
• Trouble sleeping. This is often due to hot flashes or sweating, but some women just feel less rested when they wake up. You may toss and turn more, too.
• Thin, dry hair or dry skin. Your skin may feel dryer than usual, and your hair may start breaking more easily. These are normal signs of perimenopause (the stage before actual menopause).
• Difficulty conceiving. If you’re trying to get pregnant with no luck, that alone can be a sign that your FSH levels are high. That’s why doctors often order an FSH test before pursuing fertility treatments.

How do doctors check FSH levels?

Doctors usually order an FSH test for one of several reasons.

• If you’ve been trying to conceive for at least 12 months with no pregnancy
• If you’re over age 35 and have been trying to conceive for at least 6 months with no pregnancy
• Your menstrual cycles are irregular (e.g. 19 day cycle then 30 day cycle, etc.)
• You haven’t had a period in a while

Doctors may also order FSH tests for men or children under certain circumstances. Everyone has FSH; it’s a necessary hormone for sexual development.

The FSH Blood Test

The test itself is pretty simple for the patient. Your doctor will order the test on a certain day of your cycle. A nurse then draws blood from a vein in your arm. It may hurt just a bit, but the process is often painless and lasts only a few minutes.

Some vendors sell at-home FSH tests online, but we don’t recommend them. They aren’t reliable because they use urine instead of blood.

For most patients, doctors order FSH testing on Day 3 of the menstrual cycle. (Your period begins on Day 1 of your cycle, so you’ll likely still be on your period when you have your FSH test.) That’s because your levels fluctuate throughout your cycle, and Day 3 levels are considered baseline. Some doctors order the test any day between Day 2 and Day 4, so your test day may vary a bit. For example, if your Day 1 starts on a Friday, your doctor may order the test on Day 4, which is a Monday.

What are normal FSH levels?

According to one study, women with FSH levels lower than 15 mIU/mL on Day 3 of their cycles had better pregnancy outcomes than women with levels between 15 mIU/mL and 24.9 mIU/mL. Women with levels over 25 mIU/mL had even lower chances of pregnancy. However, your lab may use different values. Most doctors have their own “normal” range based on lab values and clinical experience. You can ask your doctor to interpret your results. You may also need to look at your LH and estradiol levels to determine whether your ovarian reserves are low or not.

For example, you may have normal FSH levels on Day 3, but your estradiol levels are too high. That can also indicate low ovarian reserves or poor egg quality. If your estrogen is high, it may keep your FSH levels from rising properly.

Some women request an FSH test because they want to wait before they try to conceive. They assume normal FSH levels mean they won’t have difficulty conceiving if they wait a while longer. Unfortunately, that’s not necessarily true. You can have normal FSH levels one year and high FSH levels a year later. As mentioned earlier, FSH levels alone aren’t a guarantee that you won’t have fertility issues in the future.

FSH Levels and Fertility Success Rates

FSH levels are just one way doctors predict success rates with fertility treatments like IVF and IUI. However, they are also one of the most reliable indicators of whether you will achieve a successful pregnancy. With this test and other hormone tests, your doctor can advise you of your next steps. Fertility is all about timing, so it’s important to understand any underlying health concerns as soon as possible. With this information, you can work with your doctor to find the treatment option that gives you the greatest chance of conceiving.

Please remember that high FSH doesn’t necessarily mean you won’t conceive. It may, however, indicate that you need to consider additional options. Your doctor may also order additional tests before they make a recommendation.

If you have any questions or concerns about your FSH levels, please let your nurse or doctor know. We realize that high FSH levels can be confusing or overwhelming for patients, and we want to help you walk through your next steps with as little anxiety as possible. Contact us at the Fertility Center today with questions about you have about improving your fertility and how we can help.