Follicle Stimulating Hormone (FSH)

If you are currently going through fertility treatment, than you know how frustrating and time consuming it can sometimes be. There are so many tests, treatments, and procedures that you have to undergo, that it can be hard to keep track of them all. One particular test that you may undergo is to detect follicle stimulating hormone (FSH). This may sound like a little alien to you, but actually it is one of the predictors of ovarian reserve. This article outlines the basics of FSH and what it indicates about your fertility.

What is FSH?
FSH is just one of a number of hormones that is secreted by your brain. Inside your brain, located just at the base of your neck, there is a tiny region called the pituitary gland. This gland is responsible for releasing a variety of different hormones, including FSH. FSH hormone is used to help encourage the growth of eggs in women and sperm in men. Without FSH, neither males nor females would be able to procreate.

Ovarian Reserve and Follicle Stimulating Hormone
If you are having troubles conceiving, your health care provider will try to analyze your ovarian reserve. Your ovarian reserve refers to the number of eggs that you have available for fertilization. A high ovarian reserve usually indicates a good number of viable eggs present in your ovaries. A low ovarian reserve may indicate that you have fewer available eggs. In order to test ovarian reserve, many health care professionals rely on measurements of your FSH.

Measurements of FSH can be determined through a simple blood test. Levels of this hormone directly correlate to the number of eggs that you have "on reserve" in your ovaries. By measuring the amount of FSH, your doctor can suggest specific treatments (such as in-vitro fertilization or intrauterine insemination) that could help you to conceive. He can also predict how well you may respond to these treatments.

The FSH Testing Procedure
FSH blood tests are generally performed on the second or third day of your menstrual cycle. During this time, FSH can provide the most accurate predictions of ovarian reserve. Estradiol is also most accurate when measured on the second or third day of menstruation.

Interpreting Levels of Follicle Stimulating Hormone
Your health care provider will look for a number of things when examining the results of your FSH test. She will first compare your FSH levels to normal baseline results in most women. A normal FSH level is usually under 10, whereas an abnormal level is anything above 25. Measurements between 10 and 25 are generally considered borderline.

Your physician will also examine estradiol levels that are tested along with your follicle stimulating hormone. Estradiol is one of the estrogens that your body produces, and is secreted by the ovaries. During ovulation, estradiol levels increase rapidly, and drop again after ovulation. Estradiol levels are also helpful in indicating ovarian reserve. Levels above 75 may indicate a poor ovarian reserve.

What's Next
Once your FSH and estradiol levels have been determined, your health care provider will suggest certain treatment guidelines. A normal FSH and estradiol level probably indicate that you have a good ovarian reserve. This means that you do not have to undergo aggressive treatment right away. Instead, you have a little more time to play with when choosing and booking procedures. It is also likely that you will be able to use your own eggs.

Elevated FSH levels may suggest that you should begin treatment right away. Ovarian reserve can change rapidly, and even a short delay in treatment could mean the difference between conceiving and not conceiving. High levels of FSH and estradiol may also indicate that you should consider using an egg donor. Your eggs may not be in the best condition for use in procedures.

The Clomiphene Challenge Test
Sometimes, your health care provider may choose to perform a clomiphene challenge test. This is an extension of the FSH test, however, it is more sensitive. It is often used in older women who are trying to become pregnant.

After your FSH and estradiol levels are tested, you are given the medication clomiphene. You will take 100 mg of clomiphene everyday, throughout days 5 to 9 of your cycle. Your FSH levels are then re-tested on day 10 of your cycle. An abnormal FSH level may indicate a poor ovarian reserve.

Accuracy of the Tests
FSH testing is thought to be an accurate predictor of ovarian reserve. A New Jersey study monitored women with abnormal FSH levels who became pregnant - less than 1% actually had a live birth, with two-thirds miscarrying. High levels of FSH were also found to be good indicators of genetic abnormalities in babies.

Things to Consider
It is important to remember that FSH tests are not the be-all and end-all to pregnancy. Just because you have a poor level of FSH does not mean you won't get pregnant. It is merely an indicator used to decide upon treatment options.

It is also necessary to consider age when undergoing fertility treatment. Age is an excellent predictor of both ovarian reserve and conception rates. Women over the age of 43 have a smaller chance of becoming pregnant than women under the age of 43, no matter what their FSH levels. This means that younger women with poor FSH levels may still want to try using their own eggs before seeking a donor.

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