Saturday, February 20, 2010

How can I reduce my FSH levels ?

Human oocyte with surrounding granulosa cells,...Image via Wikipedia

One of the key factors which influences the outcome of an IVF cycle is the number of eggs the wife grows. This depends upon her ovarian reserve and this is a key metric which IVF doctors need to track.

We can measure the ovarian reserve using three tools:
• the antral follicle count;
• the AMH level ; and
• the FSH level.

Of these, the FSH level has been the blood test which has been around for the longest and is the one most infertile women are familiar with. It often becomes a number which many women start obsessing over, just like infertile men obsess over their sperm counts. This is especially true for older women, who know that the success of their IVF cycle is often dependent upon this.

It’s important to remember that the FSH level is just a marker for ovarian reserve. This means that the high FSH level is not the problem – it simply signals the fact that you have poor ovarian reserve. In fact, it’s very easy to reduce the FSH level – just take estrogen medications , and it will go down to normal in one week. This because estrogens suppress the high FSH level ( in a mechanism called negative feedback), and bring it back to the normal range. However, using estrogens to bring the high FSH level to the normal range obviously does not improve the ovarian reserve. We know that women are born with a certain number of eggs , and this ovarian reserve gets depleted as time passes, until it reaches zero, at the menopause.

So what can you do to reduce your high FSH level ? Women are often confused because they often get conflicting information from IVF specialists. Most will say that a high FSH is not treatable and will recommend the use of donor eggs straight away. Others will recommend alternative medicines such as acupuncture and DHEA to try to improve the ovarian reserve. To add to the confusion, there are lots of anecdotal success stories and first person accounts on bulletin boards all over the internet of women who have brought down their high FSH levels using diet and detoxification . A good website which compiles a lot of this information is highfshinfo.com. Unfortunately, one swallow does not make a summer – and lots of time there’s precious little we can do to affect ovarian reserve.

The major danger is the large number of websites which sell herbal medications and magic potions which claim to reduce the FSH level. Examples include Fertility Blend. They make a lot of unsubstantiated tall claims, but because they are very cleverly marketed, they find it easy to dupe thousands of desperate women who are very unhappy with their doctors who cannot help them.

It is true that FSH levels do vary from cycle to cycle, and this makes it even harder for women, because they simply cannot make sense of what causes it go down in one month and then increase in another.

So how can you make sense of your FSH levels ?

Firstly, understand that this is just one imperfect marker of ovarian reserve – and that doctors do not treat numbers, but patients.

Also, understand the inverse relationship between estradiol levels and FSH levels. It’s a good idea to check both at the same time, whenever you test your FSH level

Finally, remember that there are now better tests for checking ovarian reserve, such as AMH ( antiMullerian hormone) levels, which can be used to confirm a diagnosis of poor ovarian reserve.






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16 comments:

  1. Alice2:53 AM

    I'm not sure what you mean by unsubstantiated - FertilityBlend is backed by double blind studies published in medical journals.

    ReplyDelete
  2. I know most manufacturers of these products will "substantiate" their claims by quoting studies which appear in medical journals. Unfortunately, most patients are not sophisticated enough to assess the quality or reliability of these studies or these journals ! Garbage In - Garbage Out - whether it appears in a medical journal or in The National Enquirer !

    ReplyDelete
  3. Hi Dr. Aniruddha, I am 34 years old and was going for my 1st ICSI but 2dy, my first day, FSH report came as 13.82. Doc said no and has asked me to do test next cycle gaian and in the meantime take DHEA 25 mg thrice a day for 3 months. Is DHEA effective? what alternative method do i have. My AMH = 1.82 (6th day)last month done with Dr. lal's lab.

    husband's sperm count is 5 million with 99% immotile sperms. am very depressed now. dont know what to do? plz sir... guide me. I have always followed ur website and blogs and it has encouraged me to live on with hope for some miracle to happen.

    ReplyDelete
  4. Your low AMH level ( www.drmalpani.com/amh.htm)
    Suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    You can try the following to improve your ovarian reserve.

    1.Yoga
    2. Acupuncture
    3. DHEA, 25mg thrice a day.
    4. Take wheat germ daily
    5. Coenzyme Q10 , 100 mg daily
    6. Cholecalciferol, 60000 IU, once a week for 8 weeks

    Read the book, Inconceivable, at http://www.amazon.com/Inconceivable-Womans-Triumph-Despair-Statistics/dp/0767908201

    IVF/ICSI would be your best option as it would maximize your chances of getting pregnant quickly and help you make the most of the eggs you have left

    Treatment takes about 20 days. Should I send you the treatment plan ?

    Since we are doing ICSI , we need only 1 sperm to fertilise 1 egg, so your husband's sperm count is nor a problem !

    Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

    Treatment can be expensive, but a baby is priceless.

    Plan B would be to use donor eggs, if you are willing to consider this option

    This has a much higher success rate

    We have an active donor egg IVF program ( www.drmalpani.com/eggdonation.htm).


    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270
    FAX ( India) 91-22-22150223. Our US FAX is 1-775-249-6041
    Helping couples build families !
    PS Read our book, How to Have a Baby - A Guide for the Infertile Couple, online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://doctorandpatient.blogspot.com/

    ReplyDelete
  5. can u send me the plan for ICSI? and how much should it cost? also what is "Cholecalciferol" for? I am unable too get wheatgerm anywhere. where should i try? chemist, dietician, supplement shop?

    thanks

    ReplyDelete
  6. Anonymous5:27 PM

    hi dr malpani.... my fsh level is 7.4 and other reports are normal,will i be able to conceive,or should i go for artificial means...pls suggest...very tenced

    ReplyDelete
  7. Anonymous5:07 PM

    Dr. Malpani,

    Did i read correct 60000 IU of Cholecalciferol, is in sixtythousand? Once a week for 8 weeks? If that is the case, what about 8571 IU daily for 8 weeks?

    ReplyDelete
  8. Anonymous2:33 PM

    my AMH level is 1.4 and FSH level is 11.13. My age is 31. I will be doing my first IVF cycle soon. Is there a possibility of conception with this?

    ReplyDelete
  9. Dr. Malpani,


    i am 27 year old and i did not have period at that age without medicine i take overal "l" for periods my fsh value is 31.1 so dr. tell me i can not be get well now they tell me to take eema-d tablet thrice a day and if fsh level do not go low then there is no option for recovery.

    Please tell me what i have to do is there no scope.

    ReplyDelete
  10. Anonymous5:40 PM

    I thought you said there is little that can be done to improve/increase ovarian reserve, it depletes over time...?

    ReplyDelete
  11. Dr. Malpighi

    I am 39 yrs old and have had 3 children early in life . About 13 yrs. ago my left tube was removed because it was damaged from an ectopic pregnancy. My other tube was no functional and closed on its own. I went to my Fertility specialist because my husband and I wanted to have a child together, he also has children from a prior marriage and has been tested as well and came back good. I have had all the required testing and I still have both my ovaries. We thought this would be a cut and dry IVF case, but my first FSH test came back with a high number that even my doctor was suprised to see, it was 17.4 . I realize that because of my age that leans more towards quality than quantity she told me, however she did opt to re test me this coming month on day 2 verses day 3. My insurance and the state I live in only allows 2 cycles with 2 egg transfers each time for lifetime max. I am truly devastated that this number is so high and my doctor told me that even if they submit this to the ins. Carrier they will consider me a poor responder and basically will deny the coverage for the attempts because of that high number. I have read about the estrogen and how it can help lower the FSH number. I just want a fair shot at this, and I have a hard time thinking this is where it will end for me if it comes back high again. They also told me that although they do not know what the exceptable number would be for the insurance company, it has been their experience that it has to be at least between 12-15. Mycycle last month ironically last month seemed a bit heavier than normal and I don't know if that plays any part in that number determination but I have tried to take a estrogen patch starting a week prior to my cycle and the day 2 test. Any thoughts..in CT you have to be successful by age 40..which is in 6 mths for me or ins. Don't cover you.
    Desperate in CT

    ReplyDelete
  12. Yes, you can use estrogen to suppress the high FSH level. However, this will just bring the FSH level to a range which will allow your insurance company to pay for your IVF. It will not improve your ovarian response and the chances of your getting pregnant in an IVF cycle are quite poor, sorry.

    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    What’s your AMH level ? Read more at www.drmalpani.com/amh.htm

    ReplyDelete
  13. Dr. Malpighi
    I have retested for my FSH level after taking your advise, It came back on day 2 at 13.9 and estrogen or I believe she said E2 was 16. I realize this does not increase my chances for connception with IVF at 39 but it will possibly allow my insurance to cover the allowable 2 cycles with 2 embryo implant each cycle. I will be starting on Lupen (name?) shots for 2 weeks soon then combine with another medication. My fertility Doctor said she will give me a strong dose because of the limited trys. I believe that it does just take one but however as I stay optimistic, I stay grounded and know what I am up against. My doctor just recently 2 weeks ago removed a damaged closed tube that remained because it was liquid filled and would be an obstruction in retrieval and implantation. As I stated in an earlier post, I lost my other tube years ago to an etopic pregnancy and the non-functioning tube was quite damaged and she said most likely was never functional. Have you known of any successful cases with numbers like mine?
    Thank You
    Shmooz2930

    ReplyDelete
  14. I am 34 years old, I got pregnant last year 2012 April unfortunately got miscarriage. I want to do IVF my doctors told me to take my FSH and LH on Day 2 of my cycle. When i got my my hormone test result came to be higher FSH 119.0 and LH 46.0, prolactin is 17.5,TSH 2.8. Is it posssible that my FSH and LH is high. When I recalled i took my FSh less than 24 hours about 16 hours only. I am really worried right now because my dream of having a baby on my own isnt possible.

    ReplyDelete
  15. Dear Michelle,

    I am sorry, but your high FSH level confirms you have ovarian failure.
    You can read more about this at http://www.drmalpani.com/premature-ovarian-failure-pof.htm

    Your best option would be donor egg IVF ( www.drmalpani.com/eggdonation.htm) or embryo adoption ( www.drmalpani.com/embryoadoption.htm)

    Which would you prefer ?

    Time is now at a premium for you – please don’t waste it ! When you are 70 years old and looking back at your life, you should never have any regrets that you left any stone unturned and didn’t give yourself the best shot at fertility treatment. Treatment can be expensive, but a baby is priceless !

    Taking treatment at a world-class clinic will maximize your chances of success and give you peace of mind you did your best !


    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270
    FAX ( India) 91-22-22150223.

    Helping you to build your family !

    PS Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby – A Guide for the Infertile Couple,
    Online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    Relationship at http://doctorandpatient.blogspot.com/

    ReplyDelete
  16. Anonymous11:17 PM

    my age is 38 my fsh is 15 at day 2. and ovarian reserve is 4 to 6 eggs .my doctor asked me to repeat fsh test . as this level is not good for icsi. plz tell me what to do.how can i improve my ovarian reserve

    ReplyDelete

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