Follicle-stimulating hormone (FSH) is one of two gonadotropins secreted from the pituitary gland to regulate ovarian function and follicular growth and maturation (LH or luteinizing hormone is the other). FSH stimulates ovarian estrogen production and appears to play a critical role in the selection of a dominant follicle. Estradiol, produced by the ovaries, sends a signal to the brain to decrease FSH production. If insufficient estrogen is produced by the ovary, the brain doesn’t receive the signal; FSH production continues, and may become elevated.
Chinese medicine treatment for reducing elevated FSH and promoting fertility
Chinese medicine is very effective in correcting hormonal balance, and has a long history of helping women with elevated FSH to conceive. Through the use of acupuncture, herbs and massage, we are able to improve blood flow into the reproductive organs and restore balance to hormonal production, often reducing FSH levels in the process. Dietary modification and stress reduction techniques are often a critical component of the overall protocol for women with elevated FSH. Treatment with Chinese medicine may provide the following benefits:
- Improved egg quality
- Improved ovarian function
- Reduction in stress levels
- Regulation of the hypothalamic-pituitary-ovarian axis
- Normalization of menstrual cycles
- Induction of ovulation
- Reduction of miscarriage rate
- Improved hormonal production
- Increased rate of conception
- Improved blood flow to reproductive organs
- Reduction of menopause-like symptoms
High FSH and ovarian reserve
High levels of FSH are indicative of a disturbance in the ovarian-pituitary signaling loop. Elevations in FSH may be a marker of impaired fertility when they are abnormal, but do not accurately predict high fertility when normal. Reference ranges for FSH are laboratory-dependent, and FSH varies from cycle to cycle. High FSH, as a general rule, can be defined as a day 3 value of over 10 mg/dl. Ovarian reserve is defined as the health of the ovaries and the eggs they contain. As a woman ages, the number of eggs in reserve naturally decreases and her FSH levels increase. The estimate of the number of eggs in reserve can only be approximated.
Testing for ovarian reserve includes:
FSH blood test on day 3.
Estradiol blood test on day 3.
Clomiphene challenge test (CCT): A blood test is performed on day 3 of the menstrual cycle to determine the FSH level. Clomiphene is given days 5–9, then FSH is retested on day 10. If the FSH level is elevated on day 10, this may indicate diminished ovarian reserve.
Test for low inhibin B levels, which have to do with the feedback system from the ovaries to the brain and FSH production. If this inhibin B is low, then there is low ovarian reserve.
An ultrasound can be performed to see if basal antral follicles are present.
Interpretation of FSH levels
Less than 9 A good level; you should expect an adequate response to ovarian stimulation
9–10 Fair response is between completely normal and somewhat reduced
10–12 Reduced ovarian reserve with a reduced response to stimulation, and possibly some reduction in egg and embryo quality
12–17 Marked reduction in response to stimulation, and more reduction in egg and embryo quality
Over 17 Very poor response or no response to stimulation
Over 30-40 Menopause suspected; menstrual cycles will tend to stop
The underlying causes of high FSH may include:
- Extreme stress
- Diminished ovarian blood flow
- Lack of ovarian response to pituitary production of FSH
- Premature menopause
- Certain medical conditions, such as Swyer syndrome
Symptoms of high FSH
Elevated FSH may or may not produce symptoms; when symptoms are present, they are often similar to those of menopause, most commonly:
- Hot flashes
- Night sweats
- Vaginal dryness
- Menstrual irregularity
- Decreased libido
Western treatment options for women with elevated FSH and reduced ovarian reserve:
- In vitro fertilization
- In vitro fertilization with assisted hatching
- In vitro fertilization with co-culture
- In vitro fertilization with donor eggs