One of our routine tests is to evaluate egg quality is a day-3 follicle stimulating hormone (FSH) level. A high FSH level indicates diminished quality of a woman's eggs (ovarian reserve).
Patients with high FSH often ask us if we can lower their FSH levels. Before answering this important question, let's start with a primer on the basics of FSH testing.
What is FSH?
Follicle-stimulating hormone, also known as FSH, is a hormone checked routinely between days 2-4 of the menstrual cycle. It is produced by the pituitary gland to stimulate the ovaries to develop follicles. As a dominant follicle develops, it in turn sends certain signals (inhibin-B) that will suppress FSH release (negative feedback).
If egg quality is compromised, these negative feedback signals are weak, with a resultant increase in FSH levels. This is thus a simple test to test ovarian reserve. Basically, elevated FSH levels = bad eggs!
Ideally we want this level to be below 10 mIU/mL, but some texts state a range of 3.5-12.5 mIU/mL is within normal limits. A woman’s FSH level fluctuates daily and each cycle may reveal a different number. Different labs may also use a different assay to report the results, so lab-to-lab and technique-to-technique variations do exist.
Although the FSH level may fluctuate, most studies say the highest level found is the best predictor of a woman’s ovarian reserve and as the level increases, it signifies the egg supply is diminishing.
Can you lower my FSH level?
So now that you have been diagnosed with an elevated FSH level and diminished ovarian reserve, can we fix it? Can the FSH level be lowered?
Technically, it is very easy to suppress FSH levels by giving patients estrogen pills. However, the FSH level is an indirect indicator of ovarian reserve. The FSH level is not the problem! The compromise in egg quality is the core issue. Just lowering the FSH level will not result in an improvement in egg quality.
Can you improve egg quality?
Information is out there about different lifestyle changes that may lower the level, but little research has been done on the subject. Some of these changes include herbal supplements, DHEA, decreasing stress, exercising, acupuncture, weight loss or dietary changes. While some of these lifestyle changes are still beneficial for overall fertility success, they have not been proven to lower FSH levels.
So now what?
FSH levels are just one part of your fertility assessment. Other tests done looking at ovarian reserve include an anti-mullerian hormone (AMH) level and antral follicle count (determined by ultrasound). Typically the antral follicle count is done on the same day as a woman’s baseline hormone level blood draw, but the AMH can be done anytime in the cycle. Your physician will take all of these tests into account when meeting with you and choosing your treatment plan.