Q: If my FSH level is high, what does this mean?
Note that testing FSH on day 3 of a woman's cycle, give or take one day, is crucial.
Dr. Frederick Licciardi: If the ovary has many eggs, the FSH in a woman's blood is low because the body doesn't need to work hard to get a normal ovulation. If the egg number is low, the body needs to work harder to get ovulation, so it increases the amount of FSH in an effort to push the ovaries. A high FSH means the egg number is reduced, sometimes to levels so low that pregnancy is not possible. What is a good level? That depends on each individual lab and IVF program. For most centers, anything over 12 is considered not so good. In fact, some centers will not give fertility treatment to those over 12 because the odds of pregnancy become very low (but are not always impossible). Some doctors say once there is one elevated FSH, it's over. This is not true. FSH levels go up and down from cycle to cycle (could be by a few points), so one elevation, along with other levels that are in the normal range, does not mean sterility. Therefore, I always repeat levels when the first reading is high. Repeatedly high levels are a very bad sign and should not be ignored.
Dr. Carol Redmond: FSH testing is tricky because it can appear normal even when egg quality is compromised. That's because of the prolonged period of time in every woman's life when her egg quality is severely compromised but her day 3 FSH level is still normal. It is not uncommon to have a patient come to you at age 38 with all testing, including the FSH normal, but no pregnancy happens. Then at age 40 her FSH finally becomes elevated.
How long is the interval of infertility until the FSH is high? Impossible to know. Can it be longer than a few years? Maybe. Can it be less time than that? Maybe. You just can't know because you can't check the eggs. However, whenever a woman over age 35 sees me with infertility and all other testing is normal, the hidden problem may be many things, but it is most likely an egg quality issue. Over age 38 it is highly probable, over age 40 it is pretty much a certainty. It is
much trickier with women coming for donor sperm, as usually they do not present with a pre-existing history of infertility. If their FSH is normal, all they can do is try and see. Some will conceive, some will not, and you cannot pick off the successful ones, or the unsuccessful ones in advance. All you can quote them is the group statistic. So normal testing cannot be interpreted as 'it's okay, you're fertile.' We can only say that if the FSH is high, 'it's not okay, you're unlikely to be fertile.' It is often a bit confusing to patients. Normal testing does not infer normal fertility, because our testing cannot test many important things, like egg quality. Only the reverse is true: blocked tubes, high FSH, no ovulation and so on infer impaired fertility. No one can ever be reassured, before proceeding with donor sperm insemination, that it will work. You can only warn the ones who have testing results that pretty much tell you it will not work.
Dr. Susan Willman: In practical terms, an abnormal FSH level usually, but not always, predicts a poor response to fertility medication. More importantly it predicts a low chance for a successful pregnancy with fertility medication or IVF. A recently reported study from the large IVF program at Saint Barnabas in New Jersey reported on the outcome of IVF cycles in more than 1,000 patients with abnormal FSH levels. The pregnancy rate with IVF in these patients was less than 3 percent, and more than two-thirds of these pregnancies miscarried, resulting in a delivery rate of less than 1 percent. Women who get pregnant with an elevated FSH level have a high likelihood of miscarrying. Some studies have suggested that an abnormal FSH level is associated with a high percentage of genetically abnormal embryos. It is important to note, however, that abnormal FSH levels are not absolutely predictive of no possibility for a successful pregnancy. All of us in the field have had patients with markedly abnormal FSH levels who have gone on to deliver healthy babies. These situations are however, uncommon.
For more about FSH, see this blog post featuring insight from Dr. Arthur Wisot.
