Elevated FSH

Women are born with all the eggs that they will ever have, and they lose them constantly throughout life until menopause, when none remain.

The term "ovarian reserve" is useful in the field of reproductive medicine. It is an estimate of the reserve of the woman's ovaries - remaining egg supply - to be able to make babies in the (near) future. In other words, a woman's ovarian reserve is her remaining fertility potential.

There are several ways to attempt to predict egg quantity and quality as well as trying to estimate chances for conception with various forms of fertility treatment. Female age and "day 3 FSH levels are two very important variables. The response of the ovaries to ovarian stimulation with injectable gonadotropins (FSH) is another very important variable that affects the overall chance for conception when in vitro fertilization is attempted.

We have seen different ovarian responses to injectable gonadotropins depending on the overall health of the woman which includes the health and patency of her ovarian blood flow.

Blood transports hormones from the endocrine system to target cells or organs within the body including the hypothalamus, anterior pituitary and ovaries; the three essential organs necessary to achieve pregnancy.

If FSH is elevated the first order of business should be to increase and enhance blood flow so that proper hormonal distribution is distributed to the ovaries. At the Berkley Center for Reproductive Wellness & Women’s Health, by employing acupuncture, and our proprietary herbal formulas, we have successfully increased blood circulation to the ovaries, and lowered FSH levels while simultaneously keeping E2 between 25 and 80pg/ml. In other words, our treatments don’t falsely repress FSH levels, but rather, regulates them.

Further, we have repeatedly seen reduction in the uterine artery pulsatility index after treatment with acupuncture and herbs. The pulsatility index is a method of determining the patency of blood flow to the uterus via the uterine arteries. The pulsatility index should be < 3 and can be ascertained through a transvaginal Doppler examination. Women whose pulsatility index is >3 rarely achieve conception.

Via the release of beta-endorphins from the brain, the sympathetic nervous system is affected and causes vascular modulation with dilation of the uterine arteries, thereby reducing uterine artery impedance and increasing blood flow to the ovaries.

Antral Follicles

Antral follicles are small follicles (about 2-8 mm in diameter) that can be seen - and measured and counted - with ultrasound. Antral follicles are also referred to as resting follicles. Vaginal ultrasound is the best way to accurately assess and count these small structures. In my opinion, the antral follicle counts (in conjunction with female age) are by far the best tool that is currently available for estimating ovarian reserve and/or chances for pregnancy with in vitro fertilization.

Presumably, the number of antral follicles visible on ultrasound is indicative of the relative number of microscopic (and sound asleep) primordial follicles remaining in the ovary. Each primordial follicle contains an immature egg that can potentially develop in the future. By stimulating blood flow to these follicles with acupuncture, their health can be improved and their maturation can be facilitated.

As mentioned above, we now have proof that blood flow to the entire pelvic environment is increased through the utilization of acupuncture and herbal medicine. The consensus of Western physicians is that when there are only a few antral follicles visible, there are less eggs remaining as compared to when there are more antral follicles visible. Our view, based on clinical experience is that even though there may be a ‘few’ antral follicles present, only one ‘good’ one is required for conception and that the clinical presentation of poor ovarian reserve (few antral follicles) often coexists with diminished egg-quality. By enhancing blood flow to the ovaries we have repeatedly seen improved egg quality, even in women with low ovarian reserve. Only one good egg is necessary for conception to occur.

	FSH Significance
Less than 9	Reassuring level. Expect a good response to ovarian stimulation.
9 - 10	Fair.  Response is between completely normal and somewhat reduced (response varies widely). Overall, a somewhat reduced live birth rate.
10 - 12	Reduced ovarian reserve. Usually show a reduced response to stimulation and some reduction in egg and embryo quality with IVF. Reduced live birth rates on the average.
12 - 17	Generally show a more marked reduction in response to stimulation and usually a further reduction in egg and embryo quality with IVF. Low live birth rates.
Over 17	"No go" level in most clinics. Very poor (or no)  response to stimulation. No live births. "No go" levels must be individualized for the particular lab assay and IVF center.

Many women who visit us present with FSH levels > 17 and after three to six months of treatment see their FSH levels reduced to between 6 and 9 with normal E2 levels.

www.berkleycenter.com

mikeberkley@berkleycenter.com

Comments

[dee]

My cycle ends august 16 i will be fertile from the 18-22 what can i do to ensure pregnancy

[Dr. Berkley]

Hi Dee:

It is really impossible to answer your question. The most obvious response is: have intercourse. But, if you have been ttc for > 1year and have not been successful, the underlying reason has to be found and treated.
Warmest wishes.
Dr. B

[P.J.]

I agree with the substance of the post, however i would add two comments:
- There is a lot of variation in how FSH is measured - a hard number needs to be analyzed with respect to the lab that's doing the analysis as the same woman can have different FSH levels when measured by 2 different clinics.
- I had a day 3 FSH of 19.9 in the same cycle in which I achieved pregnancy naturally which resulted in a healthy baby boy. Prior to achieving pregnancy, I had no response to stims over 3 cycles of IUI and was turned down for IVF by 3 RE's.