Cycle Day 3 - Elevated FSH

Fertility doctors have you come in on cycle day 2-5 to test some hormone levels that can give an indication of the state of your fertility.

A couple weeks ago, I went in on cycle day 3 for my blood work.  My estrogen was in range (I mention this because if estrogen in not in range then the FSH reading may not be accurate) and my FSH was 15.  15 isn't good - in general.   If you do a quick internet search, you can learn a lot about FSH.  Here is what one fertility clinic with an office in Manhattan says about age and normal FSH levels:

What is a normal FSH level?

33 year or less = less than 7.0mlU/mL

33-37 years = less than 7.9 mlU/mL

38-40 years = less than 8.4 mlU/mL

41 years = less than 8.5 mlU/mL

I am 38, so an FSH 15 is getting close to double the top FSH this clinic would expect one to have at my age.  But, when I went to my first fertility appointment at 33 years old.  Guess what my cycle day 3 (aka follicular phase) FSH level?...28.5!  Yes, you read that right.  28.5.  I received that number by a phone message from my clinic at the time and then went to Dr. Google.  What I found was information similar to this:

FSH Test Levels

Normal Menstruating

Follicular Phase 2.5 to 10.2

Postmenopausal 23.0 to >116.3

The above is fairly typically what you will find about FSH levels online.  Do you see where 28.5 falls according to earlymenopause.com?  That's right, postmenopausal.  At 33 years old.  That was a real Uh-oh moment for me in my fertility journey.  I was concerned that I would be unable to have a biological child.

When I went back to my doctor at the time (who worked at a large Manhattan fertility clinic and New York Magazine claimed was one of the best) to discuss this, he asked if I had childhood cancer and tested me for Fragile X.  I didn't have childhood cancer and I do not have Fragile X syndrome.  According to that practice, other than childhood cancer or Fragile X there was no reason that I would have such a high FSH levels unless I was going into early menopause and the doctor was already preparing me to think about using donor eggs.  At the time this practice acted like believing immune issues would affect a pregnancy was akin to believing in Santa Claus or the Easter Bunny.  I was freaking out.

Now, I know, that doctor was wrong to start talking to me about donor eggs so early on.  And, I know that doctor was wrong to dismiss immune issues.  This is unfortunate because he (and other doctors after him) caused me a lot of stress and heartache.  But, luckily, he was wrong because I did not need donor eggs.  I just needed to go to a doctor who better understood endometriosis and reproductive immunology.

This is what Dr. Braverman's blog says about women with unexplained elevated FSH:

Many patients come to our practice with a history of recurring pregnancy loss or multiple failed IVF cycles and these patients are found to have either remarkably or even mildly elevated FSH levels. Sometimes there is no clearly identifiable cause as many of them are under age forty and that is an unusual age to have them start to have a rise in their FSH levels. My job is to find out why their FSH is going up if it is not clearly related to the patient’s age. There are several reasons for elevated FSH that can be treated and improve the chances of conception in this group of patients.

One of these diagnoses is autoimmune oophoritis which is simply an immune condition where the mother actually attacks her own ovaries and actually the follicles inside the ovaries. This can be tested for and we look for the presence of high levels of ovarian antibodies and the good news is by treating these high levels, if the diagnosis is made in close proximity to the actual onset of the disease, we can actually create a window where we may actually get a better response to the stimulatory medications that are used in either the in vetro fertilization cycle or the insemination cycle.

The second situation with unexplained elevation FSH is those patients that are found to have endometriosis. As we mentioned elsewhere on the website, when the ovaries are bathed in abdominal fluid with high levels of inflammatory cytokines such as tumor necrosis factor, this also begins a very slow degradation process in the patient’s follicles and slowly decreases her ovarian reserve. What we found in these situations if we put the patients on high doses of antioxidants and we begin to lower the attack on these ovaries by these inflammatory cytokines we can actually improve not only the quantity of eggs that we see with in vetro fertilization cycles but actually the quality of these eggs.

Sometimes our patients have to go to surgery to debulk the amount of endometriosis if the medical therapy is not working. So it’s important if you have an elevated FSH level and even if it is due to advance maternal age that you are aggressive and you treat each of the problems that are found. In our patients with no other identifiable cause except advance maternal age or a family history of premature ovarian failure, we have therapies that can increase the number of receptors on these older follicles so we get a better response from the stimulatory medications.

So if you have an elevated FSH you may be in this group of patients that still have an opportunity to have a child and you may not necessarily need donor eggs; although a large portion of patients still must be realistic that it’s a difficult battle, but one that we are willing to fight and many times we’re successful.

Luckily, I ultimately found Dr. Braverman who understands that elevated FSH can have other (apparently not as well known by many Reproductive Endocrinologists) causes.  And, luckily, I was in the group of patients that still was able to have a biological child.  Unfortunately, it took me a while before I finally became a patient of Dr. Braverman and had my miracle.  It was a mistake that I did not go to Dr. Braverman earlier.  But, hindsight is 20/20.

When I first learned that I had unexplained high FSH, I did find Dr. Braverman online and similar information to what is posted above.  It made me consider whether I may have endometriosis.  At that time, I asked my next doctor (who also worked at another big Manhattan fertility clinic)  to send me for a laparoscopy to look for endometriosis.  He said, "We only send people who have symptoms of endometriosis for laparoscopy."   I had to remind him that I did have those symptoms and ultimately I went for the procedure.  I did have stage 2 endometriosis and my surgeon removed it.  So, at least, I finally had a clue about what was causing my high FSH.

As you know, eventually, I went to Dr. Braverman and with an immune protocol I was able to carry a baby to full term.  Sadly, this was after 2 miscarriages with other clinics.

Now, for my second IVF even though my FSH is a whopping 15, I still feel hopeful I will have another biological baby because we know we are with the right doctor, for me, Dr. Braverman, and that can make all the difference.