Follicle Stimulating Hormone (FSH) and Infertility
Most people are aware that increasing maternal age leads to a decline in fertility. In fact, this decline occurs fairly acutely after age 37 and continues to decline up through the menopause. In almost any arena in which age is evaluated, advancing age leads to a decline in either treatment success or ultimate pregnancy outcome. Not only does fertility decline with advancing maternal age, but miscarriage rate increases as well as chromosomal abnormalities increase. Once a pregnancy has successfully entered the second trimester, it does not appear that other pregnancy risks are increased.
One test which can offer some insight into this aging process is the "day 3" FSH. FSH is the pituitary hormone that is primarily responsible for folliculogenesis. As such, an increasing day 3 FSH reflects ovarian resistance to ovulation. In some studies the day 3 FSH has been shown to be a better predictor of pregnancy success than chronologic age. A day 3 FSH of greater than 15 mIU/mL places the woman in a relatively poor prognostic category whereas a day 3 FSH of less than 10 mIU/mL places the woman in a good prognostic category. Those women who fall between 10 and 15 mIU/mL find themselves in the "gray zone.” It must be emphasized that the day 3 FSH value varies from cycle to cycle and that a single isolated, elevated, day 3 FSH is not the "final nail in the coffin" for a woman considering pregnancy.
On Internet message boards you find lots of success stories of women who beat the odds and achieved pregnancies with elevated FSH levels. They underwent IVF, alternative fertility treatments such as acupuncture, a combination of the two or even natural conception. “It is important that women don’t give up hope,” says Dr. Hummel, “It is important to hold on to the dream of having children despite a high FSH reading”.
