43 Yr Old With High FSH Of 30 Asks: Is There A Way To Lower It?

Question:

Dear Dr. Ramirez,

First, thank you very much for taking the time to answer so many questions. Your column has been an important part of my education on IVF.

I am writing from Cincinnati, OH. I am 43 years old and am considering IVF. I just learnt that my FSH is 30, substantially above the cutoff rate for my fertility clinic (their cutoff is 10). Are there any options other than donor eggs? Is there a way to lower FSH? Would love to get your perspective. Thank you. S.

Answer:

Hello S. from the U.S.,

I'm assuming, of course, that your FSH levels were accurately tested. The FSH level is only valid for interpretation if it is done on cycle day #2 or 3. The FSH is a measure of ovarian function (or ovarian resistance). This is mainly important to determine how well the ovaries will respond to stimulation. It is NOT a measure of fertility. However, if the CD#3 FSH level of 30 is correct, that would indicate that you are perimenopausal and your ovaries would be shutting down. You would no longer be having periods and you would have menopausal symptoms such as hot flashes. Is this the case?

If so, unfortunately, with an elevated FSH of 30 you are not eligible for any other treatments other than donor eggs. I'm sorry but there is no way to revive the ovaries at this time. I see on the web that there are many lay people claiming that there are "natural" alternatives like acupressure that can help lower your FSH levels. This is simply not true!

Please see my previous post:"41 Yr Old With High FSH, High Estradiol..." where I go into greater detail regarding this distressing issue. Remember, there are many paths you can take to motherhood and from my experience as an infertility specialist, all those paths can bring happiness.

Good Luck,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

www.montereybayivf.com

Monterey, California, U.S.A.

PCOS Challenge Radio Show Summary: Everything You Wanted To Know About PCOS, Fertility, Menopause, Pregnancy & More!

Dear Readers,
On September 29th I was interviewed by Sasha Ottey of PCOS Challenge on her BlogTalkRadio program, for an episode titled: "Ask The Fertility Specialist About PCOS And Your Fertility". I was pleasantly surprised at how quickly the one-hour interview went. It was basically a question/answer format (like my blog ). It was interesting to see how many questions I received from Sasha and her listeners that not only covered PCOS but many, many other issues that relate to women's reproductive health. For more in depth information on PCOS and infertility please see: Polycystic Ovarian Syndrome.

I will attempt to give you some idea of the many different issues that were brought up during this very enlightening hour! I can't list them all, but if any of the topics that I list below interest you, please listen to the radio show through the widget below!

Listen to internet radio with PCOSChallenge com on Blog Talk Radio

• "What is the difference between a normal menstrual cycle and one that is PCOS?" With an abnormal menstrual cycle you can develop abnormalities in your endometrial lining.
• "What are the top reasons for infertility?" Probably PCOS is the number one cause for infertility that I see, with tubal factors and age factors coming in close seconds.
• "While overweight PCOS patients are told to lose weight, lean PCOS patients are at a loss as to what to do?" I go in depth on Clomid, Femara and the injectables that might be the treatment path for "lean" PCO patients.
• "What is the difference between ovarian reserve and ovarian resistance?" With ovarian reserve you need to evaluate your FSH levels and AMH and tends to come with age, but ovarian resistance has to do with how the ovary responds to fertility medications.
• "How long do you need to wait to try for pregnancy again after you have a miscarriage?" Surprisingly, recent studies have shown that trying as soon as possible will actually increase your chances of pregnancy. You must wait until you resume your normal menstrual cycle, though.
• "What about patients that are insulin resistance and overweight, will changing their diet and losing weight help with their fertility?" This will work in a majority of patients, but some of these patients will have to go on Metformin, and possibly ovulation inducing medication.
• "I am a very heavy-bleeder during my period and are there any options besides a hysterectomy?" You need to establish first whether you want to get pregnant in the future, in which case you want to preserve your uterus. You should find out why you have the bleeding. It could be an ovarian disfunction or perhaps caused by fibroids or polyps which can be removed. Otherwise, if you don't want to get pregnant you can opt to have a D&C, bcp, Mirena, endometrial ablation, or a hysterectomy.
• "When can I expect to see or hear the heartbeat in early pregnancy?" By the seventh week you should expect to see something.
• "Can you have menopause and PCO?" Once you become menopausal PCO is not an issue anymore, you have a hormonal imbalance because your ovaries are not functioning anymore. There are treatments for menopause, including estrogen replacement therapy for the first five years.
• "What is Metformin and Spironolactone?" Metformin is an insulin blocker, while Spironolactone is a diuretic used with PCO patients that have hirsuitism as well.
• "How do you treat nausea in pregnancy?" There is a great drug out there now that I use with all my patients, including those who have just had surgery, called "Zofran". It is safe for pregnant patients.
  
  Not all the topics we covered are listed above...so tune in if you want to hear me discuss these issues and more in depth! Thank you, Sasha, for the opportunity to share this knowledge with your listeners!
  
  Edward Ramirez, MD, FACOG
  Monterey Bay IVF
  www.montereybayivf.com

44 Year Old with High FSH "Can I Get Pregnant?"

Question:
Hi,
　
I just turned 44 (today!). My periods were pretty regular up until 16 months ago when they suddenly stopped. I've had one period in 16 months, and have had my FSH levels tested twice in the past twelve months. The first time they tested, it was 112. The second time, it had dropped to 86. Estrogen levels were "normal," but they didn't give me a figure. Both doctors who have tested me said that I'm in full menopause, though I've had no other symptoms other than the missed periods.
　
I've recently started seriously dating someone. He's been tested for all STDs (and is fine, as am I), and we had unprotected sex yesterday. And suddenly, this morning, my period seems to have started!
　
I assumed because of the FSH levels and the missed periods that I cannot get pregnant, but was hoping to confirm this--is it possible to get pregnant given the FSH levels and missed periods?
　
Thanks in advance for any help you can provide!

~beth (in Baltimore)
　
Answer:
Hello Beth from the U.S.,
　
Happy Birthday! Based on the FSH levels, you are in menopause, and by the way, congratulations on the new relationship. I can't explain the bleeding but that is definitely abnormal. I doubt that it is due to pregnancy, but cannot be sure without any further testing. I recommend that you get checked. In addition, considering how young you are to be in menopause, you might want to consider starting on some form of hormone replacement therapy. The lack of estrogen production will be detrimental to your body in many ways, including vaginal lubrication. Despite all the negative press releases about hormone replacement, recent studies are showing benefit if the woman starts at the time or near the time of menopause. That is why I recommend it. I use a low-dose birth control pill in my young woman because the menopausal formulations are not made for the estrogen requirements of the younger woman's higher metabolism. That should take care of any more abnormal bleeding episodes and make your cycles regular again. More than likely, the bleeding was a last hurrah from your uterus. We call it dysfunctional bleeding, but it still needs an evaluation.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com/ check me out on facebook and twitter with me at @montereybayivf