When you go see a doctor about infertility, one of the first things they do is order blood work to evaluate your hormone levels—including your level of follicle-stimulating hormone (FSH). An FSH test gives insight into things like ovarian health and egg quality and may help a doctor pinpoint one or more issues interfering with conception.

So, what does it mean if this test comes back showing elevated FSH levels? And more specifically, how does this impact any fertility treatment you may pursue? Here’s what to know about FSH and egg quality, including what your results can (and can’t) tell you regarding your chances of success with in-vitro fertilization (IVF).

What is FSH Testing for Fertility?

Evaluating levels of follicle-stimulating hormone is a standard part of fertility diagnostic testing.

FSH is measured using a blood test on day three of a patient’s menstrual cycle. As the main hormone involved with the production of mature eggs in the ovaries, FSH plays an important role in fertility each month, as well as in determining the proper course of treatment.

What Are Considered Normal FSH Levels?

“Normal” FSH levels will differ depending on age. A normal FSH level means your ovaries appear to be functioning exactly as they should. Because FSH isn’t the only factor used to assess ovarian reserve, normal FSH levels don’t give a full picture of what’s going on. They do, however, inform treatment decisions, such as when and how to go about an IVF cycle.

For female patients, the below FSH ranges are considered normal:

  • Before puberty: 0 to 4.0 mIU/mL (0 to 4.0 IU/L)
  • During puberty: 0.3 to 10.0 mIU/mL (0.3 to 10.0 IU/L)
  • Women who are still menstruating: 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L)
  • After menopause: 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L)

Based on this chart, it’s easy to see how what is considered a normal FSH level in one patient can be considered high for another. That’s because the older you get, the higher your average FSH. Your doctor will consider your medical history and your age when assessing your FSH test results rather than just the number on the lab report.

FSH and Egg Quality: What Elevated FSH Levels Can Tell Us

If your FSH levels are very high (20 or above), you may not be able to get pregnant naturally or through IVF – at least not with your own eggs.

When it comes to IVF, elevated FSH levels suggest that you may not respond well to medications that stimulate egg production, such as Clomid or gonadotropins. Donor eggs can still be a good option, though, and your doctor will perform additional testing before making a determination one way or the other.

How to Lower FSH Levels

If you undergo FSH testing for fertility and find out your levels are high, there are a few options that could lower your FSH to normal levels. These include:

  • Medications like estrogen or Lupon
  • Diet and lifestyle changes
  • Supplementation with DHEA and/or omega-3 fatty acids

Normal FSH levels can’t always be achieved. Talk to your doctor before attempting to lower your FSH levels – they’ll be able to provide you with the best course of action, as well as test your FSH on a regular basis to check for improvements.

High FSH Patient Case Example

We recently had a 39-year-old patient with an FSH between 15-35 in her cycle. At 39, a higher FSH is common, but her baseline was still elevated. She completed three Conventional IVF cycles at another clinic, using daily injections of 225 IU Gonal-F and 150 IU of Menopur, resulting in one to two eggs each time. None made it to blastocyst.

After analyzing her past chart and cycle information, our team decided a Natural IVF cycle might work best to balance her high FSH levels. She completed two rounds, both resulting in the same number of eggs as the Conventional IVF cycle, but with the Natural Cycles, she was able to have two eggs make it to blastocyst!

So why did the Natural Cycle result in the same number of eggs with no medication and stimulation? Because the natural protocol didn’t raise her already high FSH levels. Fertility medications like daily injections are meant to raise FSH levels to produce more eggs. For most, this protocol works as intended, but if you suffer from an already high FSH this high medication protocol generally won’t gain the results intended, and could threaten egg quality in the long run.

Interested in FSH Testing for Fertility?

Our team is well-versed in helping women of all ages reach their fertility goals, and we are passionate about educating and supporting our patients throughout their journey. If you want compassionate fertility care, New Hope is the right place for you. Call us at (347) 970-8479 or schedule your initial consultation today!