If you really want a pregnancy and have seen a fertility expert then it is very likely the doctor has ordered a FSH test. After reading this article you will understand why FSH levels don’t predict your chance of natural pregnancy or if you are about to go through menopause.
Follicle Stimulating Hormone, more commonly abbreviated as FSH, is the most misunderstood of all the fertility tests in existence. The FSH test is misunderstood by patients and health care providers alike.
As a fertility surgeon, I am commonly asked what should be done about high FSH levels? Is pregnancy possible?
FSH testing is a crappy test. FSH levels and natural pregnancy don’t always predict your chance of pregnancy.
I specialize in tubal ligation reversal surgery. It is my belief the FSH test is a complete waste of time.
Again if you did not hear me then let me repeat myself, “FSH testing is a complete waste of time.”
I commonly find myself doing damage control because a woman’s mental health has been ruined after they were told they had high FSH levels. I am commonly trying to reassure these women they are not ‘over the hill’ and future, natural pregnancy are possible despite what they have been told by their doctors about high FSH levels.
I have never found the FSH test useful. In fact, after I finished my residency training, I have never even ordered a FSH test. Let me repeat myself, “I have NEVER ordered a FSH test.”
I would like to provide my personal and my professional insight into FSH, high FSH, and problems with routine FSH testing.
FSH and Your Menstrual Cycle
Before you can understand the problems with FSH you need to understand your menstrual cycle…at least the very beginning of your menstrual cycle.
This article is a series of articles written to help better explain the menstrual cycle and help women increase their chances of natural pregnancy. This is the FSH explanation article.
If you are reading this article for the first time then you should save a bookmark for this page or check back with our Tubal Reversal Blog and read the additional articles as they are published.
In the first blog article, I reviewed the menstrual cycle as simply as I possibly could:
Problems getting pregnant? Understand your menstrual cycle!
A brief review will of the menstrual cycle will be provided here. The menstrual cycle is started by your brain…more specifically the small part of your brain called the pituitary gland. The pituitary gland is the lead hormonal organizer of your entire body.
The pituitary is the maestro of the hormonal orchestra.
The pituitary releases a variety of hormones that control your entire body. The pituitary releases the following hormones:
- Adrenocorticotrophic hormone (ACTH)
- Thyroid-stimulating hormone (TSH)
- Luteinising hormone (LH)
- Prolactin (PRL)
- Growth hormone (GH)
- Melanocyte-stimulating hormone (MSH)
- Follicle-stimulating hormone (FSH)
This is not intended to be an educational article about the functions of the pituitary. The pituitary is a very complex hormonal gland.
We are only going to focus on FSH for the purposes of this educational article. Go to some other website if you want to learn more about your pituitary.
FSH release starts your menstrual cycle
The first two weeks of your menstrual cycle your pituitary tells your ovaries what to do. Your pituitary releases Follicle Simulating Hormone (FSH).
The FSH is released into the blood stream and circulates around your body. FSH is considered a hormone. The word ‘hormone’ has a negative meaning to many women. Hormones are not bad.
Hormones are your body’s way of sending instructional signals to other distant parts of your body.
Your brain has two main ways of instructing your body: 1) nerves and 2) hormones. Nerves and hormones send signals to other parts of your body.
Think of nerves as being similar to electrical wires (which they really are) and think of hormones as being similar to radio waves (or in today’s age… Blutooth signals).
- Nerves communicate with other parts of your body with electrical impulses.
- Hormones are chemical messenger released into the blood stream.
Hormones are good. Hormones are not always bad. Hormones are like free speech.
Speech when used constructively is very helpful…we could not get along or advance as a society without a helpful form of speech. Speech when used maliciously or destructively can be very harmful.
Hormones..including FSH hormone…is the way the brain speaks to the ovary.
FSH: Instructs Ovary to grow and release an egg
The ovary detects the FSH hormone secreted into the blood stream by the pituitary. The FSH tells the ovary to start producing a follicle (an early egg). A follicle is like a nest. It is a group of cells in the ovary that surround an early egg. These cells are helper cells that get the egg ready for release.
After detecting FSH in the blood stream the ovary begins to form an egg (an early egg is known as a follicle).
Not only does FSH tell the ovary to form an egg….but it also tells the ovary to make the hormone estrogen.
Estrogen is released into the blood stream by the ovaries. Estrogen circulates around the body and is eventually detected by the uterine lining. Many people mistakenly believe the estrogen and other hormones travel down the fallopian tube….not!
Estrogen hormone tells the uterine lining to start growing to get ready for a fertilized egg.
The brain talks to the ovary with hormonal secretion of FSH…the ovary talks to the uterine lining with hormonal secretion of estrogen.
After 14 days…the follicle has matured and is ready to be release the egg. The estrogen has caused the uterine lining to grow enough to support and nurture a fertilized egg. All they are now waiting for is the pituitary to scream “Go!”
Approximately 10 to 13 days after your menstrual period starts, your brain releases more FSH hormone but also a large amount of a hormone called luteinizing hormone (LH) into the blood stream. This release is called the FSH/LH surge. LH hormone is the pituitary’s way of ordering the ovary to release the mature egg.
After ovulation…FSH hormone does nothing. FSH simply tells the ovary to get the egg ready and also start making estrogen.
Is all of the above making your mind spin? Are you having trouble following? Lets use an analogy to make sure you are understanding.
FSH and Ovulation: Think of a catapult
A catapult analogy can be very helpful to understanding how FSH works.
A catapult is a medieval war machine that launches a large stone (one at a time) at an enemy. A team is required to prepare, load, and fire a catapult. A leader is required to control everything. It takes time and coordination to fire one stone and this also has to be repeated over and over again…just like ovulation!
- Your pituitary is leader of the catapult team
- Your ovary is the catapult
- Your follicle are the soldiers operating the catapult
- The large stone is the egg
Step 1. Pituitary gives the FSH command. Team get ready to “Fire Stone High“… (FSH..get it…LOL).
Step 2. Catapult team hears the FSH command, loads a large stone into the catapult, winds the catapult back, aims and positions the catapult.
Step 3. After giving sufficient time to get the stone the pituitary shouts, “FIRE STONE HIGH…LET HER go!” (FSH..LH…get it…LOL)
Step 4. Catapult team fires the stone (egg).
After the stone is fired the team rests until they get another order to “Fire Stone High”.
The FSH command now has nothing to do with where the stone goes, where the stone lands, what happens after the stone lands or if the stone does any damage to the other side.
Problems With FSH: FSH too low?
Having a FSH that is too low is usually not a common problem people have. In fact, low FSH as a sign of a major problem is very rare. The reason to have a FSH that is too low would be either the brain is not talking to the pituitary or the pituitary is not working correctly. These two conditions are not very common.
Brain causes for low FSH would be serious brain disease…either a brain tumor or major brain insult like a stroke, brain infection, or serious accident. Basically you would know about it and would not need a doctor to tell you that you had a problem…you would not be walking around complaining that your FSH is too low. Most likely you would not even be walking at all.
Stress could also be a ‘brain reason’ for low FSH. Everyone thinks they have too much stress in their life but to have the type of stress that would cause low FSH you would have to have the same amount of stress experienced by concentration camp prisoners, people on death row in solitary confinement, or so much stress that you are close to becoming psychotic. Despite what we may think, most of us don’t have that amount of stress in our daily lives.
Pituitary reasons for low FSH would be all of the same reasons for brain problems. It is also possible a person could have a tumor in their pituitary or have some genetic disease that prevents them from making FSH.
Talking about low FSH is mostly a productive waste of time. Just like Bigfoot, Loch Ness, and aliens…it is possible they exist but talking all day about it is not productive and won’t make a big difference in our daily lives.
In my personal experience, all of these conditions are very rare….and if you had one of these problems you would likely know about it and not have to guess.
It is possible to have a small or large tumor in your pituitary (micro or macro pituitary adenoma) but that is not common and you would also have other hormonal abnormalities….like under-active thyroid (hypoactive thyroid) or abnormal prolactin levels (you would have milk coming from your breast and stop having periods).
Problems with FSH: FSH too high (not really)?
In my experience…this is where most people ‘think’ they have a problem…they are told their FSH levels are too high….so we should spend more time on this topic.
Has your doctor ordered you an FSH test and told you your levels are too high? Did they tell you that you will never get pregnant or that IVF won’t work? Did they tell you that you are pre, peri, or post menopausal?
Let us go back to our catapult analogy to provide better understanding.
Problems With High FSH: Test not done correctly
If your doctor checked your FSH level once and told you it was abnormally high and now you are depressed….well maybe the test was not correct. Have you considered this?
What if you quickly listened to the catapult team and you heard the commander yell “FIRE STONE HIGH, LET HER go!“?
Would you then tell your friends that the commander yells all the time or the commanders voice is always loud?
Perhaps you just listened in at the wrong time. What if you had listened in during the time the catapult team was resting and taking a smoke break and the commander was not saying anything?
It is very common for the brain to release a surge of FSH just before ovulation. If you get your blood tested at that time then you will have high FSH levels. Why not check it again just to make sure?
Roughly 10 to 14 days after your period starts your brain releases a high level of FSH. This is called the FSH/LH surge.
If you get your blood checked at this time..yes indeed your FSH levels will be high.
So you should always have it checked a second time to make sure…never make a serious decision based on one abnormal test result!
Check a day 3 FSH!
Infertility experts recommend checking your FSH level on day 3 of your menstrual cycle. To be clear…your first day of your period is considered day #1….so two days after that would be day #3.
What is so special about day #3? The answer…nothing is special about day #3.
Day #3 is just a well defined day…it is enough time to diagnose yourself with the start of your period….and even if it is on a Friday or the weekend….3 days latter the lab is open and your doctor can order the test without you bugging them on a weekend (seriously)! Also 3 days after your period starts everyone should have a lowish FSH.
When ‘normal levels’ were set up they tested a whole bunch of women to see what the average was….to make sure they got a good average they recommended testing women who were having regular periods (ie premenopausal) on the 3rd day of their cycle.
If we had wanted to we could have set the standard at a day 5, 8 or a day 25 blood test…but we didn’t. We decided on day #3.
Essentially FSH changes throughout your menstrual cycle. To understand what a normal value is you need to know when you are checking it.
Problems With High FSH: FSH is ‘kind of high’!
As a woman ages, her FSH levels gradually increase because the ovaries become less responsive over time. Why? We dont know and anti-aging scientist are very interested in learning how aging causes these changes.
If you had your FSH levels checked (appropriately on cycle day #3) and your doctor told you that your FSH levels are kind of high then you could be premenopausal.
Back to the catapult analogy….
What if the soliders start getting tired? Well the commander will probably have to yell louder and more often. Essentially this is what happens in your body. As the ovaries start to become fatigued they stop listening and working as well. The brain has to release more FSH to get them to release an egg. The brain has to constantly yell louder at the ovaries by secreting more FSH…this is what happens when you are premenopausal.
Problems With High FSH: FSH is ‘Hella high’!
If you had your FSH levels checked (appropriately on cycle day #3) and your doctor told you that your FSH levels were sky high then you could be postmenopausal.
Back to the catapult analogy….
What if the catapult soliders partied all night and are so tired they are passed drunk …or what if the enemy had come over and captured the catapult team?
Well the commander may not be aware of these events and will be screaming at the top of their lungs and jumping up and down for the soldiers to fire the catapult…but to no avail. The team is not able to respond. This is what happens when you are postmenopausal… your FSH levels are hella high!
Your pituitary is screaming as loud as it can be secreting constantly FSH and your FSH levels are constantly high. This is what happens when you are postmenopausal.
High FSH, Low Ovarian Reserve: “You will never get pregnant.”
Most people who have high FSH feel like they are being told they will never get pregnant. This is CATEGORICALLY FALSE.
Remember early on I stated ordering a FSH test is a complete waste of time (unless you are going to have IVF)? Well here is why…
Regarding fertility…FSH testing has only been proven to be useful in predicting whose ovaries will or will not respond to in-vitro fertility (IVF) treatments. If you have high FSH then your ovaries are not being responsive. You will need more FSH medication to make your ovaries release eggs. IVF will be very expensive and you have a lower chance of getting pregnant.
Your brain has to release higher amounts of FSH because the ovaries are not listening well. They are not producing eggs as easily as they did when they were younger.
Higher levels of FSH because of lower numbers of eggs being produced is often referred to as ‘low ovarian reserve’. The ovaries have less reserve stores of eggs and are becoming increasingly unresponsive.
Many people are told they have low ovarian reserve and that their egg quality is poor. I can promise you that you still have lots of eggs (woman are born with more eggs than they can ever use or ovulate in a normal lifetime). The eggs may be less likely to listen to the FSH…which is why they say the ‘egg quality’ is poor and the ‘reserve strength’ of the ovary is less.
If you are curious to know more about egg counts the read the addendum at the bottom of this article.
Women who have high FSH and low ovarian reserve will have a much harder time getting pregnant with IVF treatment. They will need to be given higher dose hormones than other women. This will greatly increase the cost of IVF treatment and they may never end up with enough eggs to have successful IVF.
We do know that higher FSH levels are associated with lower IVF success…but this does not mean your chances of natural pregnancy are lower.
Having high FSH and low ovarian reserved DOES NOT mean you will never get pregnant but it does mean you may have less chance of success with IVF.
If FSH was so predictive of natural pregnancy then we would use the test in women when they came to our offices requesting birth control…we would say, “You want a tubal ligation? Well why dont we check your FSH level and if it is high then you don’t need a tubal ligation because you won’t become pregnant.”
For the record we don’t do this because it is non-sense and we know a high FSH does not mean pregnancy is impossible.
High FSH and low ovarian reserve does not predict the future. It means you may have more difficulty with IVF but it does not mean it is harder to become naturally pregnant.
The FSH test is not a crystal ball…it does not predict your pregnancy future….especially natural conception.
High FSH: Pre, Peri, And Post Menopausal
Want a FSH test to see if you are going through menopause? Why don’t you just check your age?
Here are some simple facts about menopause:
- You can become menopausal as early as 45 or as late as 55 but the average age of menopause is 51. Most women take, on average, about two years to go through the periomenopausal period.
- Menopause is a clinical diagnosis, which means made by symptoms and observations alone…not by lab tests or x-rays.
- The definition of menopause is not having a period for 6 continuous months while not being pregnant and being between the ages of 45 to 55.
There is no lab test for menopause but doctors would make you think there is a lab test for menopause…because they (not me) are always ordering FSH test to try and prove or diagnose something that is more easily diagnosed by talking with a patient.
Ordering a FSH to determine where you are on the menopause time line is REALLY A COMPLETE waste of time. You dont need a lab test to tell you this. I have a better test for you….the Driver’s License Crotch Test!
Driver’s License Crotch Test!
If you want to determine where you are on the menopause spectrum then pull out your drivers license.
Check your date of birth. How old are you?
Look at your crotch (basically in between your legs) daily for six (6) months and look to see if you have any blood at regular intervals (basically periods).
- If you are having periods and under age 45….then you are PRE-menopausal.
- If you are having regular or irregular periods and are between the ages of 45 to 55…then you are PERI-menopausal.
- If you are between the ages of 45 to 55…and have not had a period for six months then you are POST-menopausal.
Why do you need an expensive lab test?
What about early menopause?
There is always a smart person in the group who will ask, “What about using FSH to diagnose premature menopause?”
Premature menopause is going through menopause before the age of 40. Every woman, at some point in time, thinks they are going through premature menopause. This is wishful thinking because everyone wants to be done with ‘Aunt Flow’. Most women will not go through early menopause. In fact, in my 20+ years of working in women’s health I believe I have only seen ONE woman go through premature menopause around the age of 35!
Early menopause is rare. The vast majority of women under age 45 who are not having periods are anovulatory…or not releasing eggs. Their catapult is not firing…but the commander and the team are fine…they are just not communicating properly.
Sure you can use a FSH test to help you diagnose premature menopause…but knowing about it does not change anything. You can’t correct premature menopause…so why stress about it?
About the Author: Who is this crazy catapult analogy guy?
I am Dr. Charles Monteith. I am the Medical Director of A Personal Choice. I am located in Raleigh North Carolina and I specialize in reversing tubal ligation, Essure sterilization, and vasectomy.
I dont offer IVF. I only offer fertility surgery.
If you would like more information about IVF and natural pregnancy then you should visit this page: Tubal reversal vs IVF.
I don’t provide general medical advice over the internet…but if you were getting evaluated for IVF and were told you can’t get pregnant because of a high FSH and you want to have tubal reversal surgery then give us a call (919) 977-5050 and we can answer your questions about tubal reversal surgery.
If you want to send us your tubal ligation records for a free review then this link will provide information on how you can send us records:
Sending tubal ligation records for a free review
You are also welcome to visit our comprehensive reversal website: A Personal Choice: Tubal Reversal And Vasectomy Reversal Raleigh, NC
Dont be discouraged…FSH does not predict who will or will not become pregnant. FSH is not a crystal ball. Your age is a much better predictor of likelihood of pregnancy.
If you are having periods then you are ovulating (releasing eggs).
If you are releasing eggs…then pregnancy is always possible.
Egg Counts: High FSH and Low Ovarian Reserve
Many women will get a FSH test and be told that their ovarian reserve is low and the quality of their eggs is bad.
FSH testing is more helpful in predicting the likelihood of IVF success, IVF difficulty, or IVF failure. FSH does not predict the probability of natural pregnancy.
Remember you can tell just as much about ovarian reserve and egg quality by knowing your age…You don’t need a FSH test on someone who is 48 years of age. The age tells you just as much.
Rough Estimated Facts About Egg Counts and Ovarian Reserve
- Starting around age 18 the average woman has a total of about 500,000 eggs! You have more eggs than you could ever use!
- Each month you ovulate, your ovary prepares about 100 eggs for ovulation and only 1 or possibly 2 (hooray twins!) will be released that month. The other 99 eggs are not recycled and cannot be used in the future…so each month you lose about 100 eggs. Each year you lose about 1,200 eggs.
- If you lose 1,200 eggs a year starting at age 18 then theoretically you have 333 years worth of eggs!
- Ovaries stop working at menopause. The average age of menopause is 51.
- Unfortunately eggs also age as you age. Egg loss starts to increase after age 33 but egg loss increases more after age 43.
- It is estimated that the average woman at age 48 has at least 400,000+ eggs.
If you are uncertain of the math above then just look between your legs to see if you are having periods.
If you are having regular periods then you are releasing eggs. If you are releasing eggs then you can become pregnant. All it takes is one!