Q&A Sessions:

	-	Most Recent
	-	Age and Fertility
	-	Egg/Embryo Donation
	-	Follicle-stimulating Hormone (FSH)
	-	In Vitro Fertilization (IVF)
	-	Male Infertility
	-	Other Fertility Issues
	-	Polycystic Ovary Syndrome (PCOS)
	-	Tubal/Vasectomy Reversal
	-	Unidentified Infertility

Beth asks:
I am alarmed. I just read another women's question/concern regarding an elevated follicle stimulating hormone (FSH) and how it's difficult to treat. My concern is my FSH had been between 11-12, I am currently seeing a fertility team and the plan of action is to do one cycle of clomid and then begin injections of FSH. Are the injections going to help or will they prolong the problem?

Kurt Barnhart, MD, MSCE responds:
Yes, an elevated FSH is the most difficult cause of infertility to treat. However, in some cases it can be treated (depending on other factors including your age). Importantly you should be very aggressive in treatment. We would treat this by skipping the clomid and consider gonadotropin therapy (injections) or even in vitro fertilization (IVF). It is important to consult with your fertility care provider to understand the implication of treatment options and the true chance of success with each option.

Yatt asks:
If a woman's follicle stimulating hormone (FSH) level is 8.9 can we get pregnant?

Clarisa Gracia, MD, MSCE responds:
It is difficult to answer this question without any other information such as age or medical history, etc about your situation. However, an FSH level of 8.9 alone does not mean that you cannot get pregnant.

Diane asks:
I have gone through IVF/ISCI three times now. I have had a higher three-day FSH result for all for them 11-12-11, I'm now 32. With my last IVF, I did get pregnant but miscarried after eight weeks. I went back to the clinic to start another cycle of IVF and got my blood work done for my third day. My FSH level was at 24 so the cycle was cancelled. Will this level come down? Did to rise so much in the last three months because of the pregnancy and miscarriage?

Samantha Butts, MD responds:
The pregnancy should not be a cause of the FSH value of 24. When your FSH values are elevated somewhat they tend to become more variable from month to month, some in the normal range some more elevated. So its possible that next month your FSH could be back down around 11 or 12. I would recommend having a frank conversation with your provider about your odds of conception with IVF and your future options in light of these values.

Andrea asks:
I am 39 years of age and have recently undergone some fertility tests which confirmed that I had an FHS level of 26.4. I was told that IVF was not an option for me and that my only option is egg donor. Are there any factors which affect FSH levels other than menopause? Is there anything I can do to reverse my FSH levels to lower them? I really want a baby of my own from my own egg if possible. Are there any other options for me?

Clarisa Gracia, MD responds:
It is not known what causes an elevated FSH in someone like you however, we do know that success rates for IVF for someone like you are less than 5 percent. Donor egg is likely to be much more successful (around 50 percent per cycle).

Having an elevated FSH does not necessarily mean that you will not be able to conceive on your own or with some assistance. If you are set on trying with your own eggs, you may want to try stimulation with injectable medications and intrauterine insemination (understanding that the chances are still low).

Marie asks:
I had a follicle stimulating hormone (FSH) blood test on my mid-cycle, and it came out to be 10.2. Is this good?

Samantha Butts, MD MSCE responds:
FSH is used to assess ovarian reserve; in other words, it assesses how you may respond to infertility medications and the general quality of your eggs. The interpretation of the test varies from practice to practice and from lab to lab, so you need to ask the physician who ordered it what the number means in their experience. Higher numbers are usually associated with needing more aggressive treatments to conceive successfully.

NTrying asks:
What does it mean to have a low FSH count (follicle stimulating hormone)?

Clarisa Gracia, MD responds:
Without knowing information about your specific situation and why the test was ordered, it is difficult to answer that question. However, we often order follicle stimulating hormone (FSH) to assess ovarian reserve. In this case, an FSH above 10 is generally considered abnormal. A low FSH is generally not abnormal, and usually does not indicate a problem. However, there are specific conditions that are associated with a very low FSH.

Jennifer asks:
My husband and I are trying to conceive. I have been off of the pill for approximately eight months. About two months after discontinuing use of the pill, my doctor ran several labs to see why I had not resumed my cycles. My FSH came back elevated. Two months later I resumed normal cycles and had my FSH retested. It was normal. I have read that your FSH is only as good as your worst reading. Is this true?

Was the first test that I had a reliable reading since I had not resumed normal cycles and therefore could not be sure of where in my cycle I was? I am concerned that we have waited too long to try to have another child. I just turned 35. We have other children and had no trouble conceiving. It happened within the first three months of trying. I know it can take several months after discontinuing the pill to resume normal cycles, so I wonder if during that time a woman's FSH level might be elevated.

Clarisa Gracia, MD responds:
The FSH value varies widely throughout the menstrual cycle, so a "random" value may not be informative. In general the Estradiol level should be measured with the FSH and should be <50 for the FSH to be interpretable.

I would follow day 3 levels and continue trying to conceive. Seeing a fertility specialist would be a good idea at this point.

If you have further questions or would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Tommy ka asks:
What is the normal FSH for a woman who is 36 years old? Also, what is the best FSH value for pregnancy?

Response:
The absolute value of the FSH test depends on the lab test (assay) a particular program utilizes. So, there is no number that I can give you. You need to ask what is normal for the test (assay) your physician is using. Generally speaking, a level of less than 10 with an estrogen level less than 50 should be considered normal and indicates an appropriate ovarian reserve.

Christine asks:
I am 43 years old with a 23 year-old daughter. I would like to get pregnant. I have seen my ob/gyn and he did a FSH test of which he told me the results were "not good". I'm not quite sure what this means and was wondering if this "not good" result renders it impossible for me to conceive.

Steven Sondheimer, MD responds:
You should ask your physician what was meant by "not good." In general as women get older the number of eggs and the quality of their eggs decrease. Many of the techniques infertility specialists use to help couples achieve pregnancy work better when the eggs are plentiful and younger.

Therefore, when the follicle stimulating hormone (FSH) level is abnormal, infertility doctors are not able to help except by using the eggs of a younger women (an egg donor). The FSH level measures the ageing process of the egg. The donor egg process and embryo transfer to the recipient is one of the more successful techniques to achieve pregnancy.

Still, as long as a women is ovulating, she has some hope of getting pregnant on her own, even with an abnormal FSH. As women get into their 40's their pregnancies are more likely to end in a spontaneous miscarriage but still there is hope for a successful pregnancy. At Penn Fertility Care, the oldest patient who achieved a pregnancy with her own eggs in 2002 and delivered a baby was 45 years old.

Julia asks:
This month my follicle stimulating hormone (FSH) reading was 11 and I was told it would be difficult to conceive. Well, luckily I did. Does this high reading of FSH mean that the egg may not be a healthy one? I am only five weeks pregnant.

Steven Sondheimer, MD responds:
We wish you the best and hope along with you that there will not be any problems. You can discuss with your doctor the possibility of genetic testing for chromosomal problems such as Down's Syndrome. All pregnancies have some risk of miscarriage but this is not within your control. I do not know your age but the chances of a miscarriage in a woman above age 35 are higher than that in a younger woman with a normal FSH level. Still, there is a good chance that everything will be ok.

Michelle asks:
I am 32 and I am going through infertility testing. My FSH was normal last month 5.5, but my estrogen level was elevated 93. This cycle my estrogen was 46 normal but FSH was 26. I have read literature that states one's elevated FSH is an indication of poor chances of getting pregnant is that true?

Kurt Barnhart MD, MSCE responds:
An elevated follicle-stimulating hormone (FSH) level is associated with having a more difficult time getting pregnant. Your level is elevated. You should get a full consultation with reproductive specialist to go over your options. You are still young, so there are options.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366). You can also request an appointment online.

Whit asks:
I am 37 and my husband 32. I have been trying to conceive for three years. I had one miscarriage one and a half years ago, and since then, I cannot get pregnant. I went to see a specialist and had a day three hormone level test last week.

I was told today by my doctor that my follicle stimulating hormone (FSH) level is 47, and I have zero chance to have my own child. He never treated a woman successfully with an FSH higher than 18. I would like to know if this is true or not. I have an ovarian cyst on one side. Does this cause a higher level of FSH?

Clarisa Gracia, MD, MSCE responds:
Unfortunately, the FSH level indicates that your ovaries are aging prematurely. Rarely, women with high FSH levels will get pregnant on their own — but the chances are very low. Treatments such as in vitro fertilization (IVF) are usually not effective with such high levels. Did your doctor mention that you can get pregnant using an egg from a younger woman (donor egg)?

Ditty asks:
I just turned 39 years old and have never been pregnant. My husband I and have been seeing a fertility specialist for 2 years and have been unsuccessful. I have tried insemination several times and was unsuccessful. I did IVF once and was unsuccessful.

I do know that my FSH level is high at times, my periods have always ranged from 20 to 32 days, I only get a few follicles when stimulated to the right size therefore only a few eggs are retrieved. My mother had her last child at 43 and my sister is 42 and expecting her 3rd in a couple months. Like most women and I very depressed about this. Is there any hope for me?

Richard Tureck, MD responds:
Overall, having a high FSH level does lessen the chances for fertility. Today, there are many fertility treatments available to assist our patients in obtaining a pregnancy, including IVF and egg donation.

I wish I could give you a precise answer however, I would need to review your complete medical history to determine the course of treatment that would best meet your needs. In addition, we do offer counseling for our patients to help them cope with the emotions that often accompany fertility issues.

Anne asks:
I am a 44 year old grateful Mommy of 2 beautiful kiddos (3 and 4 years old) from two successful donor cycles four and five years ago. I knew I needed IVF due to infertility probably due to endometriosis, and then I was told I had no chance of conceiving with my own eggs after my FSH was 14 on a single blood draw. I recently had an FSH drawn for asymptom workup and was very surprised that it was 2.5!

Is there is any chance I could have been misdiagnosed with premature ovarian failure, since the entire diagnosis of premature ovarian failure was based on only one blood test and never confirmed? I know from extensive reading that reproductive endocrinologists have shown in research that even a single surge in FSH is ominous for a woman's personal fertility rate.

What I don't understand is the wisdom of proceeding with something as multi-issued as a donor cycle without diagnostic confirmation? Here I am concerned I might have been mis-diagnosed based on a single blood test. I would greatly appreciate your opinion and even a bit of guidance.

Kurt Barnhart, MD responds:
I am so pleased to hear that you have a wonderful family. It is wonderful to hear about such success. Your question about your FSH level is a good one. There is quite a bit of variation in a women's FSH value, year to year and cycle to cycle. The worst case is when it is high. That almost always meant decreased ovarian reserve, and at times premature ovarian failure.

However the FSH is not always high. Sometime the next cycle it is normal. Unfortunately that does not take away the first one. Thus, while every prudent physician often confirms an abnormal test, in your case the recent low FSH does not trump the previous high one. Good luck to you.

High FSH asks:
Is it possible for women with FSH Levels between 25 and 27 to conceive with in vitro fertilization (IVF) and if so what are the odds?

Kurt Barnhart, MD, MSCE responds:
An elevated follicle stimulating hormone (FSH) is the most difficult problem for us to overcome. Depending on your age, IVF may still be a good idea. It does give you the best chance of getting pregnant compared to inseminations and or clomid. The success depends on your age. If you are in your 30's the success is about 10 to 15 percent, if you are in your 40's the success rate is about 5 to 10 percent.

An option you should also consider is donor egg (you would be the egg recipient). By using the eggs of a younger women, your chance of conceiving and having a baby is closer to 60 to 70 percent or higher. We would be happy to discuss these options with you. Feel free to call us at 1-800-789-PENN (7366).

Mary asks:
How can you get pregnant with low FSH?

Richard Tureck, MD responds:
I suspect you mean FSH (follicle stimulating hormone). Each person is different. To advise you properly, I would have to have your health history to get a complete picture of what is going on — i.e. other hormone values, weight loss, etc.

If you would like to have an evaluation, we would be happy to help. To schedule a consultation, please call 1-800-789-PENN (7366) or request an appointment online.