Questions about ovarian reserve testing

Can herbal remedies or acupuncture improve the pregnancy rate in women with an elevated FSH?

Unfortunately, this is probably not true. Elevations in FSH levels when performed at the proper time of the cycle are reflective of decreased ovarian reserve. This occurs from a decreased number of viable eggs remaining in the ovaries or from a fundamental change within the egg cells themselves that make them less likely to produce normal viable embryos.

While some evidence suggests, for instance that acupuncture may improve blood flow to the uterus or ovaries, it is very unlikely that increased blood flow will make any difference. It can’t, for example cause new eggs to be made in the ovaries or change their internal structure.

While I believe it is possible to change the FSH level itself (this can be easily done by taking small amounts of estrogen) this does NOT result in a change in the potential for producing pregnancy. Remember, the FSH levels are not causing the problem, they merely reflect that there is a problem going on. By “manipulating: the FSH levels, all you do is eliminate it as a means for being a useful measure of ovarian function.

Herbal remedies are similarly ineffective. Herbals are very complex mixtures of chemicals derived from from various plant sources. Many of these chemicals will have hormonal activity in the body. they may mimic the actions fo estrogen or progesterone or other hormones. as such, it is possible for herbals to affect a woman’s FSH level.

However, as with the case for acupuncture, they are not changing the ovarian function itself.

Please don’t get taken in by demonstration of a reduced FSH level and believe that a “miracle” has occurred and that the ovaries are now more capable of producing pregnancy.

Furthermore, since herbals aren’t regulated or controlled in this country, there is no way determine exactly what these things actually contain or what you are putting in your body.

Does an elevated FSH level predict a baby with abnormal chromosomes?

The answer to this question is not known for certain. However, there does appear to be some evidence that women with decreased ovarian reserve as measured by an elevated FSH or abnormal clomid challenge test, are at increased risk for having babies with chromosomal abnormalities.

One study looked at women with normal FSH levels and compared them to women with elevated levels. Over a six month period, if a woman had a miscarriage, they performed chromosome testing on the fetal tissue. Bottom line: The women with high FSH levels had more fetuses with chromosomal abnormalities.

Another study followed over 1000 women with high FSH levels who tried to attempt pregnancy with their own eggs. Only a 28 women even achieved pregnancy and of those, 20 miscarried. This is a much higher miscarriage rate than would have been expected based on the age of these women. Since chromosomal abnormality is the most common cause for miscarriage, it is likely that these women had more fetuses with chromosomal abnormality.

The final piece of evidence comes from women who have undergone in vitro fertilization – IVF with PGD – preimplantation genetic diagnosis of their embryos. Women who have high FSH levels have a higher percentage of embryos with chromosomal abnormalities compared to women with normal FSH levels.

My FSH levels vary, is this better?

All hormone levels fluctuate. As a woman ages, the monthly fluctuations in her FSH levels will become more and more pronounced. At a certain point, these levels may peak into an abnormally high range. Eventually, the FSH levels will be consistently elevated.

Good data now exists to suggest that by the time these fluctuations have caused FSH levels to be sporadically elevated, that a woman’s fertility HAS ALREADY SIGNIFICANTLY DECLINED.

This means that FSH elevation, even sporadic elevation, is a relatively late sign of decreased fertility. While pregnancy at this point is not impossible, it is far less likely to occur.

A Canadian study of IVF patients compared three groups:

• Women with consistently normal FSH levels
• Women with sporadically elevated levels
• Women with persistently elevated levels

The women with always normal levels had good pregnancy rates. On the other hand, women with sporadically elevated levels and women with persistently elevated levels had the same very low pregnancy rates.