Qus & Ans: High FSH Levels or Poor Egg Quality

Qus & Ans: High FSH Levels or Poor Egg Quality

Hello. I am 31 years old and my husband is 31 as well. Because of his semen analysis (low count, low morphology and low motility), we were advised to go through an IVF cycle with ICSI. Preliminary testing was done on me and nothing was of note except that my FSH on Day 3 was "10." Around the end of November, we had the retrieval. I had responded pretty well to the Lupron, Follistim and Repronex I was taking, and nine eggs were retrieved. Of the nine, only four were good enough to fertilize and only one actually did. The fertilized egg was returned, but I did not become pregnant. My fertility specialist believes it is because of my FSH level. He states this is rare for my age. Could you explain FSH in general, levels, and its effects on the quality of eggs produced? I am also curious if this level can be changed or helped with medication, and if this level will hinder the chance of me carrying a child to term should I become pregnant. Thank you so much for your time.
-- Carol L.

Dear Carol:

I reviewed your case and feel that it is not clear whether your oocyte quality or the ICSI technique was the reason you did not get pregnant. You started with nine oocytes and only four were injected. Was this because the other five were degenerating, or were they immature? If they were immature, did they mature in vitro? It is true that you CD3 FSH is borderline, which means that your ovarian reserve may be diminished, which means that you may not stimulate properly, may need higher dosages of stimulation medication, and may have fewer follicles/oocytes of not so good quality, with a lower chance for pregnancy. I do not know how much medication (Follistim/Repronex) you actually had to use to get nine oocytes. Was this much more that an average stimulation protocol? If yes, then it does not look very promising. Your FSH level cannot be altered by medication. You may, though, change the stimulation protocol (i.e., pretreat with oral contraceptives and use microdose lupron) to hopefully get more oocytes if you indeed underwent an average type stimulation protocol with increased amounts of Follistim/Repronex. We also know that there is cycle-to-cycle variability, and a particular cycle may be more promising than another one (i.e., CD3 FSH may be lower on a given cycle.) If you do become pregnant, this CD3 FSH should *not* hinder your chance of carrying the baby to term. Wishing good luck with your next treatment.

Pette N. Zarmakoupis, M.D.
Director, Kentucky Center for Reproductive Medicine
Lexington, Kentucky

HI, I am 31 years old and recently lost 50% of my right ovary and 30% of my left due to endometriosis. (removed during surgery 3 months ago). My FSH levels were fine before the surgery and are now at 17 on day 3. FSH was 28 on day three the month before so it has come down a bit. Do you think there is a chance it will come down even more? Or am I being unrealistic...
Many thanks in advance for this wonderful service.

Technically speaking, partial loss of ovarian tissue does not seem to affect the onset of menopause - it appears that the remaining follicles redistribute themselves so that the woman continues to ovulate regularly and menopause arrives at the usually expected time (and not sooner). However, as in any biological environment, there are outliers, and thus you may be experiencing the effects of dramatic reduction of the ovarian bulk. You also may have developed this presumed and impending premature menopause regardless of your surgery.

I would watch it for few months, maybe even consider birth control pills for 1-3 months then re-evaluate, and if normal FSH then go on with IUIs with COH.

Good luck.

Rafael Haciski, MD FACOG
Gynecology & Infertility Assoc.
Baltimore MD

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