FSH
Dr. Nanette Santoro's POF FAQ

25. What is a normal FSH level?

What is 'normal' for FSH varies by laboratory, by stage of the cycle in which the FSH was taken (it will be higher in the first few days after a period and at the time of ovulation, and very low after ovulation), and by condition. Each doctor has to interpret an FSH based upon the performance of his or her lab and these other factors. All FSH levels are not created equal!

It's hard to interpret an FSH level without a reference range. Every FSH assay is different. For example, a 35 in my assay would be rather high, but in another, not so impressive. The way that it is measured makes a difference in the meaning of the level. An FSH level does not give you POF. In order to have POF you have to have amenorrhea, as in no periods. It does not mean you can't get pregnant, but if your FSH is in fact elevated, it means it is less likely to happen for you and may be a difficult process.

26. What is the average level of FSH & estrogen for women recently been diagnosed with POF?

There is no 'average level'. I just read another doctor's words about this and I think I shall adopt them: Measuring your FSH and estradiol is like taking a snapshot of the speedometer of your car: it tells you exactly what is happening at that moment but is not useful in telling you what just happened or what will happen. A high estradiol means your ovary is working NOW. How well is it working? When will you ovulate? These cannot be known from a single blood test.

27. Is the elevated FSH level on day 3 a sign of POF?

An elevated FSH on day 3 is a sign of decreased ovarian reserve. It means that you have a limited time left to get pregnant and may eventually get POF. Whether that will be in two years, eight years or four months, no one can tell you. I would encourage you to pursue aggressive treatment and take care of the fertility issues as quickly as you can! If you are over the age of 38, you may have a very difficult time getting pregnant and aggressive treatment might not work.

28. Why is FSH tested on day 3, and not 1, or 28?

To test your FSH on day 1 would mean that you would have to get to a lab on the first day of your period, it's just not very practical. To test it in anticipation of a period when your cycle might not be regular is also not practical. It happens that FSH is highest in the beginning of the cycle and it's been shown in several studies that it's elevated between days 2-5 about similarly , so those are the best days to check it.

29. I was diagnosed with POF and started on HRT. Recently, new tests were done: FSH went down. On ultrasound follicles could be seen. The diagnosis was wrong? Is it POF?

FSH levels can vary from cycles to cycle. It seems that a high FSH indicates a problem with ovarian reserve, but it may wax and wane over several cycles.

30. Why are some woman's FSH a lot higher than mine? I still get all the symptoms, hot flashes etc. Is it a possibility that with my low FSH that my ovaries are still trying to function?

There is no magic FSH level that indicates POF. If you have not had periods for 6 months to a year and have a high FSH, then that really meets most people's definition of POF.

31. Does IVF exacerbates elevated FSH?

There is no basis for the theory that stimulating the ovaries with FSH accelerates POF. The theoretical statement has no basis in fact and does not seem to be borne out by clinical experience.

It is not known whether or not eggs produced in spontaneous cycles in women with POF are more likely to result in miscarriage. It is simply not known how often this occurs. If you are younger than 30-35 years, your eggs may be able to get you pregnant on your own, without medications. There does not seem to be any harm to trying IVF, although your chances of having a egg retrieval are low.