How do I lower my FSH level?

Your site is fantastic. I have searched many infertility sites and there is nothing else like it. I have a question that I would respect your opinion on, please.
Recently, i found out that my FSH is high (20.4). My fertility doctor says that this is the reason for my infertility and it means my eggs are getting bad.  I also went to see a Chinese medicine specialist. She says I need to get a full evaluation and then she can come up with a formula of herbs that will definitely lower my FSH. I don’t really trust her. She’s not even Asian! What can I do to lower my FSH? Is there no hope for me?

Angel
Larkspur CA

Dear Angel,
I’m sorry to hear about the bad news that your doctor gave you. Since I don’t even know some very basic and crucial pieces of information, such as your age, I don’t have enough clues to directly comment about your specific situation. However, you do bring up a very popular topic, namely that of FSH values, so I will be glad to tell a little story about the significance of FSH.

FSH is the abbreviation for FOLLICLE-STIMULATING HORMONE. It is a substance created from part of the brain called the pituitary gland. In a young, healthy woman, a small wave of FSH released at the beginning of the cycle will get her follicles to start developing for that month. Why only a small amount? Because a young fertile woman’s ovaries are very sensitive. They don’t need much to get them going. After getting just a tiny whiff of FSH, they will start to do their thing. As the follicles do their thing, they start to grow bigger AND they will produce another hormone called estradiol. The news that estradiol is rising goes back up to the pituitary and tells it the good news that "OK, things are moving along just fine. You can ease up on the FSH production. Thank you very much. Talk to you later." The FSH factory supervisor gets this message and tells the production crew to slow down, get some rest and wait until next cycle. In physiological terms, this is known as NEGATIVE FEEDBACK, which is not a bad thing here, unlike the way it is when you’re talking about your EBay rating.

In a woman who is 45, the follicles are few in number and poor in quality, so a different scene plays out. The story begins the same way. At the beginning of the cycle, the pituitary faithfully sends out pulses of FSH and waits for a negative feedback estradiol signal from the follicles that will tell the pituitary to rest again. However, because the follicles are bad, they won’t develop as vigorously, if they even develop at all. So while the follicles struggle to grow and develop in a healthy manner, they will not send out a strong estradiol signal. Meanwhile, the pituitary starts to get a little nervous. "Hmm, it’s been several days and we still haven’t heard back from the follicles. Maybe they need a little more juice." The pituitary then makes the decision to crank up the FSH production and the FSH level goes up a bit. If the follicles eventually respond to this new increase of FSH, then the estradiol signal will arrive and the pituitary crew will breathe a sigh of relief. However, in a worst case scenario (for example if the woman is completely menopausal or if her ovaries have both been surgically removed), then the pituitary is in for a big surprise. The estradiol signal will never come. So what happens is the pituitary will frantically shift into panic mode, going full power and pouring out tons of FSH. The FSH levels will skyrocket!

This second scenario doesn’t just happen in 45 year-olds. It can also happen in some younger women whose ovaries for some reason or other are behaving much older than they really are. This is a condition, known as diminished ovarian reserve or in an extreme situation where the follicles have completely shut down, it is known as PREMATURE OVARIAN FAILURE.

So when your RE checks your FSH level, he is screening to see if your pituitary is overworking itself. If the FSH level is high, it typically means that the follicles are fewer in number and/or lower in quality. The elevated FSH is the INDICATOR of the bad news. It is NOT THE CAUSE of the bad news.

So the concept of trying to lower your FSH, as that herbalist suggests, is downright silly. It won’t solve your problem. It’s actually easy to lower you FSH. Can you guess how? That’s right. If you just give someone a high dose of estrogen through pills, injections or a patch, that will give the pituitary the signal it has been waiting, albeit a fake signal. The pituitary will then ease up on the FSH production. But you haven’t achieved anything helpful. The follicles are still as poor as they always were.

Think of it like this. You are happily driving your car when all of a sudden, a bright red warning light starts flashing telling you that the engine is overheating. Trying to lower the FSH would be like taking a wire cutter and cutting the wire that powers the warning light. The light will go off and you will longer see the bad news. However, that doesn’t change the fact that something is very wrong with the engine.

In general, FSH levels over 10 IU/L are a little bit concerning. If they are over 12 IU/L, it’s definitely a predictor of poor follicle function. And if it’s over 20, it’s almost for sure that something is seriously wrong with the follicles. I will share that I’ve had patients with FSH levels over 20 who eventually got pregnant with their own eggs, but those cases are so rare that they are distinctly memorable. But it’s not entirely without hope.

So now that you understand this, I hope that you don’t let anyone mislead you. As for your Chinese medicine provider not being Asian, you shouldn’t let that alone prejudice you against her. I once took martial arts from a non-Asian master and he’s definitely someone not to mess with.