QUESTION:
I am looking for some information on high FSH/high estradiol levels. I am 31 and had blood work done in November 2008 on day 1 of my cycle because my skin keeps breaking out, so my dermatologist was trying to figure out if my hormones were the culprit. Turned out my androgen levels were fine, but my FSH was 17.7. So, I went straight to my OBGYN who tested me on day 3 of the next cycle in December 2008. More bad news. FSH was 11.9 and estradiol was 89. He referred me to an RE and said I probably wouldn’t be able to get pregnant on my own (without drugs). Why is this happening to me at 31 years old? I don’t smoke, drink occasionally, and I work out and eat well. What could have possibly happened to me that, at 31, my hormone levels are indicating that my ovarian reserve is either low or of poor quality (or both)? I was on the pill (on and off, but mostly on) for about 12 years. I had a miscarriage (chemical pregnancy) back in October 2008 (I went off the pill in July 2008). I have a history of endometrial polyps, and had a polypectomy back in October 2006. The polyps have not come back, but despite that, I still have dull aches/cramps in my lower abdomen on a regular basis. However, transvaginal ultrasounds show no more polyps growing. I recently had a CT scan which showed a small cyst (less than 2 cm in size) on my right ovary, but the radiologist didn’t seem to think it looked too alarming. Could any of these things be related to my high FSH/estradiol levels? Is this POF/premature menopause? If so, wouldn’t my estradiol be low, not high? I’ve read that the one thing in my favor is my age. Is that true, or do high FSH/estradiol levels mean bad news, despite being only 31?
Megan
Dear Megan,
I am sad for you about your news. Your situation points out the fact that a woman’s ovaries could age faster than expected without any obvious signs. It doesn’t happen to many women, but it happens to about 1%. It’s lucky that some random quirk of fate involving your skin led you to get your FSH tested, so you discovered this now rather than waiting until after it gets above 25. Your results predict that you are likely to have a harder time conceiving as compared to other women your age who have normal FSH values. An elevated FSH at 31 years of age still gives you hope for getting pregnant, either naturally or with help. However, the odds of getting pregnant naturally are probably pretty low (less than 2% per month), whereas the odds WITH the help of medications or IVF are likely to be higher. High estradiol levels (greater than 80 pg/ml) througout one’s cycle are good, but on day 3, high values are bad. The reverse is true. Lower E2 levels on day 3 are good, whereas if they stay low throughout one’s cycle, that is bad.
As for factors that are related to this, the polyps that you mentioned are not related to the FSH. The cysts are also unrelated. Your past history of taking birth control pills would probably have been of benefit (or at least neutral), rather than contributing harmfully.
While it is a natural human reaction to want to know WHY something bad has happened, the utility of knowing why is strongest when it can guide us to do something to reverse or halt it. In this case, if your diminished reserve were due to intense smoking, chronic illness, chemotherapy, environmental toxins or surgical damage to the ovarian blood supply, then it would be helpful to think about changing our behavior. However, in many cases, diminished ovarian reserve is due to unknown causes or to factors that exerted their effect before you were even born. So asking why becomes less useful than asking “What can I do now?”
Your doctor’s action of referring you to an RE was wise. It could be very helpful for you to discuss your fertility options promptly. Some options would include injectable gonadotropins or even IVF. If you are currently using contraception to intentionally delay childbearing, you might want to rethink things promptly. There still seems to be hope, but you have been given an indirect warning signal via your dermatologist. Good luck!
