Your follicle stimulating hormone (FSH) level is considered to be an important indicator of your potential for fertility. In fact, some fertility clinics will decide whether or not a woman is a good candidate for IVF based on what her follicle stimulating hormone levels are.
Used in the biomedical model as an indicator of “ovarian reserve” (the number and quality of eggs that are left in the ovary), the level of this reproductive hormone is usually measured on day 3 of the menstrual cycle when all of the reproductive hormones are at their lowest levels. To get the complete picture of how responsive your ovaries are, it is important to also measure at the same time what the estrogen levels are, since these 2 hormones work together.
Where does follicle stimulating hormone come from?
Let’s back this up a little bit and start at the beginning. Reproductive hormones are a bit complicated, involving 3 distinct organs in the body. Together, they are referred to as the hypothalamus- pituitary-ovarian axis (“H-P-O axis”). The hypothalamus and pituitary gland are in the brain, and they communicate with the ovaries in the lower abdomen through the blood.
At the beginning of puberty, the hypothalamus begins to secrete in a pulsatile manner a substance called gonadotropin-releasing hormone (GnRH). This hormone causes the anterior pituitary gland to release luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones lead to the changes in the body we see during puberty, and then play a role in regulating the menstrual cycle and producing ovarian follicles (and also in sperm production in men).
What do follicle stimulating hormone & estrogen do?
At the beginning of each menstrual cycle, the pituitary gland releases FSH and LH. These hormones work on the ovary to stimulate the growth of new egg-containing follicles. By about day 7 of the cycle, one (or sometimes two) of the follicles has grown more than the others, and starts to produce a large amount of estrogen. This follicle is referred to as the “dominant follicle”.
Estrogen has 3 main functions at this point. The first is to signal to the pituitary to stop releasing FSH & LH so that no new follicles are stimulated (this communication, where increasing estrogen levels cause a reduction of pituitary hormone levels is called a “negative feedback loop”). The second function of the estrogen is to make the lining of the uterus proliferate (grow and thicken). And the third function of the estrogen is to make the glands in the cervix produce the lubricating, fertile cervical mucus.
As the estrogen level rises above a certain level, it triggers the anterior pituitary gland to start releasing luteinizing hormone (LH) again. In other words, the negative feedback loop between the ovary and the pituitary becomes a positive feedback loop (high estrogen causing higher LH). The release of this LH causes the egg to mature, and also the wall of the follicle to become thin, eventually rupturing and allowing the release of the egg (a process known as ovulation).
So, what do high follicle stimulating hormone levels mean in terms of my fertility?
A high FSH level indicates that the estrogen producing follicles are not responding very well in the ovary. The normally occurring negative feedback loop has not been activated, and the pituitary continues to release FSH without restriction. Gynecologists and reproductive endocrinologists see high FSH levels as an indicator that there are not very many egg-containing follicles left in the ovary, or that those which remain are not of very good quality. They are not growing well, they are not producing adequate estrogen, and they are not shutting off the supply of pituitary hormones. As well, high follicle stimulating hormone levels indicate that the ovaries will likely not respond very well to the medications used in IVF, which mimic the effects of the H-P-O axis.
Can Chinese Medicine lower my follicle stimulating hormone levels?
Indeed, this is a very common question I am asked. In short, the answer often is – yes! However, it is important to clarify this a bit. Traditional Chinese Medicine developed without the concept of hormones. In Chinese Medicine theory, the concept of ovarian reserve / egg-quality is referred to as the Kidney Yin & Essence. After a few months of nourishing the Yin and the Essence with herbal medicine and acupuncture (and, healthy lifestyle choices), many women will see their FSH levels drop, sometimes quite dramatically.
But in Chinese Medicine it is not quite so straightforward. If a woman comes to me and says she has high FSH, the first question I ask myself is “why are her ovaries not responding?” A woman who presents with high FSH in her late 20s or early 30s is different than a woman who presents with the same thing in her late 30s or 40s. Before looking at reduced number of follicles or poor egg-quality as the only possibility, I want to know if there is something that may be blocking the delivery of pituitary hormones to the ovaries. Is there a build-up of phlegm, damp, or fat? Is there some stagnant blood or poor circulation which is preventing good communication from the pituitary to the ovaries? Is there some inflammation present which is causing the ovary not to respond? Is there so much stress in a woman’s life that her H-P-O axis is being negatively influenced from the top-down, or the bottom-up?
Nourishing the Yin and Essence is a good way to promote fertility in Chinese Medicine theory. However, it is important to consider the physical and mental health of the entire woman when doing so, and clear out any pathogenic influences which may be interfering with her endocrine system. In Chinese Medicine theory, high FSH levels may be indicative of deficient Yin or Essence, but it also may indicate the presence of a pathogenic factor which is interfering with the communication of the reproductive hormones.
