What does your FSH level say about you?

One of the most common tests we order on patients who are having a harder time conceiving is the cycle day 3 FSH level.

Here are some quick facts you should know:

You are not a number. You are not your FSH level. There is no test that tells anyone, “you cannot get pregnant.” We only use FSH levels as a guide. If your level is above 12 in our lab, your chances of pregnancy are reduced. If your FSH level is elevated and you have 5 or more antral follicles, depending on your age, it may be in your best interest to proceed with treatment. If your antral follicle count is less than 5 then you may want to consider doing everything possible to understand your fertile cues and optimize chances at home or start exploring other options to grow your family.

FSH levels fluctuate from month to month. You may get a level of 19 one month then the next month have a level of 8. The fact that you once had a level of 19 is significant. You shouldn’t ignore the level. The fact that your level is 8 doesn’t mean that things have changed. It just shows how FSH bounces around from month to month.

The FSH level is always interpreted in conjunction with an estradiol level. An FSH level alone does not tell the whole story. Oftentimes, I see patients who have only had a day 3 FSH level drawn and no estradiol and they are told that everything is reassuring too soon. Estradiol levels should be low at the beginning of a cycle. If the estradiol level is high it signals the brain to lower the amount of FSH sent to signal the ovary to make more estradiol. So basically the FSH is suppressed and could be low only because the estradiol level is high.

FSH levels can be drawn cycle days 1-5. Please ask your doctor but we pick day 3 because most fertility studies have to be designed so that everyone gets levels drawn on the exact same day. But in reality, you don’t have to go on day 3. I tell my patients that if day 3 is on a Sunday and the lab isn’t open, go the day before or day after. No need to wait for the next month to do testing because day 3 was a day you couldn’t go in.

Take home point: you’re not a number. FSH level is simply a guide that should help you decide what is the best treatment option. If your FSH level is in the lower range, consider less aggressive treatments. If it’s in the higher range, consider more aggressive treatments first.

Hope this helps. But I don’t like thinking of FSH levels as “normal” or “abnormal.” The information is simply used to guide treatment and tell us what someone’s chances of pregnancy are and what fertility treatment they should consider. Just don’t forget: you’re not your FSH level and whatever your result is, it is normal because it’s your level! We believe in the fertility of everyone who walks in our doors.