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Follicle Stimulating Hormone (FSH)

Follicle stimulating hormone (FSH) is one of the two primary hormones that control the reproductive cycle in both men and women (the other is luteinizing hormone). FSH is secreted by the pituitary gland and stimulates the ovaries to produce eggs and the testes to produce sperm. Many women with "unexplained infertility" end up having low levels of FSH which prevents them from ovulating or causes them to ovulate very irregularly.

If you are having problems conceiving, your doctor will test your blood to d etermine your FSH levels. Results will depend on your age and can also be affected by heavy cigarette smoking and hormonal medications (such as birth control pills and testosterone). Normal FSH levels for menstruating women range between 5 and 20 IU/L during the follicular or luteal phase of their menstrual cycle and 30 to 50 IU/L during their mid-cycle peak. FSH values higher than this indicate you may have ovarian failure (if you are under 40), polycystic ovary syndrome (PCOS), or that menopause has occurred. High FSH levels in men can be caused by Klinefelter Syndrome, absent or non-functioning testicles, or testicles that have been damaged by disease (such as alcohol dependence) or treatments (such as x-rays and chemotherapy). Low FSH levels may indicate you are not producing eggs, your pituitary gland is not functioning normally, that you may have a tumor that is interfering with your brain's ability to produce FSH, or you are under extreme stress or are severely underweight.

If your ovaries are found to be capable of producing eggs but your FSH levels are insufficient to stimulate the development of a mature follicle, your doctor may prescribe synthetic follicle stimulating hormone. Synthetic FSH is also used to increase the number of eggs available for retrieval as part of controlled ovarian stimulation during ART treatments such as in-vitro fertilization, embryo transfer, gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI).

Human chorionic gonadotropin (hCG) injections are generally used in conjunction with FSH to stimulate egg release (hCG mimics the natural LH surge). Synthetic luteinizing hormone releasing hormone (LHRH) analogues may also be paired with FSH to suppress the ovaries. When suppressed, the ovaries are more receptive to FSH therapy and tend to produce higher quality eggs. This is particularly useful for women with PCOD (polycystic ovary disease) not responding to FSH alone.

Follicle stimulating hormone is sold under the brand names Follistim, Follistim AQ Cartridge, and Gonal-F, and must be injected subcutaneously (under the skin) or intramuscularly (into the muscle). Because each patient reacts to the hormone differently, no fixed dosage can be recommended and each regimen must be individualized. Your doctor will use periodic ultrasound exams and test your blood estrogen levels to assess your ovarian response to FSH.

Follicle stimulating hormone is successful in stimulating ovulation in 10 percent of patients and increases the success rate of intrauterine insemination (IUI) from 4 percent (non-medicated IUI) to between 15 and 18 percent according to Boston IVF, a leading fertility research center.

FSH can cause side effects such as nausea, vomiting, diarrhea, and flatulence; fever or chills; headache; dizziness; rapid heart rate; muscle or joint weakness or pain; breast tenderness; dry, itchy skin or hair loss. Approximately 5 percent of women taking FSH develop ovarian hyperstimulation syndrome (OHSS). Symptoms of OHSS include severe pelvic pain, swelling of the hands or legs, abdominal pain and swelling, shortness of breath, weight gain, and nausea or vomiting. Call your doctor immediately if you experience any of these symptoms. FSH also increases the likelihood of multiple births, which occur in about 20 percent of patients.

Multiple pregnancies carry additional risks for both the mother and her babies. Before taking this medication, tell your doctor if you might be pregnant, have a thyroid problem; adrenal dysfunction; have cancer or a tumor of the breast, ovary, uterus, hypothalamus, or pituitary gland; have undiagnosed abnormal vaginal bleeding; or have ovarian cysts or enlargement due to polycystic ovary disease (PCOD). These conditions may preclude you from using FSH or your dosage may be altered or you may be monitored more closely. It is not clear whether FSH enters breastmilk, so tell your doctor if you are breastfeeding a baby.

 


 

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