FSH test in the diagnosis of female infertility – preparation for the test and interpretation of the result

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In the diagnosis of female infertility, several tests are performed that are helpful in identifying the causes of this problem. One of the tests to be performed when infertility is suspected is a laboratory test that determines the concentration of the hormone FSH in a woman’s body. What is FSH and what role does it play in the female body? How to prepare for the test? How to interpret the result?

What are the causes of female infertility?

Infertility is a problem that both women and men struggle with. In the case of women, hormonal disorders or abnormal ovulation are responsible for infertility or problems with getting pregnant. However, there are many causes of infertility and the most frequently diagnosed and treated ones include:

1. endometriosis – is a chronic disease that leads to female infertility in 96% of cases. In the course of endometriosis, the mucosa of the uterine cavity implies outside the uterus, e.g. in the fallopian tubes, ovaries or on the peritoneum. It also happens that the endometrium may travel to the intestines or lungs;
2. polycystic ovary syndrome – is an endocrine disease that is diagnosed in 5-15% of modern women. In the body of a woman who struggles with polycystic ovary syndrome, much more male hormones, i.e. androgens, are produced. This causes many other disorders, including metabolic and ovulatory disorders. The effect of these disorders is the reduction of female fertility;
3. frequent or advanced inflammation of the pelvis and scarring changes in the fallopian tubes – inflammation of the female reproductive organs can cause permanent damage to the fallopian tubes, which is a direct cause of infertility. The risk of problems with getting pregnant increases the more often a woman struggles with inflammation;
4. uterine fibroids – this is a type of benign tumor located in the womb. Uterine fibroids affect the infertility and premature miscarriage of pregnancy;
5. polyps – these are, among others, in the uterus, flat, oblong formations formed from the mucosa. Polyps can cause vaginal bleeding and infertility;
6. Turner syndrome – is a genetic disease that only affects women. Turner syndrome is caused by the absence or incomplete development of the X chromosome. Girls born with Turner syndrome, in most cases, suffer from underdevelopment of the ovaries, which in turn results in delayed puberty, amenorrhea and infertility;
7. congenital defects of the uterus and its cervix – they cause fertility disorders and recurrent miscarriage problems;
8. diseases of the adrenal glands, thyroid gland and pituitary gland – these are diseases caused by disorders in the hormonal balance. This is one of the most frequently diagnosed causes of female infertility. The implementation of appropriate treatment allows you to regulate the levels of individual hormones and significantly increases a woman’s chances of becoming pregnant;
9. venereal diseases – sexually transmitted diseases can affect female fertility problems. The diseases that can cause infertility include gonorrhea and chlamydiosis;
10. obesity or underweight – problems with weight relate to extreme cases, i.e. morbid thinness and high obesity. After adjusting the weight, the chance of having a baby increases;
11. alcohol abuse or tobacco addiction;
12. disorders of the immune system.

Learn about possible treatments for fertility problems. Read: Infertility Treatment Methods

What is the FSH hormone?

The FSH hormone is a follicle-stimulating hormone whose short name comes from the English follicile-stimulating hormone. FSH is a peptide substance secreted by the pituitary gland. Follicle stimulating hormone is a protein, or more precisely a glycoprotein, which consists of 200 amino acids divided into two subunits.

The FSH hormone is not a hormone specific to women, as it plays an equally important role in the male body. The mechanism of the secretion of follicle stimulating hormone is based on the feedback principle, and the factors stimulating the metabolism are estradiol and gonadoliberin. The secretion of the hormone FSH in women is closely related to the menstrual cycle. Fluctuations in the concentration of this hormone change depending on the day of the cycle. FSH is metabolized in the urine. The FSH hormone is responsible for stimulating the follicles to produce estrogens.

Do you want to know what tests are performed when infertility is suspected? Check: Diagnosis of infertility in women – what tests should be performed?

The role of the FSH hormone in the female and male body

The FSH hormone in the body of a woman and a man has different functions. In the case of the female sex, follicle stimulating hormone is responsible for stimulating the maturation of the follicles so that they produce enough estrogen. The FSH hormone also increases the activity of the aromatase enzyme, which in turn is involved in the conversion of androgens into estrogens.

The same hormone plays a different role in men. It stimulates the sperm-forming epithelium and affects the functioning of testosterone. It is worth noting that scientists have tried to thoroughly investigate the FSH hormone, paying attention to the molecular structure of this hormone. It turned out that the FSH hormone taken from the urine of menopausal women can be administered to women who have been unsuccessfully trying to conceive. This procedure is designed to stimulate ovulation and thus increase your chances of becoming pregnant.

Moreover, other studies have shown that a significant proportion of neoplasms have follicle stimulating receptors in the vicinity of cancer cells. Further research may make a significant contribution to the diagnosis and treatment of neoplastic diseases.

What expenses are related to the diagnosis of infertility? Read: How much do women’s fertility tests cost and where to do them?

FSH testing – when should it be performed?

The decision to test FSH levels is usually dictated by persistent problems with becoming pregnant. The most common indications for an FSH test are:

1. the need to determine the ovarian reserve when infertility is suspected. The FSH examination is most often performed together with the AFC ultrasound examination and the AMH examination;
2. irregular menstrual cycles and menstrual disorders;
3. menopausal period;
4. visible disturbances in the maturation process, which may be the result of pituitary and hypothalamic insufficiency;
5. in men, this test is done to find out the cause of low sperm levels in semen;
6. if hypogonadism is suspected;
7. diagnostics of polycystic ovary syndrome.

For more important information about infertility, see Infertility

How to prepare for the FSH test?

The determination of the level of FSH is performed on a blood sample taken under laboratory conditions. The FSH level should be tested at the very beginning of the cycle, preferably between the first and fifth day, i.e. in the early follicular phase. Depending on the reason for the test, your doctor may order a blood sample to be taken on a specific day of the menstrual cycle.

In preparation for FSH testing, it may be necessary to discontinue some medications. Some medications should be discontinued up to four weeks before the scheduled examination. Therefore, during the consultation visit, the patient should inform the doctor about all medications currently taken. In addition, the test result is influenced by radioactive markers that appear as a result of examining the thyroid gland or bones. You should also notify the doctor who ordered the test about all such tests.

The woman does not need to fasten during the FSH test. However, it is advisable to drink a glass of water or unsweetened tea before the test.

What gynecological examinations should be performed? Check: Gynecological examination

How is the FSH test carried out in the diagnosis of female infertility?

The FSH test is a laboratory test that involves taking blood from a vein in the arm once. The test material is blood serum. This test can also be performed on a urine sample. In this case, it is recommended to do a XNUMX-hour urine test as its concentration varies depending on the time of day. Note that FSH testing should run in parallel with estradiol as FSH is negatively fed back by estradiol. It may happen that a low FSH value is the result of a high concentration of estradiol produced by a functional ovarian cyst.

FSH concentration norms and results interpretation

The level of FSH in a woman’s body depends on the day of the menstrual cycle. The norms of the FSH hormone are as follows:

1. in the follicular phase – less than 12 IU / l;
2. in the ovulation phase – from 20 to 90 IU / l;
3. in the luteal phase – less than 10 IU / l;
4. in the menopausal period – from 40 to 250 IU / l (after the menopause the FSH concentration increases),
5. during pregnancy – trace concentration.

Conclusions when interpreting the results can be presented as follows:

1. 9-12 mlU / ml – decreased ovarian reserve;
2. 12-18 mIU / ml depleted ovarian reserve, stimulation of ovulation is difficult;
3. > 18 mIU / ml Stimulation of ovulation is very difficult, therefore the likelihood of pregnancy is unlikely.

The levels of FSH in your body may be too high or too low. Too high FSH usually means menopause. If the woman is not menopausal, a high score indicates premature ovarian failure. In men, too high FSH can indicate testicular failure, testicular damage, and primary hypogonadism. Reduced FSH in both men and women is associated with pituitary or hypothalamic insufficiency.

How much does an FSH test cost?

The FSH test can be performed as part of the NHF reimbursement. To do this, you will need a referral from your doctor. FSH testing can also be done without a referral in a private laboratory. The cost of performing such a test may differ depending on the city and facility in which we perform it. The average fee for an FSH test is PLN 20-28.

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