My periods have stopped, an my doctor has done several FSH tests on me to find out why. My first three FSH levels were high -- one of them was in the 70s. Then the next one I had was 3.5. My doctor doesn't seem to know why this happened. He had thought I was in menopause, but ruled that out due to the low FSH level. Is there something else that could cause my FSH level to go so high and then just drop back down to normal? I'm 30 years old and haven't taken any medications.

Lisa

FSH hormone is produced by the pituitary gland to stimulate growth of ovarian follicles. In response to this stimulation, the ovaries increase production of a substance called inhibin B. Inhibin B enters into the circulation and "notifies" the pituitary gland that the ovary has responded, and that an adequate number of follicles is present. When the pituitary receives the inhibin message, it backs off on FSH production. That means FSH levels vary during the course of the cycle. The most appropriate time to investigate FSH is on day 2 or 3 after the period begins.

If the FSH level or estradiol level are high on day 3, or if the inhibin B value is low, that generally indicates that ovarian reserve and fertility are significantly diminished. When these abnormalities occur in the late 30s or early 40s, close to menopause, their predictive value is quite high. However, when abnormal values occur in younger women, there is serious cause to question the results. First, I look for history factors such as chemotherapy, radiation, antibody production, chromosomal anomalies or removal of an ovary. These factors may suggest that the ovarian abnormality is irreversible.

In some women FSH levels may vary from cycle to cycle. In others, the level may be abnormal for six months to a year and spontaneously correct itself. This may indicate a subclinical viral infection or immune disorder. Unfortunately, few studies offer ideas on how physicians can determine an appropriate course of action. Infertility treatment (short of donor eggs) is of little value for most women with elevated FSH levels. For those with documented ovarian antibodies, a few successes have been achieved by steroid hormone suppression. Some doctors have reported spontaneous resolution and pregnancy rates of 2-3 percent per year in women treated with estrogen hormone replacement therapy.

Researchers are working to determine whether transfer of egg cytoplasm from a younger woman will "resuscitate" the eggs from older women or those with elevated FSH levels. Whether there is any effective treatment to restore egg quality when the FSH level is elevated is unknown.