QUESTION:
Dear Dr. Ramirez,
I am 30 years old and recently started trying to conceive. My periods have always been regular and I always been ovulating on day 13. But I still could not succeed after 2 /3 attempt. I did all the blood tests, pelvic ultrasound. My husband did his semen analysis and everything came out OK. I had an FSH 28.5 and LH 81.9 on day 13 (ovulation time) and then again I did the test on Day 1 with an FSH 10.48 and LH 4.72 and again i did on day 4 FSH 8.72 and LH 14.42. Recently my day 3 FSH was 11.54 and LH 4.18. My doctor has prescribed me to take tablet Duoluton L for 3 months.
What is surprising to me is that all my FSH and LH ranges are within the reference range given in the lab test report and more over I have regular periods which start on every 26th day and I am ovulating (which i check through ovulation test kit). I have a normal height and weight, no excessive body hair etc. Why is my doctor considering me a patient of PCOD?
Is my LH and FSH proportion so bad that I have to take these tablets for 03 months?
Please advise, thanking you, Sarika from India.
ANSWER:
Hello Sarika from India,
I'm afraid to say that based on your description, your doctor does not know what she is doing. Sorry to be so blunt. FSH and LH levels only make sense if drawn on cycle day # 2 or 3. We do not draw them at other times in the cycle because the levels can vary. Therefore, the standard is CD# 2 or 3 only.What they tell you, if interpreted by someone who knows what they are doing, is how the ovaries are functioning. The FSH and LH are hormones that the pituitary sends to stimulate the ovary. If the ovary is picking up the hormones correctly, then the levels are low. If not, the levels are high. This is on cycle day # 2 or 3 only.
Your ovaries are functioning correctly as evidenced by regular menstrual cycles. This means that you are ovulating, and based on your cycle day # 3 FSH/LH levels, your ovary is NOT menopausal nor PCOD. However, the worrisome thing is that your FSH level is high (11.54). This is a sign of "ovarian resistance" which means that the ovaries are tending toward menopause, although they have not reached that level yet (> 20). We interpret it as shortening the amount of time you have for ovarian function, therefore we approach this situation more aggressively. I recommend IVF in these patients because we don't want to waste time. There is a disorder called "premature ovarian failure" or POF, whereby a young woman (less than 40) enters menopause early. That is what I would fear with you. So don't waste time. Go see a fertility specialist!!
Follow-Up Question:
Thanks a lot for picking my question! It helped me a lot to understand what's been going wrong for a long time. In the mean time I did my follicular study today (i.e. Day 5) and it showed two follicles in the left ovary : F1 - 18.5mm (dominant follicle) and F2 5.0 mm. So I thought of giving one more try this month also. Is that OK? Or this also indicate that I am moving towards "premature ovarian failure"? Also in the report it is written "Minimal free fluid in Pouch of Douglas". What does this mean? Please help me more with this.
I will be always grateful to you Dr. Ramirez for giving so much information. Regards, Sarika
Follow-Up Answer:
Hello,
If your ovary is functioning, then you should continue to try to get pregnant. Don't give up. You are not in premature ovarian failure yet. Also, the fluid found on ultrasound is a normal finding.
You are wise to question what is going on, please consider switching over to a fertility specialist as I mentioned above! Good luck with your procedures!
Regards,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, USA
