QuestionHello, Dr. Ramirez.
My husband and I have been trying to conceive for about a year. We both recently went in to see a fertility specialist. He is scheduled for a varicocele microsurgery next month. My physician started testing for me with a sonogram (I believe he found 4-6 antral follicles on each side). He mentioned that number was basically normal, but his view would be influenced by my hormone levels. My day two results came in at: FSH 0.102, LH 2.87, estrogen 57.4, thyroid 1.78, and prolactin 1.09. The nurse told me these results are way too low, and they want to repeat. However, when I got the test results, they appeared to be within the lab's normal levels (except the prolactin, if I remember correctly). Could you help me understand why confirmatory testing is necessary here? Some background--I'm 35 and very healthy. All the results from my recent physical were excellent.
Jane in Washington, DC
AnswerHello Jane from the U.S. (D.C),
When we evaluate laboratory results, we have to evaluate them from a clinical point of view and not necessarily from the laboratory norms point of view. In fertility, we look at the FSH and LH levels to give us an idea of ovarian function. The levels can be normal, but what the levels are give us an indication of how it functions. In general, we want the FSH level to be less than 7.0, so your levels look good, but if you typed the number correctly (0.102) that is a very low level, and could indicate a little decreased function of the pituitary or hypothalamus. However, as long as your ovaries are working i.e. ovulating each month, then the level being that low is not a major concern. It should not interfere with your ability to get pregnant. The purpose of "fertility drugs" is to increase the FSH levels which in turn, slimulate the ovaries to grow follicles and mature the eggs within, so it is something easily treated. As you have entrusted your care to your doctor, I think that you need to continue trusting him/her and follow his advice. I would have the level repeated as well.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate. I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy). Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.
