High FSH

HIGH FSH? CAN ACUPUNCTURE HELP?
Elevated follicle stimulating hormone (FSH) levels ( >10) can cause problems for some women when they are trying to conceive naturally or starting IVF as it is considered to be a predictor for reduced fertility with eggs of questionable quality, reduced pregnancy rates and poor response to ovarian stimulation medication during IVF.
Women whom I have worked with over the years can feel quite anxious and disappointed when they are told by their doctors that they have raised FSH and there is nothing they can do. Very often they are advised to do IVF with donor eggs as this would be their best option to conceive. They are understandably disappointed as they feel that they have never even had a chance to try with their own eggs.

So what is elevated FSH?
FSH is a hormone produced by the pituitary gland to stimulate ovarian follicles to grow. There are a few number of follicles growing early in each menstrual cycle until a dominant follicle is selected that will eventually release an egg for fertilisation. FSH is low at the beginning and the end of menstrual cycle and peaks in midcycle. Elevated FSH in the beginning of cycle indicates that the follicles are not responding efficiently to endogenous FSH to grow so the pituitary gland keeps producing more and more FSH.

Known causes of high FSH mostly due to advanced reproductive age, diminished ovarian reserve, premature ovarian failure in younger women and in my clinical experience lifestyle factors also play a part.

High FSH and IVF
Most IVF clinics are unlikely to start IVF with FSH higher than 12 as it generally results in low pregnancy rates. These women are often instructed by some clinics to postpone the start of IVF and retest FSH at the early days of the next menstrual cycle to see if FSH levels have dropped after a previous high reading. The reason for this is that high FSH measured early in the menstrual cycle can drop from high to a more favourable level in the next cycle so it is not necessarily constantly high in each cycle. Once the levels have dropped then there is the likelihood of better response to ovarian stimulation drugs. During the early reproductive years FSH level stays low and towards the end of reproductive years it can fluctuate until eventually it remains constantly high at all times.
There is no medication currently to lower FSH levels however some IVF clinics would administer Estradiol, a type of estrogen during the luteal phase (from ovulation to the start of next menstruation) in the previous menstrual cycle to trick the body into thinking that there is high enough estrogen. In return, there will be less FSH produced and secreted by the pituitary gland early in the following menstrual cycle. DHEA (steroid hormone) supplementation a few weeks prior to the start of IVF can be a good choice for some women, not for all, as it is believed to improve low ovarian reserve that very often is the underlying cause of high FSH. Also, some women with low ovarian reserve and high FSH might opt for something called ‘natural IVF’ cycle that seems to give similar results but using minimal amount of drugs during IVF.
Women with high FSH are given no or very limited help and guidance by their IVF clinics to lower their levels and they are often told ‘just relax and try next month’. This can however become a waiting game for some women as they are sent home month after month. Those women often feel frustrated because they don’t feel actively involved with what they can do to optimize and regulate their hormone levels.

Can FSH be lowered naturally?
My answer is …maybe.
Over the years I have worked with many women helping them to regulate their hormone levels including lowering FSH with the use of acupuncture. From the western medical perspective the exact mechanism how acupuncture is able to lower FSH is not known. There are studies in the literature demonstrating the regulatory effects of acupuncture and Chinese herbal medicine to restore the communication between the hypothalamus, pituitary gland and ovaries thus improving ovarian function and balanced hormone production. Other studies confirmed the ability of acupuncture to improve blood flow to the ovaries and uterus and this in return can potentially improve ovarian function and the uterine environment. Acupuncture relaxes the body and reduces high stress levels as this can prohibit conception by blocking blood flow to the reproductive organs and causing an imbalance in hormonal production.
Chinese medicine doesn’t treat high FSH specifically but looks at the body with a wider perspective to restore balance by incorporating the emotional, physical and mental wellbeing of a person. It also takes into account dietary, lifestyle and environmental factors and their impact on one’s health.The aim of acupuncture is to help women to be as healthy as possible in order to optimize their reproductive health. This might take in some cases just a month or in other cases longer depending on personal circumstances.
The most common causes of high FSH among women I treat are advanced reproductive age and/or high stress levels and poor lifestyle. I observed during my practice that acupuncture in combination with nutrition and lifestyle changes in some cases can give good results. Some of those women can achieve pregnancy even naturally or could start IVF as their FSH levels drop. For some women however when FSH stays constantly high very often the most promising treatment is egg donation.
All in all, I believe that women should not be entirely discouraged if they have high FSH levels because FSH as a singular marker can’t give a full picture of one’s fertility potential.

References:
Xiaoming, M. Ding, L. Yunxing, P. Guifang, X. Xiuzhen, L. & Zhimin, F. (1993). Clinical studies on the mechanism for acupuncture stimulation of ovulation. Journal of Traditional Chinese Medicine, 13(2), 115-119.
Dong, H. Ludicke, F. Comte, I. Campana, A. Graff, P. & Bischof, P. (2001). An Exploratory Pilot study of Acupuncture on the Quality of life and Reproductive Hormone Secretion in Menopausal Women. The journal of Alternative and Complementary Medicine, 7 (6), 651-658.
Lim, C. & Wong, W. (2010). Current evidence of acupuncture on polycystic ovarian syndrome. Gynecological Endocrinology, 26(6), 473-478.
Qin, Z. Ling, H. Xia, X. Meng, L. & Wu, Z. (2007). Effects of electro-acupuncture of SanyinJiao (Sp6) on genitor-endocrine in patients with premenopausal syndrome.
Shang, Y. Zhang, Y. Kong, L. Wang, Y. Wang, D. & Liu, J. (2009). Clinical observation on combination of source point and back shu point for treatment of peri-menopausal syndrome. Zhongguo zhen jiu=Chinese acupuncture and moxibustion, 29(6), 444-8.
Effect of Acupuncture on Premature Ovarian Failure: A Pilot Study
http://www.hindawi.com/journals/ecam/2014/718675/

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