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    fertility basics

    Follicle Stimulating Hormone Test - Purpose, Indications, Risks and Test Results

    • 4.5   (1 Votes)

    Follicle stimulating test helps to identify the levels of follicle stimulating hormone (FSH) in the body. The purpose of follicle stimulating hormone blood test is to measure the FSH levels in the bloodstream. Indications for FSH test are infertility, menopause-related issues. Risks of FSH test are minimal.

    The female reproductive system is an amazingly complex system involving incessant communication between the brain centers and the ovary. Hormones secreted by the hypothalamus, pituitary, and ovaries are the messengers which are responsible for effectively regulating a woman’s monthly cycle. A normal FSH level for a woman hoping to get pregnant is usually below 10mIU/ml. The level of FSH which a woman’s body produces correlates directly to her ovarian reserve (the quality and quantity of the remaining eggs). Low FSH levels can also affect fertility in several ways, resulting in improper functioning of reproductive cycles.

    This article gives detailed information about:

    1. What is a follicle stimulating hormone test?

    A follicle-stimulating hormone blood test helps in measuring the amount of follicle-stimulating hormone (FSH) in a blood sample. FSH is produced by the pituitary gland. Follicle stimulating hormone helps women in controlling the menstrual cycle. It also helps in the production of eggs by the ovaries in women. The amount of FSH levels varies throughout a woman's menstrual cycle and is highest just before the ovulation takes place. (1) Follicle stimulating hormone is one of the most essential hormones for pubertal development and the function of women's ovaries and men's testes. In women, FSH is responsible for stimulating the growth of ovarian follicles in the ovary before the release of an egg from one follicle at the time of ovulation.

    Follicle Stimulating Hormone Test
    Follicle Stimulating Hormone (FSH) also increases estradiol production. This hormone helps in controlling the production of sperm in men. Follicle stimulating hormone levels usually remain constant in men. The FSH level can help in determining whether male or female reproductive organs (testicles or ovaries) are functioning properly. In men, FSH instructs the cells in the testicles to produce sperm. In women, FSH travels to the ovaries where it is responsible for the development of eggs during the menstrual cycle. FSH plays an important role in children for effective sexual and reproductive growth and development. (2)

    2. Role of FSH in Fertility Levels:

    Follicle Stimulating Hormone (FSH) is one of the crucial hormones which are responsible for regulating the female reproductive system. FSH is produced by the pituitary gland during the first half of a woman’s menstrual cycle. It is responsible for stimulating the growth of the maturing ovarian follicle. It also controls the ovum production in women and sperm production in men. (3) Follicle stimulating hormone (FSH) is a part of the glycoprotein hormone (GPH) family. The hormone is secreted by gonadotropes, which are found in the anterior pituitary gland. FSH is an essential hormone for the production and growth of gametes in women.

    The hormone is a part of a cascade that takes place with the release of gonadotropin-releasing hormone. Gonadotropin hormone is released from the hypothalamus and stimulates gonadotropes in the pituitary gland. These stimulated gonadotropes release follicle stimulating hormone and the luteinizing hormone (LH) into the bloodstream where they travel via the bloodstream to the gonads. In men, FSH stimulates the Sertoli cells to produce inhibin and ABP, or androgen-binding protein. ABP keeps testicular testosterone concentrations increased for spermatogenesis, while inhibin goes back to the anterior pituitary to stop production of FSH. In women, the hormone is responsible for stimulating ovarian follicular granulosa cells to continue to develop and divide, secrete estradiol, and become responsive to LH stimulation. FSH binds to the FSH receptor (FSHR) for stimulating cellular responses. (4) 

    The most essential hormone for reproduction is known as gonadotropin-releasing hormone better called as GnRH. This hormone is released in an incredible rhythmic flow every 60 to 120 minutes. GnRH helps in stimulating the pituitary gland to produce follicle stimulating hormone (FSH), which is responsible for starting follicle (egg) development. It causes the level of estrogen, the primary female hormone, to increase to a certain extent. (5)

    3. Indications for Follicle Stimulating Hormone Test:

    FSH levels are one crucial part of the complete health status a fertility doctor has to figure out. To get a clearer picture of the exact condition, further tests are likely to be performed as per the requirement of each of the case. Examples include tests for:

    • Progesterone: the hormone which is involved in a woman’s menstrual cycle, pregnancy, and embryogenesis of humans and other species
    • Estradiol: It is an estrogen steroid hormone and the most essential female sex hormone. Estradiol or oestradiol hormone is involved in the regulation of the estrous and menstrual female reproductive cycles.
    • Testosterone: testosterone hormone plays an important role in the development of male reproductive tissues like prostate and testes. It is also helpful in promoting secondary sexual characteristics such as increased bone and muscle mass, and the growth of body hair.
    • Luteinizing hormone: This hormone is used for evaluating fertility issues and function of reproductive organs (ovaries or testicles). This hormone is also useful in detecting the release of an egg from the ovary (known as ovulation). (6)

    Indications for Follicle Stimulating Hormone Test
    Also, while testing for fertility levels in the body, a specialist may ask a woman to track her body temperature, as there are chances that temperature may shoot up during ovulation. Similarly, certain imaging scans are also recommended to check the fallopian tubes. If the fallopian tubes are blocked, the woman's egg cannot travel to the uterus for successful implantation. The North American Menopause Society states that if a woman has an FSH level of 30 milli-international units per milliliter (mIU/mL) or higher, and do not get her period for one year, she has probably reached menopause. However, women who have single FSH test with such results, they tend to have fewer chances of reaching the stage of their menopause. Certain impactful medical tests need to be performed to find out the current scenario in the patient. Based on a research study, the most typical FSH reference values are:

    • Males above 18 years: 1.0 to 18.0 International Units per Liter (IU/L)
    • Postmenopausal women: 16.7 to 113.6 IU/L
    • In premenopausal women: 
    • Follicular phase: 3.9 to 8.8 IU/L
    • Midcycle phase: 4.5 to 22.5 IU/L
    • Luteal phase: 1.8 to 5.1 IU/L

    A fertility doctor provides a reference list for FSH testing results, to let patients identify whether the state of FSH levels. A fertility doctor explains the results of the test to the respective patient and recommends treatments accordingly. For women who are in early menopause stage, the specialist may recommend Hormone Replacement Therapy (HRT) to minimize the associated symptoms. (7)

    4. Uses of Follicle Stimulating Hormone Test:

    Fertility specialists often order the FSH test as part of a range of other tests. There are a number of purposes to carry out the FSH test, which includes:

    • Menopause testing: In cases where women experience irregularity in their menstrual cycle or lacked periods cycle for a few months in a row, a doctor may recommend the test. High FSH levels in the test result could indicate menopause. This test is performed when the patient has reached the age of menopause phase. 
    • Female fertility level testing: In cases where ovulation does not take place, the FSH levels might be either high or low in such cases, depending on the causes of infertility.
    • Male fertility testing: In men, follicle stimulating hormone stimulates the growth of sperm cells. If the levels of FSH are high in men, this indicates that testicles are not functioning properly.

    In addition to conduct test for fertility and menopause, fertility specialistsmay recommend an FSH test to look for a pituitary disorder or to ascertain if a child is entering puberty too early or too late than expected. The FSH test may also be used to check for any disease or damage associated with the testes or ovaries, hypothalamus, an almond-sized area of the brain that connects the nervous system with the hormone-producing endocrine system or pituitary gland. (8) A recent research study showed that the U.S. Food and Drug Administration (FDA) has given consent to a urine test that measures FSH levels as required as per the case of the patient. This test can be performed at home. If a woman is having difficulty conceiving a baby, the test can depict whether she is in the early stages of menopause. Such cases are quite rare as menopause age and reproductive age are considerable away from each other. The follicle stimulating hormone test can prove to be a useful tool for determining the conditions of optimizing stimulation protocols in IVF and planning out the respective IVF procedure. (9)
    Uses of Follicle Stimulating Hormone Test

    Also, Follicle Stimulating Hormone (FSH) test is performed to help diagnose or examine the following conditions in women:

    In men, the test can be performed to help diagnose or examine the following conditions:

    • Males who do not have testicles or whose testicles are underdeveloped
    • Men who are unable to impregnate their partner or possess some kind of male factor infertility problems

    In children, FSH test is performed to determine the cause of problems with the development of sexual features. It is recommended for children in the following cases:

    • Ones who develop certain sexual features at a very young age
    • Ones who have not yet experienced puberty

    5. Follicle Stimulating Hormone Test Results:

    The test results of follicle stimulating hormone levels vary based on gender and age of the patient. The results also vary depending on which stage a woman is currently present in her menstrual cycle. Each laboratory has a slightly distinguished reference range. Patients should discuss FSH results with their doctor for better understanding and complete guidance.

    Follicle Stimulating Hormone Test Results

    Follicle stimulating hormone test range:

    Normal Results:
    Normal FSH levels vary depending on a person's age and gender.

    For Males:
    Before puberty: 0-5.0 mIU/mL (0 to 5.0 IU/L)
    During puberty: 0.3-10.0 mIU/mL (0.3 to 10.0 IU/L)
    Adult: 1.5-12.4 mIU/mL (1.5 to 12.4 IU/L)

    For Females:
    Before puberty: 0-4.0 mIU/mL (0 to 4.0 IU/L)
    During puberty: 0.3-10.0 mIU/mL (0.3 to 10.0 IU/L)
    Women who are still menstruating: 4.7-21.5 mIU/mL (4.5 to 21.5 IU/L)
    After menopause - 25.8-134.8 mIU/mL (25.8 to 134.8 IU/L)

    Normal value ranges may differ slightly among different renowned laboratories. Some labs utilize different measurements or test different sampling methods for testing. Patients should talk to their specialist about the meaning of a specific FSH test result.

    What does Abnormal FSH Test Result Mean?

    Follicle stimulating hormone may be present in high levels in women owing to the following reasons:

    • During or after menopause, including premature menopause, some of the women tend to have increased levels of FSH.
    • If a woman is receiving hormone therapy, she may experience some abnormal FSH levels in the test results if the test was performed during the same period.
    • Following certain types of tumor in the pituitary gland, there are possible chances of having increased levels of FSH
    • Due to Turner syndrome, a chromosomal disorder, the FSH may have increased levels in some women
    • Being underweight or having had a recent rapid loss of weight
    • Not producing eggs (not ovulating)
    • Parts of the brain (the pituitary gland or hypothalamus) not producing appropriate amounts of some or all of its hormones
    • Pregnancy

    Follicle stimulating hormone (FSH) levels may be higher in men owing to the improper functioning of the testicles which may occur due to:

    • Advancing age (male menopause which is seen only in few men)
    • Problems with genes, such as Klinefelter syndrome
    • Damage to testicles caused by alcohol abuse, chemotherapy, or radiation
    • Treatment with hormones
    • Certain tumors in the pituitary gland

    Low FSH levels in men could mean parts of the brain (the pituitary gland or hypothalamus) do not produce appropriate amounts of some or all of its hormones. High levels of FSH in boys or girls may mean that puberty is about to occur. 

    6. How reliable is the follicle stimulating hormone test?

    Follicle stimulating hormone tests accurately detect FSH about 9 out of 10 times. This test cannot detect the menopause or perimenopause phase in a woman. As a woman grows older, her FSH levels may rise and fall during her menstrual cycle. Being severely underweight and stress factors can leave a significant impact on the FSH values in both men and women. 
    How Reliable Follicle Stimulating Hormone Test

    How the FSH test is performed?

    A blood sample is drawn by a tiny needle from a vein in the arm or hand. In some cases, a random urine sample is collected but, due to the cyclic secretion of the hormone, a 24-hour collection of urine is usually requested. By measuring FSH levels produced over a 24-hour period, the variation in FSH levels seen throughout the day can be reduced. When the needle is inserted in the arm or hand to draw blood, some people might feel moderate pain. Others may feel only a prick or stinging feeling during the test. Afterward, patients may experience some throbbing or a slight bruise. This soon settles down in a few minutes.

    How to Prepare for the Test:

    No special preparations or arrangements are needed for this test. For women of childbearing age, the highly-skilled and experienced health care provider may want a patient to get the test performed on certain days of her menstrual cycle.

    7. Risks associated with FSH Test:

    The FSH test typically consists of a simple blood test. A small sample of blood is needed for testing and the risks of the test are minimal, so patients can resume their regular activities afterward. Mild risks associated with FSH test are:

    • Vertigo
    • Dizziness
    • Bruises
    • Vasovagal syncope or fainting at the sight of blood
    • Pain
    • Increased chances of infection
    • Redness at the needle site
    • A hematoma

    How is the level of Follicle Stimulating Hormone (FSH) controlled?

    The levels of a number of circulating hormones released by the ovaries and testes are responsible for regulating the production and release of follicle stimulating hormone. This system is called the hypothalamic–pituitary–gonadal axis. A Gonadotropin-releasing hormone is released from the hypothalamus and binds to receptors in the anterior pituitary gland for stimulating both the synthesis and release of follicle stimulating hormone and luteinizing hormone. The released follicle stimulating hormone is carried in the bloodstream where it binds to receptors in the ovaries and testes. Using this mechanism, follicle stimulating hormone, in conjunction with luteinizing hormone, can be useful in controlling the functions of the testes and ovaries. In women, when hormone levels move towards the end of her monthly cycle, this is sensed by nerve cells in the hypothalamus. These cells produce a more gonadotropin-releasing hormone, which in turn encourages the pituitary gland to produce more follicle stimulating hormone and luteinizing hormone, and release them into the bloodstream.
    Level of Follicle Stimulating Hormone

    The rise in follicle stimulating hormone encourages the growth of the follicle in the ovary. With this growth, the cells of the follicles produce rising amounts of oestradiol and inhibin. Resultantly, the production of these hormones is sensed by the hypothalamus and pituitary gland and a less amount if gonadotropin-releasing hormone and follicle stimulating hormone will be released. However, as the follicle grows, and more and more estrogen is produced from the follicles, it consequently simulates a surge in luteinizing hormone and follicle stimulating hormone, which stimulates the releasing of the viable egg from a mature follicle. This process is called ovulation. Therefore, during each menstrual cycle, there is a rise in FSH secretion in the first half of the monthly cycle that stimulates follicular growth in the ovary. When ovulation occurs, the ruptured follicle forms a corpus luteum, which produces high levels of progesterone hormone.

    This restrains the release of follicle stimulating hormone. By the end of the menstrual cycle, the corpus luteum breaks down, the production of progesterone hormone decreases and the next menstrual cycle begins when follicle stimulating hormone starts to rise once again. In males, levels of FSH production are regulated by the circulating levels of inhibin and testosterone hormone. Testes in men are responsible for the production of these hormones. Follicle Stimulating Hormone (FSH) is responsible for regulating testosterone levels and when these levels rise, they are sensed by nerve cells in the hypothalamus so that gonadotropin-releasing hormone secretion and as a result follicle stimulating hormone is decreased. The opposite occurs when testosterone levels decline. This is referred to as a 'negative feedback' control so that the production of testosterone remains stable. The production of inhibin hormone is also controlled in a similar way but this is sensed by cells in the anterior pituitary gland rather than the hypothalamus. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) are also produced by men in their bodies, and these hormone levels are vital for male reproduction as well. In men, FSH works by stimulating the testes to produce sperm just as in women it stimulates the ovaries to produce viable eggs. In men, luteinizing hormone can be measured to investigate the cause of low levels of testosterone hormone. (10)

    8. Frequently Asked Questions about Follicle Stimulating Hormone Blood Test:

    Q. What does a positive FSH test mean?
    A positive FSH test can only measure whether the level of follicle stimulating hormone is at or greater than 25 mIU/mL (above average) and the transition of menopause is guided accordingly. Menopause by definition is having gone around one year without a menstrual cycle. A positive FSH test does not indicate exactly when a woman will reach her menopause.

    Q. Can stress affect FSH levels?
    Various studies have revealed that stress can cause an obstruction in pregnancy by increasing the number of fight-or-flight hormones like adrenaline and cortisol, that may reduce sperm count and prevent ovulation. Ultimately, this means that stress affects fertility in women in more than just one way.

    Q. Is fasting required for FSH blood test?
    Usually, FSH levels are measured with a blood test between days two and four of a woman’s menstrual cycle (day one being considered the first day of menstrual bleeding). Patients generally don’t need to fast before an FSH blood test. Effective and accurate results can be achieved even if the patient is not fasting. (11)

    Follicle Stimulating Hormone (FSH) test helps a fertility doctor to evaluate and diagnose fertility issues or menopause status. A fertility specialist may suggest a woman several blood samples drawn over the course of her monthly cycle to check if her FSH levels are in the desired levels. For more information about FSH test or any other information related to infertility or IVF treatments, you can visit or talk to the best fertility experts at +918268260808.



    1 Comment


    Moulik Hiranandani

    June 1, 2019, 3:51 p.m. 4.5

    Leave a Comment



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