Does This FSH Level Mean I Cannot Conceive?

Question

I have a 16 month old son, and have just stopped breastfeeding him. We have been trying to get pregnant for about a year, unsuccessfully. I recently had blood work as well as an endometrial biopsy (while still breastfeeding). My progesterone level was 6.5, and my FSH 12.1. I use NFP and take my BBT daily, chart my fertile mucous, ovulation, and have an average cycle of 25 days. My physician recommended taking Clomid, however I am wondering why progesterone treatment isn’t recommended. I would like to know if Clomid is the preferred treatment, or are there other drug therapies recommended.
In addition, he mentioned some research he read indicating women with an FSH of 12 and above could not achieve pregnancy with any type of fertility treatment. Do you have any knowledge in this area, and does breastfeeding also affect FSH?

Debra

Answer

Dear Debra,

It’s great that you chart your cycle and the data you collect can help guide the evaluation for infertility. Since the progesterone is not a constant level, but climbs for about seven days after ovulation and then decreases in normal women, it is extremely important to know when you had the progesterone level drawn in relationship to the day you ovulated that cycle. Sometimes it helps to get a series of progesterone levels to be sure to capture the curve. If it’s true that you only reached a peak level of 6.5, you would be progesterone deficient, but if the level was drawn at the wrong time, it could be perfectly normal.

Clomid not only helps ovulation but will also increase the progesterone and estrogen levels after ovulation. However, it will dry up the mucus somewhat, so the quality of your mucus should be monitored. Progesterone supplementation is another way to increase the progesterone levels, and would need to be taken about three days after your signs of ovulation, not just prescribed according to the timing of previous cycles.

The FSH of 12.1 does not mean that it is impossible to conceive, but does put you in a group of women where conception will be more difficult. However, your description of your regular cycles sounds very good, and there is room for hope.

I wish you the best,

Sincerely, Lynn Keenan, MD

Answered By:

Lynn Keenan, MD
Lynn Keenan, MD, Immediate Past President of the CANFP Executive Board, is a Clinical Professor at the UCSF/Fresno Internal Medicine Residency Program (now retired), Board Certified in Sleep and Internal Medicine, and Vice President of the International Institute for Restorative Reproductive Medicine. She earned her BSN at UCLA, her MD at Temple University School of Medicine, and completed her Residency in Internal Medicine at UCSF/Fresno. Dr. Keenan served on the Executive Board of CANFP since 2004, as President of CANFP since 2010, and graciously agreed to continue her service to CANFP on the Advisory Board at the beginning of 2019, upon her retirement from the Executive Board of CANFP

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