Recently I treated a Japanese lady Lucy with FSH reaching 100 after she stopped estrogen treatment. Lucy came to Boston when she was 13 years old. She was very athletic when she was a teenager in Needham High School and has been in good shape until now. She studied and worked so hard for the past 38 years and found a good research job in a biotech company in Weston. She suddenly realized that she needs to have a baby as soon as possible at the age of 39 years old. Since she has not found the right person to share the future life together, she decided to go to the sperm bank in Boston Medical Center.
Lucy does have a family history of premature ovarian failure. Her mother stopped her period when she was 35. Lucy still has regular light period before she started her hormone therapy, but her FSH went up to 40 after they used hormone to stimulate her ovaries to produce more than one egg in order to bank the eggs and fertilize the sperm, then transfer the good embryo into her uterus later. The idea is that her infertility specialist in Newton Wellesley Hospital should be able to retrieve multiple eggs after a few times of hormone stimulation cycle in order to bank more than 10 eggs, then they use the sperm in the bank fertilize the eggs and freeze the embryo. Theoretically, Lucy will take the estrogen to build up her uterine lining and progesterone to maintain the uterine lining. The infertility specialist will transfer the embryo when everything is in the right condition after the good eggs are fertilized by healthy sperms.
Since Lucy has a very low level of estrogen and progesterone, her infertility specialist started hormone stimulation treatment with estrogen. Unfortunately Lucy only produced one follicle with the first time of stimulation, the retrieval was sadly cancelled. Lucy started her BCP for the next few weeks to shut down her ovaries so her infertility specialist can stimulate the ovaries again with a higher dosage of hormones. In this way the eggs will mature at the same time. When the endocrinologist stopped BCP, Lucy could not get her period for a few months, it seems that her ovaries were ready to shut down forever. Her infertility specialist started using estrogen to stimulate her ovaries hoping the ovaries started functioning again. When Lucy started reducing her estrogen pill to prevent the ultra-thick uterus lining, she had light bleeding because the uterus lining was built up pretty thick without sufficient progesterone support. With the tapering of estrogen pill, her FSH reached 100, which is the highest I have known.
Lucy is a scientist and read many papers about high FSH. She explained to me that when stopping or cutting down the estrogen, the FSH can jump sharply. She has been back on the estrogen pill at a higher dosage to bring down her FSH. After two months, her infertility specialist in Boston Medical Center wanted to stimulate her ovaries again thinking her FSH was lowered around 13, she may start ovulating again. With higher dosage of hormone stimulation, her ovaries produce two big follicles and two small ones, but after a few days the two big follicles disappeared miraculously. She only had two small follicles left. When the infertility specialist finally started to retrieve the two follicles, the quality was so bad that they could not fertilize the eggs with the sperm. In this case, using estrogen and progesterone to stimulate the ovaries and maintain the uterus lining does bring down the FSH, but the FSH is not the only indicator to predict the ovarian function and reserve. Using herbs and acupuncture to bring the energy to the ovaries and uterus is the key to produce healthy eggs.
Lucy had a lower estrogen level when she was a teenager because she built up so many muscles that the testosterone level is much higher than it should be. She grows a lot of hair on her legs. She also tends to sleep very late, which also compromised her ovarian function. She used to eat a lot of processed food when she first came to America for her Ph.D study that is why her ovarian function is declining so fast. The BCP suppresses the ovarian function, Asian women seem to respond to BCP much stronger than A Caucasian. When a woman already has a compromised ovarian function with the family history of premature ovarian failure, using BCP can shut down the ovaries permanently. That is why Lucy has such a high level of FSH at the age of 40 years old while other women can still get pregnant at this age.