FSH & LH levels

[Sunshine2988]

Just wondered whether anyone can help with interpreting FSH & LH levels, I had them done in November but the fertility service is closed until at least feb! So managed to get the results from the gp but not been able to speak to a dr to interpret.
I’m 32, unexplained infertility at the mo after 14 months ttc, my FSH is 5.9 and my LH was 2.3, had them done day 4 of my cycle.
They were repeats to see what my next steps would be whether to refer for ivf or not. Just waiting for the progesterone which will be the main thing,

From googling I can see a lot of info on the ratio, ideally 1:1 and if LH is higher it can be pcos. These are both in the normal follicular range but obviously not the right ratio.

Anyone had anything similar? Would appreciate any help! Xx

Bump

Has your man been tested to date, if not he should be. If they are suggesting IVF as well it may well be male factor issues.

You need a diagnosis as a couple first and foremost.
Do not ever accept unexplained subfertility; its not a diagnosis at all and is usually given to couples when they have not been adequately investigated. They have merely failed to date to find out what is wrong so that is why you are unexplained.

I would ensure as far as possible that these tests are carried out by the hospital going forward. The most common tests that tend to be omitted are:-

Adequate x-rays of the uterus which may show abnormalities not otherwise seen at laparoscopy.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not seen otherwise

Repeated sperm counts over several weeks and months to make sure there is no subtle abnormality

Testing the sperm in special media such as swim up tests/velocity testing. However, when they are done, they often uncover a hidden cause for the supposed unexplained problem

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone

Scanning of the ovaries to see if follicles really are developing and there are no sign of polycystic ovaries

FWIW your LH/FSH looks ok.

Thank you for your reply, yes we’ve had all the tests done already and everything came back with no problems. I wasn’t having periods or ovulating after coming off the pill, but after we got referred and I was booked for my HSG when my periods started by themselves again. Consultant said to go away and try naturally for 12 months which it has been now and still no joy so she’s asked to repeat these bloods and progesterone which will determine whether she recommends clomid or IVF.
I’m kind of hoping my progesterone does come back low as I think that is a problem as currently I’m ovulating day 18 with only a 9 day luteal phase.

It’s difficult because I believe the NHS will always go for ivf before suggesting those tests as they aren’t routine, but I will certainly push for a reason as I agree with you unexplained isn’t actually a diagnosis!

What tests have you actually had done to date and particularly within the last six months?. There is clearly a problem here and they have not found out why that is, they've just given you the unhelpful "unexplained" tag. Its sometimes also given to couples when they have not been adequately investigated.

Why did they tell you to go away and try for another year?. Hmm. It is possible that a problem pertaining to ovulation has been missed here entirely. If your periods did not resume after stopping the pill this is a problem anyway.

Progesterone is only part of it, if that level is low then it could well be that your LH and FSH levels (that should be compared against each other on a day 2 blood test) are out of sync as well.

So I had all of my tests done over 12 months ago, the standard internal, external ultrasounds, all of the hormone blood tests, then I had a HSG, husband had a semen analysis. As far as I’m aware they don’t do the tests you mentioned without good reason. I don’t have any of the symptoms for needing a hysteroscopy, and I definitely don’t think they’d be in a rush to refer me for a laparoscopy either!
The reason she said to go away and try naturally is because I had been referred due to not ovulating/having periods after coming off the pill. Seeing as all the other investigations were normal I understand why she said to try naturally because of my age.

I’m not sure what others’ experiences of the NHS fertility is but it does seem like it it more of a “if this then this” rather than trying to work out if there is a problem.
If there is an issue with progesterone then the consultant will recommend clomid, if progesterone is fine then we will be referred for IVF. That’s why I want to know my progesterone as I do feel there is a hormone issue somewhere as my cycles aren’t how they should be.

They preformed an external ultrasound?.

I really do think you've been fobbed off here and getting you to go away after being referred was appalling as well. May I ask how old you are now?.

You need to discount those results as they were done more than 6 months ago. The tests I wrote of are all pretty much standard fertility test. However, financially strapped NHS fertility units and a lack of resources generally means that they can be missed or not done as thoroughly. Also it is true to say that some NHS units are far better than others.

Both of you need up to date test results; the tag "unexplained" should not apply here and its been given here because they do not know what is wrong. Sometimes it is indeed given to couples when they have not been adequately investigated. For example as well, one semen analysis is not definitive.

Yeah it does feel that way, I’ve never really felt like they were interested in trying to get to the root of the problem, partly because of our age I think. I’ve just turned 32 so still classed as young but things take so much time before you know it a year has gone by!!

We’re thinking of going private tbh, just because I think it’s going to be such a long wait with COVID. I just wondered if anyone could give a helping hand with these bloods seeing as I can’t get them looked at by the Dr at the mo! I know if we did go private they would repeat all these tests as well because like you say they’re not really still valid!