FSH and LH are classified as gonadotropins, hormones which stimulate the gonads. FSH and LH play significant roles in sperm production in males while they regulate the maturation and release of eggs from the ovary in women.
FSH and your Reproductive System
FSH (Follicle Stimulating Hormone) is responsible for the maturation of the follicles. The normal ratio of FSH to LH (Luteinizing Hormone) is 1:1 but in women with PCOS, LH levels are usually elevated. An LH to FSH ratio or 2:1 or even 3:1 is often considered to be diagnostic of PCOS. This hormonal imbalance is why ovulation does not occur naturally as it should.
Correcting the LH and FSH imbalance among women with PCOS addresses the problem of not ovulating (anovulation). Starting a low-dose regimen of FSH for women diagnosed with PCOS has been shown to be effective in stimulating ovulation1; by reaching, but not exceeding, the threshold dosage for FSH, the risk of multiple ovulations is also reduced so that the probability of multiple pregnancies and births are also lowered. 2
Will FSH therapy work where Clomiphene has failed?
Medical studies show that FSH therapy is more effective than conventional infertility treatments. In clinical studies using clomiphene-resistant subjects, the use of low-dose FSH therapy have had some success. 3
FSH therapy for PCOS patients
A number of medical publications show that aside from being effective in causing ovulation, FSH therapy is less likely to cause OHSS (ovarian hyperstimulation syndrome)4, one of the more common complications which can occur as a result of undergoing fertility treatment. This is significant because women with PCOS are actually at a higher risk for OHSS compared to the average fertility patient.
Sometimes, when the ovary becomes overly stirred from medications taken to stimulate egg production, it can suddenly swell up and become edematous. This causes fluid to leak from the abdominal cavity into the lungs, and can be a serious condition. OHSS is more often associated with injected doses of hCG, especially if it results in pregnancy. Although there are several measures which can satisfactorily address OHSS, preventing its occurrence is of course preferable.
Safer FSH therapy options
As early as 1999, medical experts were already aware that not all forms of FSH were equal. Recently, a study carried out on PCOS patients who were clomiphene-resistant and infertile compared the efficacy and safety of recombinant human FSH (rhFSH) against urinary human FSH (uhFSH). 2
The 20 patients were divided into two test groups, with one group receiving rhFSH and the other receiving uhFSH. Both were subjected to the same dosages and the same duration of treatment. The test subjects were all subjected to hCG injections as well, to be able to compare the incidence rates of OHSS between the two forms of FSH. After the 14 day period, six patients from the group which received rhFSF had gotten pregnant. There were also much lower incidences of OHSS compared to the group which received uhFSH, which supports previous studies which found that rhFSH was indeed superior to uhFSH in terms of pregnancy success rates for PCOS as well as IVF (In-vitro fertilization).
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1 “Low-dose FSH therapy for anovulatory infertility associated with polycystic ovary syndrome: Rationale, results, reflections and refinements” PubMed Health, 1999 Sept-Oct. http://www.ncbi.nlm.nih.gov/pubmed/10582786
2 “Low-dose ovulation induction with urinary gonadotropins or recombinant follical stimulating hormone in patients with polycystic ovary syndrome” PubMed Health, Jan 2004. http://www.ncbi.nlm.nih.gov/pubmed/15106360
3“Follicular development and hormone concentrations following recombinant FSH administration for anovulation associated with polycystic ovary syndrome: Prospective, randomized comparison between low-does step-up and midified step-down regimens” PubMed Health, April 2001. http://www.ncbi.nlm.nih.gov/pubmed/11278212
4 “Ovarian Hyperstimulation Syndrome” PubMed Health, 11 Sept 2011. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004549/