Follicular Stimulating Hormone (FSH) Test

Follicle-stimulating hormone (FSH), with luteinising hormone (LH), assists with adequate follicular development and growth. FSH is a significant gonadotropin hormone produced by the pituitary gland under the influence of gonadotropin-releasing hormone (GnRH) from the hypothalamus. The FSH test has different concerns depending on whether you are a child, female or a male.

More simply, the hierarchy of the female hormonal system goes as follows:

Step I: GnRH (gonadotropin-releasing hormone) from the hypothalamus acts on the pituitary glands to produce the gonadotropins, as the name suggests.

Step II: The pituitary gland then produces the gonadotropins: Follicle-stimulating hormone (FSH) and luteinising hormone (LH).

Step III: These hormones are essentially necessary for the follicles to nurture and develop to secrete oestrogen and progesterone - the female reproductive hormones.

In males, FSH hormone is crucial to maintain and stimulate spermatogenesis, a series of steps that makes a mature sperm available for fertilisation. In addition, an FSH test can also determine the cause behind a low sperm count and help with delayed or early onset of puberty.

FSH test is needed to evaluate if adequate levels of FSH are in the bloodstream for fertility concerns of both men and women.

According to the All India Institute of Medical Sciences (AIIMS), 15% of couples face infertility and 2.2% to 22% of females face PCOS along with the psychosocial stress associated with it. Multiple factors like genetics, inactive lifestyle, arrested follicular development, obesity, diabetes mellitus and high androgen levels (male sex hormones) have been associated with the occurrence. The follicle-stimulating hormone test is used for the diagnosis of the cause behind infertility or progressive ovarian and testicular dysfunction.

Other Names of Follicular Stimulating Hormone Test

• Follitropin blood test
• FSH
• Follicle-stimulating hormone test

What does the FSH test detect or measure and who is this prescribed for?

The follicle-stimulating hormone test, abbreviated as FSH test, measures the amount of anterior sex hormone, FSH, present in the bloodstream of a woman, man or child. It is analysed based on a blood sample collected by the healthcare professional.

The FSH test can help assess the following:

• Infertility
• PCOD/PCOS and ovarian failure in females
• Oligospermia and gonadotroph adenoma in males
• Delayed or early onset of puberty in children

An FSH blood test is prescribed to those experiencing symptoms like:

1. Symptoms faced by the couple:

• Unable to get pregnant despite multiple efforts
• Decreased libido of either one or both
• Fatigue, weakness, depression
• Loss of appetite

1. Symptoms faced by women:

• Headache, night sweats, hot flashes
• Vision changes
• Ovarian cysts
• Decreased libido
• Dryness in vagina
• Abnormal menstrual cycles (oligomenorrhea or amenorrhea)
• Pelvic pain
• Infertility

1. Symptoms faced by men

• Low energy and quickly exhausted
• Loss of body and facial hair
• Erectile dysfunction
• Decreased sexual desire
• Infertility

1. Symptoms faced by children

• Early or delayed appearance of secondary sexual characteristics.
• These characteristics can be changes in the hoarseness or pitch of the voice and growth of pubic, axillary, chest and facial hair.
• Menstruation in a girl aged below nine years or delayed menses.

The FSH test results are based on analysing a blood sample collected from the arm's vein.

Test preparation

1. Before the test

No specific preparations are needed before the FSH procedure. Prepare during your initial 3-5 days of menstruation or as directed by the doctor.

• Fasting is not required.
• Biotin, hormone therapies and pregnancy can also interfere with the FSH test results.
• Certain medications can interfere. Inform the doctor about oral contraceptives or birth control pills, phenothiazines, digitalis, cimetidine, etc.

1. During the test

A nurse or sample collector will use your arm's vein to collect the blood sample. Preferably, wear a short sleeve for convenience during sample collection.

1. After the test

When done hygienically and according to protocol, the FSH test procedure poses no serious threats to an individual.

Test inclusions: What parameters are included?

Blood Test: The FSH test estimates the amount of follicle-stimulating hormone present in the blood. The test values account for any menstrual irregularities, pregnancy-related issues, ovarian or testicular dysfunction. FSH reports vary from person's age, sex, before or after puberty and lifestyle modifications.

Other related tests to further evaluate the physiological functioning of the body are:

• LH or luteinising hormone test
• Oestrogen and Progesterone test
• Testosterone level test

Polycystic ovary syndrome (PCOS), Infertility, Testicular dysfunction, Ovarian tumour

Your healthcare professional will help you understand the different FSH test ranges during different times of the month as the menstrual cycle progresses.

Table I: Menstrual cycle-based FSH test range for females

Explanation of the 4 phases:

Let us assume a menstrual cycle of 30 days. In these 30 days, the first day is the day of menstruation or period (bleeding) that can last for 5-6 days. These 30 days will include the follicular, ovulatory and luteal phases in the same sequence.

1. Luteal phase: Luteal phase is the phase of fixed duration, i.e. 14 days. All other phases are bound to vary in their course but not the luteal phase. Your ovulation (release of an egg) does not take place in the middle of the cycle. It takes place 14 days before the next menstrual cycle. Thus, 30 minus 14 days makes it the 16th day. The 16th day is the day of ovulation from your first day of menstruation. The duration of 14 days between ovulation and the next menstrual cycle is called the luteal phase.
2. The ovulatory phase is the day of ovulation, i.e. the 16th day itself in case of 30 days of the menstrual cycle.
3. Follicular phase: Follicular phase is the duration between your first day of menstruation to the day of ovulation; here, it is from the 1st to 16th day.
4. Post-menopausal phase: It is a natural phase that marks the ending of a woman’s reproductive stage. It is when a woman has not gotten periods (menses) for an entire year and so on, commonly seen in age groups 45-51 years old women.

Table II: FSH test range for males

Table III: FSH test range for children aged 1-10 years old

It is essential to consult your doctor or paediatric endocrinologist before concluding the FSH results. A pregnant woman will have low levels of FSH in her blood. The normal values, parameters, and reference ranges of the test may vary from lab to lab. Please refer to the ranges mentioned in the report and consult a doctor to understand the interpretation of lab reports.

The results of the FSH test can help yield information about abnormal levels of FSH in women, men and children.

1. Abnormal levels in a woman

1. Abnormal levels in a man

1. Abnormal levels in a child (<9 years old girl and <10 years old boy)

1. For the diagnosis of Polycystic ovary syndrome (PCOS)

LH to FSH ratio is > 2.5

How frequently should you take this test?

Doctors will only prescribe an FSH test if your concerns are related to being unable to get pregnant, early or delayed onset of puberty or if there are concerning signs and symptoms.

1. For woman

The FSH test, along with LH and estrogen, shall be performed in the initial 3-5 days of the menstrual cycle. Day one is considered the first day of menstruation.

1. For males and children

No specific consideration.

Consult your healthcare professional or physician about the upcoming steps regarding follow-ups for IVF treatments or hormonal therapies.

What is a normal FSH level in a woman?

There are multiple normal ranges for a woman depending upon the different times of the menstrual cycle. They are: