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Infertility/Fertility/19 year old and high FSH

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QUESTION: I am 19 and have not had my period in 3 months.  I did get my period every 21 days but it has been lighter over the last six months...maybe because I was taking tumeric capsules for acne.  I usually exercise aerobic ally about 2 hours a day and lift weights but my weight is around 125 pounds...I do eat a low fat diet.  My labs are FSH 9.33, LH 6.81, progesterone .3 and total estrogen 79...my vitamin d was 23.5 so the OB GYN recommended 50,000 vitamin d once a week and continuous progesterone cream...is this helpful and are my other numbers ok if I am not getting my period?

ANSWER: Hello Becca from the U.S.(Indiana),

The FSH and LH are the only measures of ovarian function and do show that the ovaries are probably functioning normally.  The progesterone is low but the value depends on where you are in the cycle.  FSH and LH should be measured on the 2nd or 3rd days of the menstrual cycle whereas progesterone is measured between the 20th-22nd days of the cycle.  Measuring progesterone is NOT done to see if you have adequate progesterone in your system and I do not agree with your doctor's prescription for continuous progesterone.  That is a total misinterpretation of the lab and shows a lack of understanding of the hormonal status.

If you are not getting your period, having a normal FSh (albeit increased but not menopausal) and LH does not rule out ovarian dysfunction, which may be the case.  It rules out hypothalamic dysfunction, as would be seen with premature menopause or exercise induced causes.  It shows that the ovaries are not working correctly.

My recommendation would be to go see someone a little more knowledgeable about reproductive hormones.  I'm a little skeptical about this doc.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your quick and very helpful response.  I think the information is very informative and I am hoping you can answer a few other questions:
1) I went to a GP doctor before the OB because about the time I was to get my period (but didnít) I had severe abdominal pain while having a BM that caused nausea and dry heaves and to lay on the floor of the bathroom for about an hour or two.  My parents were going to take me to the ER but the pain subsided after about 2-3 hours.  I asked the doctor if could have been an burst cyst or ovarian torsion but she said no because the pain would have continued and it was probably IBS. She did order labs and the only abnormal was the Monocyte Abs  (.2), MCV (100) but the RBC (3.99) and WBC(4.6)  were low normal.   Should I try to request an ultrasound just to be sure?
2)I had a follow-up with a different OB to get a referral to an endocrinologist.  She said there is no need to worry until 6 months of no cycles and in 6 months she would give me 10 days of oral progesterone.  When I told her about the cream, she said I could just use that for 10 days and it would be the same as the oral progesterone (this is being made by a compounding pharmacist so not sure the concentration or dose yet).  With my labs, would 10 days of using the cream start my periods or would  using the cream for 10 days just throw off my hormones even more?
3)Is there any way to stimulate my ovaries besides the progesterone cream?
4)As I said, I do exercise daily, but have cut back.  Is there any significance to the fact that the Progesterone/Estrogen is so low and the FSH/LH seem to be normal?
5)I have read that turmeric binds to estrogen and progesterone receptor sites.  Could the turmeric supplements have caused the low progesterone/estrogen?
Thank you for your response.  You are the only doctor (and now I have been to 3) that seems to understand the relationships of the hormones.

Answer
Hello Again,

You need to see a competent Ob/Gyn or Reproductive endocrinologist otherwise you are just wasting your time and not getting any answers.  In answer to your questions:

1.  Seeing a competent doctor will be able to evaluate this further and decide of any other testing needs to be done.
2.  Progesterone cream is probably equivalent to oral but it does NOT make the hormone problem resolve.  Rather, it just induces the endometrial lining to slough and lead to a period.  We call this a medical induction of a period or withdrawal.  It does nothing more.  I think you doctor is absolutely WRONG.
3.  Progesterone does not stimulate the ovaries.  The only way to stimulate the ovary is to cause the problem that is causing it not to work.  This can be in the hypothalamus, pituitary, thyroid, adrenal. ovaries or uterus.  If the problem is ovarian, the most common cause, then we either use fertility medications to stimulate the ovaries to ovulate or, in patients not wanting pregnancy, we use the birth control pill to suppress the ovaries and provide the necessary hormones.  
4.  You cannot interpret the FSH,LH, Estriol, Progesterone as you are doing.  These hormones change levels depending on where it is in the cycle.  These hormone levels have to be evaluated based on the clinical interpretation.
5.  I can't address this question as I have no experience or knowledge about this.

Please seek out a competent reproductive endocrinologist.  That way you will be managed appropriately.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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