High FSH:LH Ratio.. or low LH Question!

MsGMChick

Hi girls. I hope you don't mind me posting here. I'm a regular poster on 3T but was hoping maybe you may be able to help with my in depth question..

First I wanted to say I'm 26 so none of my drs have ever tested me for DOR or POF. I was having really short unmedicated cycles (think 20 days including ovulation on cd 9 and an 11 day LP) and read that could be a sign of DOR. I had to beg to get my FSH tested a few cycles ago and it came back at a 6.1 so I never thought about it again. It was the only time it was tested. I know 6.1 is a good number but I also know you're only as good as your highest number and I've only had one. 

Fast forward to now I'm on my first inject cycle with IUI #4 so I'm being monitored by bloodwork better. My beginning LH came back at 1.7 (on cd 6- so logically cd 3 would have been lower since it's a slow rise, right?).  On cd 9 LH was only 2.2 (with two 15mm follies, three 11mm follies, a lining of 9.8 and a 262 E2). After looking at these LH readings- those are really low! Most sources say 3 should be the lowest LH goes. 

I've done some research and found, from what little info is out there, that a high FSH:LH ratio is indicative of DOR (and a high LH:FSH ratio is pcos). Mine would be 2.8:1 - so almost 3:1 ratio. 

Do any of you know anything about low LH? Some sources say it's indicative of secondary ovarian failure and some say its the beginning of DOR/POF.  

I plan to have my RE test my AMH on Tuesday when I go in for my IUI but I'd like to hear about anything you ladies know. 

Thank you so much for any info or stories.

lynn0926

I dont know anything about LH numbers. Your FSH is excellent. Getting your AMH tested and your knowing AFC are an important part of DOR. Do you happen to know what your AFC is from going in for baselines? Maybe it is news to me, but I havnt heard of LH having something to do with DOR. I could be wrong though. Do you typically O early? I know a few of us do O early. I usually O on cd10/11. I have Od on cd 9 on a couple of cycles.

MsGMChick

Hey Lynn, dear! I don't know my AFC. Honestly I don't think my REs ever looked. My injects baseline was the fastest thing ever where he just made sure there were no cysts and sent me on my way. I do typically ovulate really early unmedicated. The IUI cycles I've had have been my latest ovulations. Most unmedicated cycles I ovulate between day 9 and 11. My femara cycles were all day 12 and this follistim cycle will be day 13.

I'm on my phone now but later if you're interested at all I can post some of the links on LH and DOR. They've had some interesting studies out there. Thank you hun for your reply!

lynn0926

MsGMChick:

Hey Lynn, dear! I don't know my AFC. Honestly I don't think my REs ever looked. My injects baseline was the fastest thing ever where he just made sure there were no cysts and sent me on my way. I do typically ovulate really early unmedicated. The IUI cycles I've had have been my latest ovulations. Most unmedicated cycles I ovulate between day 9 and 11. My femara cycles were all day 12 and this follistim cycle will be day 13.

I'm on my phone now but later if you're interested at all I can post some of the links on LH and DOR. They've had some interesting studies out there. Thank you hun for your reply!

Thanks! Can you send them my way. Def have them count your AFC! That along with AMH and FSH are the main tools they use in this dx. GL and I hope you get good results! 

tootlebug

i never really understood the FSH/LH ratio in terms of a PCOS identifier. maybe someone who has PCOS can chime in on that.

but an FSH of 6.1 and an LH of 1.5 or 2.8 etc on CD3 is totally normal.  Irrespective of FSH, those are totally normal LH numbers as you approach ovulation.  for example, mine was always 1.5ish until i got close to the surge. a couple times i would get the LH tested close to the surge, and it was always 3 something.  if it got much higher than that i knew i was starting to surge soon. 

it is different for those that have LH issues, but typically, the LH is going to stay below 4-5ish until you start to surge.

however, the short cycles arent normal and should be looked in to....i suppose some women could just have really short cycles and be fine, but 20 day cycles are usually a sign that something is amiss. 

ceemonkey

So high FSHers generally have high LH too, I'm talking like those with FSH greater than 15 or 20. And I'm not talking about the ratio, just the number. Like if on CD3 one's FSH was 20, it wouldn't be a surprise for the LH to be around 15-20. Now if the ratio of LH:FSH was 2:1 or where the LH was quite a bit higher, then PCOS would be a concern.

This website is a good reference for numbers to see how yours compare: 

https://www.fertilityplus.org/faq/hormonelevels.html 

MsGMChick

tootlebug:

but an FSH of 6.1 and an LH of 1.5 or 2.8 etc on CD3 is totally normal.  Irrespective of FSH, those are totally normal LH numbers as you approach ovulation.  for example, mine was always 1.5ish until i got close to the surge. a couple times i would get the LH tested close to the surge, and it was always 3 something.  if it got much higher than that i knew i was starting to surge soon. 

I'm not trying to be ignorant but.. don't you have DOR, tootle? So, wouldn't your low LH be a common symptom with me and not "normal"? 

Cee- Thanks for the link. I'd looked at that one before. It's not very specific except to say it should be below 7 and similar to my FSH.

Lynn- Here's some of the links I'd found!

This is an abstract from a John Hopkins study that says.. High FSH:LH ratio because of low LH = inferior IVF and DOR

 https://www.hopkinsguides.com/hopkins/ub/citation/16740213/Elevated_day_3_FSH/LH_ratio_due_to_low_LH_concentrations_predicts_reduced_ovarian_response_ 

This one says how high FSH:LH ratio is DOR even if FSH is normal

 https://www.infertilityspecialist.com/female_fertility_tests_hormone.html

 This one is a little long but one of the bullet points reads.."An exaggerated FSH/LH ratio, even with normal FSH, is a sign of diminished ovarian reserve."

 https://www.infertilityspecialist.com/ovulation_toner.html

This one is a short spiel on LH in general but does read that an LH of under 2 is indicative of hypogonadotropic hypogonadism

 https://www.drmalpani.com/lh.htm

This one is a study done that talks about high FSH:LH ratio and how low LH (< 3) effects egg development in IVF or other ovarian stimulation. 

 https://www.ncbi.nlm.nih.gov/pubmed/11665665

 

 

tootlebug

...not ignorant and that's a good question. i totally just erased what i wrote bc i honestly dont know. i do know that both my REs never said that my LH numbers on CD3 were abnormally low.  ....they always hovered between 1.5ish-3.5ish between cycle days 1-11 or 12, then the LH would rise very quickly.  i had really regular cycles - ovulated on day 14 with a 13-14 day luteal phase...the only way i knew about the DOR is when i went back to the RE and they did the hormone tests.  your LH could rise very quickly.  your lining is there but the follicles not quite.  have you been asking for your e2 levels as well?  ....you may not have DOR btw.  as PP said you will want to get the AFC/AMH and all that. 

MsGMChick

tootlebug:

...not ignorant and that's a good question.  i have DOR but my LH numbers were never out of wack....both my REs always said that my LH levels on CD3 were normal.  i had very regular cycles and ovulated usually on day 14 exactly with a 13-14 day luteal phase. the only "off" hormone level was the FSH, which was only tested 3 times. 

(when i had hypothalamic ammenorrhea (i always spell that last part wrong) the LH was abnormally low on CD3......that was a few years ago though.)

i think fertilityplus.org indicates an LH level of 7 or below as "normal" for CD3.  but i think most REs would agree that a level of 7 on CD3 would be a little high and that under 4 or 5 is more normal.  others can chime in on this.  idk, my REs never said that my LH was abnormally low.  despite FSH numbers, i didnt think it was good for LH numbers to be elvevated at all on CD3?  i dont know, good question.

i was so regular...with the ovulation on day 14 and 13-14 day luteal phases, the only way i knew about the DOR is when i went to the RE.  i had no outward signs pointing to it.

Ah! Thanks for the good explanation. And I'm sorry about the DOR dx. There's no history in your siggy, I think I've seen you post about ivfs and I wish you the best. I'm def do not hope to have DOR. I guess I'm just going a bit crazy about to hit the 2 year mark and want to make sure we're not missing something. I know many have tried longer than me.. just wallowing.

tootlebug

MsGMChick:

tootlebug:

...not ignorant and that's a good question.  i have DOR but my LH numbers were never out of wack....both my REs always said that my LH levels on CD3 were normal.  i had very regular cycles and ovulated usually on day 14 exactly with a 13-14 day luteal phase. the only "off" hormone level was the FSH, which was only tested 3 times. 

(when i had hypothalamic ammenorrhea (i always spell that last part wrong) the LH was abnormally low on CD3......that was a few years ago though.)

i think fertilityplus.org indicates an LH level of 7 or below as "normal" for CD3.  but i think most REs would agree that a level of 7 on CD3 would be a little high and that under 4 or 5 is more normal.  others can chime in on this.  idk, my REs never said that my LH was abnormally low.  despite FSH numbers, i didnt think it was good for LH numbers to be elvevated at all on CD3?  i dont know, good question.

i was so regular...with the ovulation on day 14 and 13-14 day luteal phases, the only way i knew about the DOR is when i went to the RE.  i had no outward signs pointing to it.

Ah! Thanks for the good explanation. And I'm sorry about the DOR dx. There's no history in your siggy, I think I've seen you post about ivfs and I wish you the best. I'm def do not hope to have DOR. I guess I'm just going a bit crazy about to hit the 2 year mark and want to make sure we're not missing something. I know many have tried longer than me.. just wallowing.

you're not wallowing at all!  you have been ttc for 2 years?  yeah, if it's been that long then it's definitely time to go see someone. we had well-timed intercourse jan-april (OPKs and charting) and i just felt like something wasnt right.  so i went back to the RE.  the DOR dx sucked, that's for sure (AMH is .22 and im 32, or at least it was in july).  ....esp. bc we conceived my son so "easily" a few years prior after i got over the HA). 

...i havent done IVF....did clomid over the summer and am now 26 weeks pregnant with twins ; ) (....i dont mess around with siggys)  you are super young, your odds are GREAT. 

varsh06

know that its an old post, yet. Am 32, mother of a DD 5yrs and ttc #2 after an early miscarriage in 2010, recently had my harmone tested, have a day 3 fsh of 8.4 and LH of 1.26. My gyn says its not a problem n i should still try naturally. Just in case that helps...