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What causes low level FSH in blood while on Clomiphene?

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Posted on Wed, 27 Jul 2016
Question: I got a low FSH (0.84) around a year back. LH, Proloactin and Testosterone were in range. My endocrinologist advised that I may take the clomiphene citrate tablet 25mg daily for 3 weeks every month and 1 week off, for next 3 months. I repeated the tests after that. It is still at 0.77. Please advise what to do.
doctor
Answered by Dr. Om Lakhani (36 minutes later)
Brief Answer:
What is the problem that we are treating ?

Detailed Answer:
You have not told us why you consulted the doctor in the first place. From you reports it seems to be that you consulted your doctor for possible infertility.

Here are my opinion about your problem

1. FSH and LH are pituitary hormones are secreted in a pulsatile form. Which means the value may differ depending on which time of the pulse the sample is taken.
2. If you FSH was low and you have no problem , then there is no indication for treatment.
3. The values of FSH and LH are relative. WE DONOT true absolute value. It does not matter in endocrinology if you values are above or below as the reference range if you are Asymptomatic.
4. Giving clomiphine for treatment of infertility is outdated. There are better medications for you problem.

Here is my advice
1. Stop worrying about FSH and LH values.
2. Please let us know the real problem you consulted the doctor in first place.
3. Stop the Clomiphine. It is not indicated.
4. If you have issue of infertility, please share with us the other investigation reports.
5. If infertility is not a problem, then don't worry about low or high FSH and LH.

Regards
Dr. Om J Lakhani, MD
Department of Endocrinology
Sir XXXXXXX XXXXXXX Hospital,
New XXXXXXX
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Om Lakhani (50 minutes later)
You are right that was indeed the reason. To be more precise, I had high DNA fragmentation of around 44%. However, subsequently while researching I was also relating a couple of other things that I was experiencing for last couple of years. They are loss of concentration with occasional heaviness in rear of head and the fact that despite following a rigourous exercise regime under professional supervision, my muscle growth was quite on lower side.
doctor
Answered by Dr. Om Lakhani (19 minutes later)
Brief Answer:
Please see answer below

Detailed Answer:
Yes so basically you had
1. Infertility with high DNA fragmentation
2. poor muscle growth.

Let me address your problems.

1. If you testosterone level is normal then the muscle issue is unlikely to be associated with your FSH.
2. Some endocrinologist do treat infertility issue with clomiphene citrate, however the monitoring of therapy is done with sperm count and testosterone level and not with FSH and LH. clomiphene will cause in an increase of FSH eventually, however that is NOT the goal of treatment.
3. Nowadays there are better options for male infertility than clomiphene citrate. The results for fertility with clomiphene citrate in males is generally poor and hence we use other forms of therapy.
4. Please share with us a recent Semen analysis report , so that I can give you better advice on the fertility issue. Also share the Prolactin and testosterone reports, which will shed more light into the problem.

Regards
Dr. Lakhani.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Om Lakhani (48 minutes later)
I have uploaded a couple of additional reports. Just wanted to bring to your note a couple of things: The loss of concentration and heaviness in head has no link to FSH?? On the infertility side also, there are various medicines like maxoza, carnitor etc and all that I have tried and they increase count, motility etc but don't help on DNA fragmentation side
doctor
Answered by Dr. Om Lakhani (1 hour later)
Brief Answer:
you really donot have any major cause of infertility

Detailed Answer:
I have gone through your reports and here is my opinion

1. "the loss of concentration and heaviness in head has no link to FSH?" - No the loss of concentration and heaviness in your head has absolutely nothing to do with your FSH

2. You semen analysis is more or less normal. You sperm count is not bad. Progressive motility is a bit low but total motility is fine. I wouldn't really worry about the semen analysis

3. DNA fragmentation is controversial, no everyone believes increase DNA fragmentation has significant link with infertility. DNA fragmentation increases with age and at your age of 34, I am not really surprised by your report. As such Clomipihine will certainly not improve your DNA fragmentation. You need to take antioxidants and Conenzyme Q10 on daily basis to reduce DNA fragmentation.

4. Karyotyping and Yq microdeletion ordered by your Endocrinologist are unnecessary as based on your reports, you donot fit the profile of a person who is likely to have disorders associated with karyotype.

5. You testosterone is adequate.

In summary, you really donot have any major cause of infertility. Some couples have unexplained infertility. For infertility management, I would need a more detailed evaluation or both the husband and wife and details of investigations of your wife as well. It is a more complex issues and this would not be the right forum for the same. I would advice you to consult a good infertility specialist in your area for further management of infertility.

In summary, apart from your hypothyroidism, you per se donot suffer from any major endocrine issue at present. I would not advice any further investigations or management on that front. You have got on the wrong tract there. For the infertility, consult an infertility specialist or you can consult me in person as it is a more complex issues.

Regards
Dr. Lakhani.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Om Lakhani

Endocrinologist

Practicing since :2004

Answered : 319 Questions

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What causes low level FSH in blood while on Clomiphene?

Brief Answer: What is the problem that we are treating ? Detailed Answer: You have not told us why you consulted the doctor in the first place. From you reports it seems to be that you consulted your doctor for possible infertility. Here are my opinion about your problem 1. FSH and LH are pituitary hormones are secreted in a pulsatile form. Which means the value may differ depending on which time of the pulse the sample is taken. 2. If you FSH was low and you have no problem , then there is no indication for treatment. 3. The values of FSH and LH are relative. WE DONOT true absolute value. It does not matter in endocrinology if you values are above or below as the reference range if you are Asymptomatic. 4. Giving clomiphine for treatment of infertility is outdated. There are better medications for you problem. Here is my advice 1. Stop worrying about FSH and LH values. 2. Please let us know the real problem you consulted the doctor in first place. 3. Stop the Clomiphine. It is not indicated. 4. If you have issue of infertility, please share with us the other investigation reports. 5. If infertility is not a problem, then don't worry about low or high FSH and LH. Regards Dr. Om J Lakhani, MD Department of Endocrinology Sir XXXXXXX XXXXXXX Hospital, New XXXXXXX