What causes low level FSH in blood while on Clomiphene?
What is the problem that we are treating ?
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 Giving clomiphine for treatment of infertility is outdated.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.
Dr. Om J Lakhani, MD
Department of Endocrinology
Sir XXXXXXX XXXXXXX Hospital,
Please see answer below
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.
you really donot have any major cause of infertility
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.