At a Glance
Why Get Tested?
To evaluate your pituitary function, especially as it relates to fertility issues, gonadal failure, maturation concerns, or pituitary tumors
When to Get Tested?
When you are having difficulty getting pregnant or are having irregular menstrual periods; when your doctor thinks that you have symptoms of pituitary or hypothalamic disorders or symptoms of ovarian or testicular disease; or when a doctor suspects that a child has delayed or earlier than expected sexual maturation
Test Preparation Needed?
The Test Sample
What is being tested?
Follicle-stimulating hormone (FSH) is made by the pituitary gland in the brain. Control of FSH production is a complex system involving hormones produced by the gonads (ovaries or testes), the pituitary, and the hypothalamus.
In women, FSH stimulates the growth and maturation of eggs (follicles) in the ovaries during the follicular phase of the menstrual cycle. The menstrual cycle is divided into the follicular and the luteal phases, characterized by a mid-cycle surge of FSH and luteinizing hormone (LH). Ovulation occurs shortly after this mid-cycle surge of hormones. During the follicular phase, FSH initiates the production of estradiol by the follicle, and the two hormones work together in the further development of the egg follicle. During the luteal phase, FSH stimulates the production of progesterone. Both estradiol and progesterone help the pituitary control the amount of FSH produced. FSH also facilitates the ability of the ovary to respond to LH. At the time of menopause, the ovaries stop functioning and FSH levels rise. In men, FSH stimulates the testes to produce mature sperm and also promotes the production of androgen binding proteins. FSH levels are relatively constant in males after puberty.
In infants and children, FSH levels rise shortly after birth and then fall to very low levels by 6 months in boys and 1-2 years in girls. Concentrations begin to rise again before the beginning of puberty and the development of secondary sexual characteristics.
How is the sample collected for testing?
A blood sample is drawn by needle from a vein in the arm. Sometimes, a random urine sample is collected but, due to the cyclic secretion of FSH, a 24-hour collection of urine may be requested. By measuring FSH levels produced over a 24-hour period, the variation in FSH levels seen through out the day can be minimized.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is required, but a woman's sample should be collected at specific times during her menstrual cycle.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 629-631.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 412-416.
Storck, S. (Updated 2009 September 2). FSH. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003710.htm. Accessed February 2010.
Jabbour, S. (Updated 2009 June 15). Follicle-Stimulating Hormone Abnormalities. eMedicine [On-line information]. Available online at http://emedicine.medscape.com/article/118810-overview through http://emedicine.medscape.com. Accessed February 2010.
Meikle, A. W. et. al. (Updated 2009 November). Amenorrhea. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/Amenorrhea.html# through http://www.arupconsult.com. Accessed February 2010.
Brzyski, R. and Jensen, J. (Revised 2007 March) Female Reproductive Endocrinology, Introduction. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec18/ch243/ch243a.html?qt=FSH&alt=sh through http://www.merck.com. Accessed February 2010.
MayoClinic.com: Menopause. Available online at http://www.mayoclinic.com/health/menopause/DS00119 through http://www.mayoclinic.com. Accessed February 2010.
National Institute on Aging: Menopause. Available online at http://www.nia.nih.gov/HealthInformation/Publications/menopause.htm through http://www.nia.nih.gov. Accessed February 2010.
MedlinePlus Health Topics: Female Reproductive System. Available online at http://www.nlm.nih.gov/medlineplus/femalereproductivesystem.html through http://www.nlm.nih.gov. Accessed February 2010.
Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 360-361.
Helzisouer KJ, Alberg AJ, Gordon GB, et al. Serum gonadotropins and steroid hormones and the development of ovarian cancer. JAMA 274(24):1926-1930, 1995.
Backer LC, Rubin CS, Kieszak SM, et al. Serum follicle stimulating hormone and national health and nutrition examination survey (NANES III, 1988-1994). Menopause 6(1):29-35, 1999.
Sources Used in Previous Reviews
Corbett, JV. Laboratory Tests & Diagnostic Procedures with Nursing Diagnoses, 4th ed. Stamford, Conn.: Appleton & Lang, 1996. Pp 429-431, 726.
Clinical Guide to Laboratory Tests. 3rd ed. Tietz N, ed. Philadelphia: W.B. Saunders & Co; 1995: 248-249, 210-211.
The InterNational Council on Infertility Information Dissemination, PCOS in Pediatrics: When and How Does it Start? Originally written and presented by Silva Arslanian, MD, Children's Hospital of Pittsburgh, Pittsburgh, PA; summarized in online version by Christine M. Schroeder, PhD. Available online at http://www.inciid.org/pcos/PCOS-pediatrics.html through http://www.inciid.org.
Gonadotropins: Luteinizing and Follicle Stimulating Hormones. Available online at http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/hypopit/lhfsh.html through http://arbl.cvmbs.colostate.edu.
Blondell RD, Foster MB, Kamlesh CD. Disorders of Puberty. American Family Physician, July 1999 (online publication). Available online at http://www.aafp.org/afp/990700ap/209.html through http://www.aafp.org.
Hormone Society. Fact Sheet on Female Infertility. Available online at http://www.endo-society.org/pubrelations/patientInfo/infertility.htm through http://www.endo-society.org.
The Hormone Foundation. Fact sheet on Polycystic Ovary Syndrome (PCOS). Available online at http://www.hormone.org/pcos_factsheet.html through http://www.hormone.org.
Laurence M. Demers, PhD. Distinguished Professor of Pathology and Medicine, The Pennsylvania State University College of Medicine, The M. S. Hershey Medical Center, Hershey, PA.
A Manual of Laboratory & Diagnostic Tests. 6th ed. Fischbach F, ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby; 1998.
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Thompason, Sharon. LH response to GnRH. (Updated Aug 2005) MedlinePlus (online information). Available at http://www.nlm.nih.gov/medlineplus/print/ency/article/003709.htm.
Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL (July 1995). Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatric 127(1):47-52 from PubMed. Available online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=7608810 through http://www.ncbi.nlm.nih.gov.
Nirupama Kakarla, M.D.; Karen D. Bradshaw, M.D. (Posted 03/05/2004.) Disorders of Pubertal Development: Precocious Puberty. From Seminars in Reproductive Medicine 21(4):339-351 from Medscape. Available online at http://www.medscape.com/viewarticle/468259 through http://www.medscape.com.
Brito VN, Batista MC, Borges MF, Latronico AC, Kohek MB, Thirone AC, Jorge BH, Arnhold IJ, Mendonca BB. (1999 Oct) Diagnostic value of fluorometric assays in the evaluation of precocious puberty. J Clin Endocrinol Metab. 84(10):3539-44. Available online through http://www.ncbi.nlm.nih.gov.
Sheehan, M (Dec 2003). Polycystic Ovarian Syndrome: Diagnosis and Management. Clinical Medicine and Research, 2(1): 13-27. Available online at http://www.pubmedcentral.gov/articlerender.fcgi?artid+1069067 through http://www.pubmedcentral.gov.