# FSH and drugs



## PinkPeacock (Nov 9, 2006)

Hi,

I'm afraid I've been posting about this pretty much everywhere but everytime I post someone suggests posting elsewhere    So, I'm asking here too.

My day three FSH had to be taken on day 5, and came back as 14.2. I'm 25 so was gutted that it was so high. I've been doing some research and found quite a few journal articles and unrefferenced web sites saying that certain drugs can affect fertility and specificall ovulation. I'm wondering if any of the drugs I'm on would have affected the FSH level?

I'm taking
Mefanamic acid
Tramadol
Codeine
Paracetamol
Amitriptylene (50g) for pain releif

I'm particuarly concerned about the mef acid and the amitriptylene as they keep cropping up with the phrase "may reduce ovulation". I'm going to stop taking these but would really appreciate your opinions? Is there any chance that the meds would have upped my FSH level, and if so, is the damage reversable?  Will coming off it now (day 10 ofmy cycle) affect my chances of having a lower FSH on my next day 3 test? We're hoping it will come back lower as the clinic have said we can go ahead with my next period so long as the FSH is about the same or lower.  

Thanks for taking time to read. 

Love
Carys
xxx


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## mazv (Jul 31, 2006)

Hi pinkcarys,

Will do my best to answer what I can but I probably have more questions for you to be honest 

FSH levels fluctuate during the menstrual cycle and start to rise at the beginning of the cycle peaking by day 7. A day 5 level is a bit late in the cycle to be measuring. Did your oestrogen levels get taken too and if so what was the result? A single FSH reading isn't really too much to worry about and you really need to know the oestrogen levels in order to interpret them correctly. The levels certainly aren't high enough to indicate any serious worries about ovarian reserve at your age. Younger women can sometimes have higher FSH levels than expected but have no problems with conception. Chances are if you have a day 3 sample next cycle it'll be perfectly fine (<10) If your clinic aren't worried then you shouldn't be either.

There is no evidence that any of the drugs mentioned affect FSH levels (the only drugs that do affect gonadotrophin levels directly are endocrine/fertility drugs and that is an intentional effect)

There is no direct evidence that proves either mefenamic acid or amitriptyline interfere with fertility and/or ovulation.

There are some recent papers suggesting that NSAIDs (the class of drugs mefenamic acid belongs to) are linked to a particular condition where ovulation is delayed for a day or two after the LH surge that is usually associated with egg release from the follicle. This has been shown in both rats and humans however the controlled trials involving women have been VERY small and the numbers aren't big enough to prove a link that could be extrapolated to the population as a whole. Basically think about how many women take, aspirin, ibuprofen, mef acid etc.. every day (millions) and how many of those get pregnant (likely to be the majority that try to). These small studies have shown the effects of NSAIDs to be reversible so they don't permanently affect ovulation.

Amitriptyline has a very rare side effect of causing an increase in prolactin levels (hyperprolactinaemia) and in extreme cases could possibly cause periods and ovulation to stop. I've never come across this in practice and I can find no actual reports of this in the literature or in the national adverse effects reporting system. Your prolactin levels should have been checked already at some point during your clinic assessments and if this had been high it would have been investigated.

I would strongly advise you *do not* stop any of your drugs without speaking to your prescriber first. I'm assuming you are prescribed these for dysmenorrhea? Do not stop amitryptyline abruptly as it is commonly associated with quite nasty withdrawal side effects, even though you are taking a low dose for pain relief it is possible to get symptoms so you must speak to your doctor about this before deciding to stop.

Hope the above all makes sense and answers your questions. Bottom line is there is no substantial evidence that any of the drugs you are on affect your fertility. If there was then these drugs would not be used in everyday practice in women.

Hope all goes well for you next month and you can go ahead with treatment 
Best wishes
Maz x


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## PinkPeacock (Nov 9, 2006)

Hi,

Thanks so much for your reply. Its very reassuring to hear your not overly worried and I might even get a lower reading next time. Thanks for the info on the drugs. Although its a bit dissapointing that I can't just blame the drugs, its reassuring to know they aren't doing me too much damage.

Thanks so much!

Carys
xxx


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## mazv (Jul 31, 2006)

Hi Carys,

I know it's hard not to worry about everything you do when you're trying so hard to get pregnant   Hope that next tests show better levels   Know what you mean about blaming the drugs as sometimes it can feel better being able to find a cause for problems (I'm unexplained infertility and it still makes me   that there's no reason we can find why I can't get pregnant naturally   )

Have you chatted with your clinic about your current meds to see what they say about it? All the best for treatment  
Maz x


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## PinkPeacock (Nov 9, 2006)

I did ask them when we had our appointment and she just brushed over it so I wasn't overly confident in her answer. They've been very good in all other aspects though. I do worry that all these drugs can't be good for me!

Thanks so much for the advice. It must be very frustrating to not havce any answers. At least I know why I can't get pg. 
xxx


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