Follicle-stimulating hormone
Encyclopedia
Follicle-stimulating hormone (FSH) is a hormone
found in humans and other animals. It is synthesized and secreted by gonadotrophs of the anterior pituitary gland. FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH and Luteinizing hormone
(LH) act synergistically in reproduction.
. Each monomeric unit is a protein molecule with a sugar attached to it; two of these make the full, functional protein. Its structure is similar to those of LH
, TSH
, and hCG
. The protein dimer contains 2 polypeptide units, labeled alpha and beta subunits. The alpha subunits of LH, FSH, TSH, and hCG are identical, and contain 92 amino acids. The beta subunits vary. FSH has a beta subunit of 118 amino acids (FSH β), which confers its specific biologic action and is responsible for interaction with the FSH-receptor
. The sugar part of the hormone is composed of fucose
, galactose
, mannose
, galactosamine
, glucosamine
, and sialic acid
, the latter being critical for its biologic half-life
. The half-life of FSH is 3–4 hours.
The 92-amino-acid-long FSH alpha subunit in humans has the following sequence:
NH2 – Ala – Pro – Asp – Val – Gln – Asp – Cys – Pro – Glu – Cys – Thr – Leu – Gln – Glu – Asn – Pro – Phe – Phe – Ser – Gln – Pro – Gly – Ala – Pro – Ile – Leu – Gln – Cys – Met – Gly – Cys – Cys – Phe – Ser – Arg – Ala – Tyr – Pro – Thr – Pro – Leu – Arg – Ser – Lys – Lys – Thr – Met – Leu – Val – Gln – Lys – Asn – Val – Thr – Ser – Glu – Ser – Thr – Cys – Cys – Val – Ala – Lys – Ser – Tyr – Asn – Arg – Val – Thr – Val – Met – Gly – Gly – Phe – Lys – Val – Glu – Asn – His – Thr – Ala – Cys – His – Cys – Ser – Thr – Cys – Tyr – Tyr – His – Lys – Ser – OH
The 118-amino-acid-long FSH beta subunit in humans has the following sequence:
NH2 – Asn – Ser – Cys – Glu – Leu – Thr – Asn – Ile – Thr – Ile – Ala – Ile – Glu – Lys – Glu – Glu – Cys – Arg – Phe – Cys – Ile – Ser – Ile – Asn – Thr – Thr – Trp – Cys – Ala – Gly – Tyr – Cys – Tyr – Thr – Arg – Asp – Leu – Val – Tyr – Lys – Asp – Pro – Ala – Arg – Pro – Lys – Ile – Gln – Lys – Thr – Cys – Thr – Phe – Lys – Glu – Leu – Val – Tyr – Glu – Thr – Val – Arg – Val – Pro – Gly – Cys – Ala – His – His – Ala – Asp – Ser – Leu – Tyr – Thr – Tyr – Pro – Val – Ala – Thr – Gln – Cys – His – Cys – Gly – Lys – Cys – Asp – Ser – Asp – Ser – Thr – Asp – Cys – Thr – Val – Arg – Gly – Leu – Gly – Pro – Ser – Tyr – Cys – Ser – Phe – Gly – Glu – Met – Lys – Glu – OH
Like its partner LH
, FSH release at the pituitary gland is controlled by pulses of gonadotropin-releasing hormone
(GnRH). Those pulses, in turn, are subject to the oestrogen feed-back from the gonads.
s in the ovary
. In early (small) antral follicles, FSH is the major survival factor that rescues the small antral follicles (2-5 mm in diameter for humans) from apoptosis
(programmed death of the somatic cells of the follicle and oocyte). In the luteal-follicle phase transition period the serum levels of progesterone and estrogen (primarily estradiol) decrease and no longer suppress the release of FSH, consequently FSH peaks at about day three (day one is the first day of menstrual flow). The cohort of small antral follicles is normally sufficiently in number to produce enough Inhibin B to lower FSH serum levels.
In addition, there is evidence that gonadotrophin surge-attenuating factor produced by small follicles during the first half of the follicle phase also exerts a negative feedback on pulsatile luteinizing hormone (LH) secretion amplitude, thus allowing a more favorable environment for follicle growth and preventing premature luteinization.
(As a woman nears perimenopause, the number of small antral follicles recruited in each cycle diminishes and consequently insufficient Inhibin B is produced to fully lower FSH and the serum level of FSH begins to rise. Eventually the FSH level becomes so high that down regulation of FSH receptors occurs and by menopause any remaining small secondary follicles no longer have FSH receptors.)
When the follicle matures and reaches 8–10 mm in diameter it starts to secrete significant amounts of estradiol
. Normally in humans only one follicle becomes dominant and survives to grow to 18–30 mm in size and ovulate, the remaining follicles in the cohort undergo atresia. The sharp increase in estradiol production by the dominant follicle (possibly along with a decrease in gonadotrophin surge-attenuating factor) cause a positive effect on the hypothalamus and pituitary and rapid GnRH pulses occur and an LH surge results.
The increase in serum estradiol
levels cause a decrease in FSH production by inhibiting GnRH production in the hypothalamus.
The decrease in serum FSH level causes the smaller follicles in the current cohort to undergo atresia as they lack sufficient sensitivity to FSH to survive. Occasionally two follicles reach the 10 mm stage at the same time by chance and as both are equally sensitive to FSH both survive and grow in the low FSH environment and thus two ovulations can occur in one cycle possibly leading to non identical (dizygotic) twins.
FSH enhances the production of androgen-binding protein by the Sertoli cell
s of the testes by binding to FSH receptors on their basolateral membranes, and is critical for the initiation of spermatogenesis
.
of the menstrual cycle, typically day three to five, counted from last menstruation. At this time, the levels of estradiol (E2) and progesterone are at the lowest point of the menstrual cycle
. FSH levels in this time is often called basal FSH levels, to distinguish from the increased levels when approaching ovulation.
and, in females, high after menopause
.
. High levels of Follicle-Stimulating Hormone indicate that the normal restricting feedback from the gonad is absent, leading to an unrestricted pituitary FSH production.
If high FSH levels occur during the reproductive years, it is abnormal. Conditions with high FSH levels include:
Most of these conditions are associated with subfertility and/or infertility. Therefore high FSH levels are an indication of subfertility and/or infertility.
Conditions with very low FSH secretions are:
including more purified forms of urinary gonadotropins such as Menopur, as well as without LH activity as recombinant FSH (Gonal F, Follistim, Follitropin alpha). It is used commonly in infertility therapy to stimulate follicular development, notably in IVF therapy, as well as with interuterine insemination (IUI). (See Gonadotropin Preparations
.)
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
found in humans and other animals. It is synthesized and secreted by gonadotrophs of the anterior pituitary gland. FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH and Luteinizing hormone
Luteinizing hormone
Luteinizing hormone is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone , it stimulates Leydig cell...
(LH) act synergistically in reproduction.
Structure
FSH is a glycoproteinGlycoprotein
Glycoproteins are proteins that contain oligosaccharide chains covalently attached to polypeptide side-chains. The carbohydrate is attached to the protein in a cotranslational or posttranslational modification. This process is known as glycosylation. In proteins that have segments extending...
. Each monomeric unit is a protein molecule with a sugar attached to it; two of these make the full, functional protein. Its structure is similar to those of LH
Luteinizing hormone
Luteinizing hormone is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone , it stimulates Leydig cell...
, TSH
Thyroid-stimulating hormone
Thyrotrophin-stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland, which regulates the endocrine function of the thyroid gland.- Physiology :...
, and hCG
Human chorionic gonadotropin
Human chorionic gonadotropin or human chorionic gonadotrophin is a glycoprotein hormone produced during pregnancy that is made by the developing embryo after conception and later by the syncytiotrophoblast .. Some tumors make this hormone; measured elevated levels when the patient is not...
. The protein dimer contains 2 polypeptide units, labeled alpha and beta subunits. The alpha subunits of LH, FSH, TSH, and hCG are identical, and contain 92 amino acids. The beta subunits vary. FSH has a beta subunit of 118 amino acids (FSH β), which confers its specific biologic action and is responsible for interaction with the FSH-receptor
FSH-receptor
The follicle-stimulating hormone receptor or FSH-receptor is a transmembrane receptor that interacts with the follicle-stimulating hormone and represents a G protein-coupled receptor . Its activation is necessary for the hormonal functioning of FSH...
. The sugar part of the hormone is composed of fucose
Fucose
Fucose is a hexose deoxy sugar with the chemical formula C6H12O5. It is found on N-linked glycans on the mammalian, insect and plant cell surface, and is the fundamental sub-unit of the fucoidan polysaccharide...
, galactose
Galactose
Galactose , sometimes abbreviated Gal, is a type of sugar that is less sweet than glucose. It is a C-4 epimer of glucose....
, mannose
Mannose
Mannose is a sugar monomer of the aldohexose series of carbohydrates. Mannose is a C-2 epimer of glucose. It is not part of human metabolism, but is a component of microbial cell walls, and is therefore a target of the immune system and also of antibiotics....
, galactosamine
Galactosamine
Galactosamine is a hexosamine derived from galactose with the molecular formula C6H13NO5. This amino sugar is a constituent of some glycoprotein hormones such as follicle-stimulating hormone and luteinizing hormone...
, glucosamine
Glucosamine
Glucosamine is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. Glucosamine is part of the structure of the polysaccharides chitosan and chitin, which compose the exoskeletons of crustaceans and other arthropods, cell walls in fungi and...
, and sialic acid
Sialic acid
Sialic acid is a generic term for the N- or O-substituted derivatives of neuraminic acid, a monosaccharide with a nine-carbon backbone. It is also the name for the most common member of this group, N-acetylneuraminic acid...
, the latter being critical for its biologic half-life
Half-life
Half-life, abbreviated t½, is the period of time it takes for the amount of a substance undergoing decay to decrease by half. The name was originally used to describe a characteristic of unstable atoms , but it may apply to any quantity which follows a set-rate decay.The original term, dating to...
. The half-life of FSH is 3–4 hours.
The 92-amino-acid-long FSH alpha subunit in humans has the following sequence:
NH2 – Ala – Pro – Asp – Val – Gln – Asp – Cys – Pro – Glu – Cys – Thr – Leu – Gln – Glu – Asn – Pro – Phe – Phe – Ser – Gln – Pro – Gly – Ala – Pro – Ile – Leu – Gln – Cys – Met – Gly – Cys – Cys – Phe – Ser – Arg – Ala – Tyr – Pro – Thr – Pro – Leu – Arg – Ser – Lys – Lys – Thr – Met – Leu – Val – Gln – Lys – Asn – Val – Thr – Ser – Glu – Ser – Thr – Cys – Cys – Val – Ala – Lys – Ser – Tyr – Asn – Arg – Val – Thr – Val – Met – Gly – Gly – Phe – Lys – Val – Glu – Asn – His – Thr – Ala – Cys – His – Cys – Ser – Thr – Cys – Tyr – Tyr – His – Lys – Ser – OH
- Note: The carbohydrate moiety is linked to the asparagine at positions 52 and 78.
The 118-amino-acid-long FSH beta subunit in humans has the following sequence:
NH2 – Asn – Ser – Cys – Glu – Leu – Thr – Asn – Ile – Thr – Ile – Ala – Ile – Glu – Lys – Glu – Glu – Cys – Arg – Phe – Cys – Ile – Ser – Ile – Asn – Thr – Thr – Trp – Cys – Ala – Gly – Tyr – Cys – Tyr – Thr – Arg – Asp – Leu – Val – Tyr – Lys – Asp – Pro – Ala – Arg – Pro – Lys – Ile – Gln – Lys – Thr – Cys – Thr – Phe – Lys – Glu – Leu – Val – Tyr – Glu – Thr – Val – Arg – Val – Pro – Gly – Cys – Ala – His – His – Ala – Asp – Ser – Leu – Tyr – Thr – Tyr – Pro – Val – Ala – Thr – Gln – Cys – His – Cys – Gly – Lys – Cys – Asp – Ser – Asp – Ser – Thr – Asp – Cys – Thr – Val – Arg – Gly – Leu – Gly – Pro – Ser – Tyr – Cys – Ser – Phe – Gly – Glu – Met – Lys – Glu – OH
- Note: The carbohydrate moiety is linked to the asparagine at positions 7 and 24.
Genes
The gene for the alpha subunit is located on chromosome 6p21.1-23. It is expressed in different cell types. The gene for the FSH beta subunit is located on chromosome 11p13, and is expressed in gonadotropes of the pituitary cells, controlled by GnRH, inhibited by inhibin, and enhanced by activin.Activity
FSH regulates the development, growth, pubertal maturation, and reproductive processes of the human body.- In both males and females, FSH stimulates the maturation of germ cells.
- In males, FSH induces Sertoli cells to secrete inhibin and stimulates the formation of sertoli-sertoli tight junctions (zonula occludens).
- In females, FSH initiates follicular growth, specifically affecting granulosa cells. With the concomitant rise in inhibin B, FSH levels then decline in the late follicular phase. This seems to be critical in selecting only the most advanced follicle to proceed to ovulation. At the end of the luteal phase, there is a slight rise in FSH that seems to be of importance to start the next ovulatory cycle.
Like its partner LH
Luteinizing hormone
Luteinizing hormone is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone , it stimulates Leydig cell...
, FSH release at the pituitary gland is controlled by pulses of gonadotropin-releasing hormone
Gonadotropin-releasing hormone
Gonadotropin-releasing hormone , also known as Luteinizing-hormone-releasing hormone and luliberin, is a tropic peptide hormone responsible for the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. GnRH is synthesized and released from neurons within...
(GnRH). Those pulses, in turn, are subject to the oestrogen feed-back from the gonads.
Effects in females
FSH stimulates the growth and recruitment of immature ovarian follicleOvarian follicle
Ovarian follicles are the basic units of female reproductive biology, each of which is composed of roughly spherical aggregations of cells found in the ovary. They contain a single oocyte . These structures are periodically initiated to grow and develop, culminating in ovulation of usually a single...
s in the ovary
Ovary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
. In early (small) antral follicles, FSH is the major survival factor that rescues the small antral follicles (2-5 mm in diameter for humans) from apoptosis
Apoptosis
Apoptosis is the process of programmed cell death that may occur in multicellular organisms. Biochemical events lead to characteristic cell changes and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation...
(programmed death of the somatic cells of the follicle and oocyte). In the luteal-follicle phase transition period the serum levels of progesterone and estrogen (primarily estradiol) decrease and no longer suppress the release of FSH, consequently FSH peaks at about day three (day one is the first day of menstrual flow). The cohort of small antral follicles is normally sufficiently in number to produce enough Inhibin B to lower FSH serum levels.
In addition, there is evidence that gonadotrophin surge-attenuating factor produced by small follicles during the first half of the follicle phase also exerts a negative feedback on pulsatile luteinizing hormone (LH) secretion amplitude, thus allowing a more favorable environment for follicle growth and preventing premature luteinization.
(As a woman nears perimenopause, the number of small antral follicles recruited in each cycle diminishes and consequently insufficient Inhibin B is produced to fully lower FSH and the serum level of FSH begins to rise. Eventually the FSH level becomes so high that down regulation of FSH receptors occurs and by menopause any remaining small secondary follicles no longer have FSH receptors.)
When the follicle matures and reaches 8–10 mm in diameter it starts to secrete significant amounts of estradiol
Estradiol
Estradiol is a sex hormone. Estradiol is abbreviated E2 as it has 2 hydroxyl groups in its molecular structure. Estrone has 1 and estriol has 3 . Estradiol is about 10 times as potent as estrone and about 80 times as potent as estriol in its estrogenic effect...
. Normally in humans only one follicle becomes dominant and survives to grow to 18–30 mm in size and ovulate, the remaining follicles in the cohort undergo atresia. The sharp increase in estradiol production by the dominant follicle (possibly along with a decrease in gonadotrophin surge-attenuating factor) cause a positive effect on the hypothalamus and pituitary and rapid GnRH pulses occur and an LH surge results.
The increase in serum estradiol
Estradiol
Estradiol is a sex hormone. Estradiol is abbreviated E2 as it has 2 hydroxyl groups in its molecular structure. Estrone has 1 and estriol has 3 . Estradiol is about 10 times as potent as estrone and about 80 times as potent as estriol in its estrogenic effect...
levels cause a decrease in FSH production by inhibiting GnRH production in the hypothalamus.
The decrease in serum FSH level causes the smaller follicles in the current cohort to undergo atresia as they lack sufficient sensitivity to FSH to survive. Occasionally two follicles reach the 10 mm stage at the same time by chance and as both are equally sensitive to FSH both survive and grow in the low FSH environment and thus two ovulations can occur in one cycle possibly leading to non identical (dizygotic) twins.
Effects in males
FSH stimulates primary spermatocytes to undergo the first division of meiosis, to form secondary spermatocytes.FSH enhances the production of androgen-binding protein by the Sertoli cell
Sertoli cell
A Sertoli cell is a 'nurse' cell of the testes that is part of a seminiferous tubule.It is activated by follicle-stimulating hormone and has FSH-receptor on its membranes.-Functions:...
s of the testes by binding to FSH receptors on their basolateral membranes, and is critical for the initiation of spermatogenesis
Spermatogenesis
Spermatogenesis is the process by which male primary germ cells undergo division, and produce a number of cells termed spermatogonia, from which the primary spermatocytes are derived. Each primary spermatocyte divides into two secondary spermatocytes, and each secondary spermatocyte into two...
.
Measurement
Follicle stimulating hormone is typically measured in the early follicular phaseFollicular phase
The follicular phase is the phase of the estrous cycle, during which follicles in the ovary mature. It ends with ovulation. The main hormone controlling this stage is estradiol....
of the menstrual cycle, typically day three to five, counted from last menstruation. At this time, the levels of estradiol (E2) and progesterone are at the lowest point of the menstrual cycle
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
. FSH levels in this time is often called basal FSH levels, to distinguish from the increased levels when approaching ovulation.
Disease states
FSH levels are normally low during childhoodChildhood
Childhood is the age span ranging from birth to adolescence. In developmental psychology, childhood is divided up into the developmental stages of toddlerhood , early childhood , middle childhood , and adolescence .- Age ranges of childhood :The term childhood is non-specific and can imply a...
and, in females, high after menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
.
High FSH levels
The most common reason for high serum FSH concentration is in a female who is undergoing or has recently undergone menopauseMenopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
. High levels of Follicle-Stimulating Hormone indicate that the normal restricting feedback from the gonad is absent, leading to an unrestricted pituitary FSH production.
If high FSH levels occur during the reproductive years, it is abnormal. Conditions with high FSH levels include:
- Premature menopause also known as Premature Ovarian Failure
- Poor ovarian reservePoor ovarian reservePoor ovarian reserve is a condition of low fertility characterized by 1): low numbers of remaining oocytes in the ovaries or 2) possibly impaired preantral oocyte development or recruitment...
also known as Premature Ovarian Aging - Gonadal dysgenesisGonadal dysgenesisGonadal dysgenesis is a term used to describe multiple reproductive system development disorders. They are conditions of genetic origin. It is characterized by a progressive loss of primordial germ cells on the developing gonads of an embryo....
, Turner syndromeTurner syndromeTurner syndrome or Ullrich-Turner syndrome encompasses several conditions in human females, of which monosomy X is most common. It is a chromosomal abnormality in which all or part of one of the sex chromosomes is absent... - CastrationCastrationCastration is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testicles or a female loses the functions of the ovaries.-Humans:...
- Swyer syndromeSwyer syndromeSwyer syndrome, or XY gonadal dysgenesis, is a type of hypogonadism in a person whose karyotype is 46,XY. The person is externally female with streak gonads, and left untreated, will not experience puberty...
- Certain forms of CAHCongenital adrenal hyperplasiaCongenital adrenal hyperplasia refers to any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands ....
- Testicular failure.
Most of these conditions are associated with subfertility and/or infertility. Therefore high FSH levels are an indication of subfertility and/or infertility.
Low FSH levels
Diminished secretion of FSH can result in failure of gonadal function (hypogonadism). This condition is typically manifested in males as failure in production of normal numbers of sperm. In females, cessation of reproductive cycles is commonly observed.Conditions with very low FSH secretions are:
- Polycystic Ovarian Syndrome
- Polycystic Ovarian Syndrome + Obesity + Hirsutism + Infertility
- Kallmann syndromeKallmann syndromeKallmann syndrome is a genetic disorder marked by anosmia and hypogonadism - the decreased functioning of the glands that produce sex hormones. Abnormalities in various genes may cause a defect in the hypothalamus, causing a deficiency of gonadotropin-releasing hormone ; this in turn causes...
- Hypothalamic suppression
- HypopituitarismHypopituitarismHypopituitarism is the decreased secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain...
- Hyperprolactinemia
- Gonadotropin deficiency
- Gonadal suppression therapy
- GnRH antagonist
- GnRH agonist (downregulation).
Availability
FSH is available mixed with LH activity in various menotropinsMenotropins
Menotropin is an active substance for the treatment of fertility disturbances. It consists of gonadotropins that are extracted from the urine of postmenopausal women, usually luteinizing hormone and follicle-stimulating hormone...
including more purified forms of urinary gonadotropins such as Menopur, as well as without LH activity as recombinant FSH (Gonal F, Follistim, Follitropin alpha). It is used commonly in infertility therapy to stimulate follicular development, notably in IVF therapy, as well as with interuterine insemination (IUI). (See Gonadotropin Preparations
Gonadotropin preparations
Gonadotropin preparations are drugs that mimic the physiological effects of gonadotropins, used therapeutically mainly as fertility medication. For example, the so called menotropins consist of LH and FSH extracted from human urine from menopausal women...
.)
Potential role in vascularization of solid tumors
Elevated FSH receptor levels have been detected in the endothelia of tumor vasculature in a very wide range of solid tumors. FSH binding is thought to upregulate neovascularization via at least two mechanisms - one in the VEGF pathway, and the other VEGF independent - related to the development of umbilical vasculature when physiological. This presents possible use of FSH and FSH-receptor antagonists as an anti tumor angiogenesis therapy (cf. avastin for current anti-VEGF approaches).External links
- Day 3 FSH levels From the Infertility Blog by Dr. Fred Licciardi
- High FSH: an excuse to send patients away From the Infertility Blog by Dr. Fred Licciardi
- FSH and Estradiol
- Causes & Symptoms of High FSH
- Information on high FSH compiled by a woman with high FSH
- High FSH Levels background information
- Getting Pregnant with High FSH by Julia Indichova, author of Inconceivable (Doubleday 2001) and The Fertile Female (Adell Press 2007)