Clomiphene Citrate Challenge Test

Women are born with their lifetime supply of eggs within the ovaries.  Each month follicles, each of which contains one egg, are recruited under the influence of follicle stimulating hormone. One follicle will become dominant, develop to maturity, and be ovulated.

Ovarian reserve is a measure of the “quality” of the eggs remaining within the ovaries. Ovarian reserve naturally declines as a woman ages and approaches the menopause. However, diminished reserve can occur in younger women due to perimenopause, genetics, or for unknown reasons.

In the standard infertility evaluation, levels of the hormones FSH, LH, and estradiol are measured on day 3. An elevated FSH level on day 3 is one indication of poor ovarian reserve or that the menopause is approaching.

The clomiphene citrate challenge test (CCCT) provides an additional assessment of ovarian reserve. It is performed by measuring the day 3 FSH and estradiol levels, the patient takes 100 mg of Clomid on cycle days 5-9, and her FSH is measured again on day 10.  The test is abnormal if either the day 3 or day 10 FSH values are elevated or if the day 3 estradiol is greater than 80 pg/ml.

A poor CCCT test, regardless of patient age, indicates that their will be a decreased response to injectable FSH in assisted reproductive technology cycles. Pregnancy success rates are very low in these women and there is an increased chance of miscarriage.

Many infertility treatment centers do not offer IVF to women who have a poor clomiphene citrate challenge test result.  IVF using donor eggs or adoption are usually the best options for these couples.