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 (FSH). 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 menopause. However, diminished reserve can occur in younger women due to perimenopause, genetics or for unknown reasons.
Measuring Ovarian Reserve
In the standard infertility evaluation, levels of the hormones FSH, luteinizing hormone (LH) and estradiol are measured on day 3. An elevated FSH level on day 3 is one indication of poor ovarian reserve or that menopause is approaching. Learn more about female hormone evaluations.
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.
You take 100 mg of Clomid on cycle days 5-9, and your 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, regardless of your age, indicates that there 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.