The clomiphene challenge test permits an assessment of the “ovarian reserve” or fertility capacity of a woman. Sadly, all women lose fertility potential over time and ultimately all women become sterile. The CCT is the most sensitive test available to estimate a woman’s ability to produce eggs of good quality. In all women an abnormal CCT predicts poor egg quality but in younger women the FSH level can be higher before we see a decrease in pregnancy rates.

The CCT involves measuring FSH (follicle stimulating hormone) and estrogen early in the menstrual cycle, usually cycle day 3. Then, 100 mg of clomiphene citrate is taken from cycle day 5 through 9 followed by another FSH level on cycle day 10. FSH tends to rise as the quantity and quality of oocytes within the ovary falls. An elevated FSH level (over 11 mIU/mL) on either CD 3 or CD 10 accurately predicts reduced ovarian reserve. For any FSH level, the decrease in ovarian reserve depends on the age of the woman. Additionally, because FSH levels can fluctuate significantly from cycle to cycle, the highest FSH level is used to predict ovarian reserve.

At NCRS, we recommend a CCT for all patients undergoing assisted reproductive techniques (“ART”) or ovulation stimulation with repeat testing at least yearly. We recheck CD 3 FSH levels with each treatment cycle. We find that this helps us to determine the best dose of medication for stimulation.