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Fertility

Clomid Challenge Test

Egg quality can be evaluated by a test called a clomiphene citrate-Clomid challenge test (ccct) (The brand name for clomiphene is Clomid; the terms are often usedinterchangeably). The Clomid challenge test is designed to see how efficiently the ovaries are working. A healthy ovary will only require a small level of follicle stimulating hormone (FSH) to produce an egg; whereas, if the ovary is not functioning as well, it will require substantially higher levels of FSH to produce an egg. High levels
of FSH are usually a negative indicator of fertility; however, a normal FSH doesn’t guarantee egg quality. In essence, an elevated FSH is a poor indicator while a normal FSH is neutral.

The following analogy is sometimes used to explain a Clomid challenge test: A person sitting comfortably in a chair should have a low “resting” heart rate. If she were to run around a track a few times, her heart rate would increase as the body adjusts to the increased need for oxygen. If our runner is healthy, when she stops running her heart rate should return to the low resting level relatively quickly. If she is out of shape, she will be struggling to catch her breath and her heart will be
beating rapidly for an extended period of time after she stops running.

The Clomid challenge test illustrates roughly the same principle: We should begin with a low “resting” FSH level on day 3. Next, 100 mg of Clomid is taken from days 5-9 of the menstrual cycle. This is the phase of the test that is similar to our runner circling the track, as the Clomid is causing the ovaries to work harder than they normally would. After taking the last dose of Clomid, the FSH level should return to a normal level by the next day – menstrual cycle day 10. If the ovaries are not functioning normally, the FSH level will still be elevated by the time we draw the blood on day 10. So just as with the example of the runner, the optimum result is a low level before the body is asked to perform at a higher level, and it should resume to a low level very soon after stopping the stressful activity. An important distinction in this analogy is that the runner can get her heart muscle into shape after a
period of training; however, the ovaries do not respond to conditioning, and there is no medicine that will make them function at a healthy level once the FSH has increased beyond the normal level. We prefer both the day 3 and the day 10 FSH levels to be below 10.

The test consists of three parts:

  1. Blood draw on day 3 of menstrual cycle. (FSH level is measured).
  2. Take 100mg of clomiphene citrate in the morning during cycle days 5-9.
  3. Blood draw on day 10. (FSH level is repeated).

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