Clomid Challenge Fertility Test (CCCT)

Assessing Ovarian Reserve

The day 3 hormone fertility tests are a cornerstone of the fertility evaluation. An elevated FSH level on day three can indicate reduced ovarian reserve or ovarian failure depending upon the FSH level. It is the blood stream marker that has the most data to substantiate its usefulness.

The Clomid challenge test is sometimes ordered to further evaluate ovarian reserve and predict the likelihood of success of ovarian stimulation with FSH for in vitro fertilization. Clomid, often prescribed to stimulate or regulate ovulation, is used in the Clomid challenge fertility test. It can also be used in other groups of women, particularly in those 35 and older.

Follicle stimulating hormone (FSH) is produced by the pituitary gland and stimulates egg recruitment and development within the ovarian follicles. As healthy follicles mature, they produce increasing amounts of estrogen and estrogen levels in the blood rise and are monitored by the hypothalamus, which “regulates” hormone production by the pituitary gland.

Medical research studies have shown that fertility is quite low if FSH or estrogen hormone levels are elevated significantly (FSH >12) early in the cycle (day 2, 3, or 4). The Clomid challenge fertility test provides more information about ovarian reserve by measuring the FSH level after the administration of Clomid.

If FSH is elevated on cycle day 10 or 11, after Clomid administration, it is another indicator of reduced ovarian reserve and fertility treatment outcomes using FSH are poor. Patients over 34 years of age failing the Clomid challenge fertility test have a very low chance for successful pregnancy with in vitro fertilization. In fact, the Clomid challenge fertility test was developed as a means to predict patients’ probable response to FSH medications. It is less well established whether patients who fail the Clomid challenge fertility test have reduced fertility related to all forms of treatment, however, it is likely.

Clomid Challenge Fertility Test- Administration

  • Fertility tests are performed to measure the levels of FSH and estradiol on cycle days 2,3, or 4
  • Clomid, 50mg tablets, 2 daily, are taken on cycle days 5 through 9
  • The FSH level is measured again on cycle day 10 or 11

Clomid challenge fertility test results are available the following day and patients may call the office to obtain their results. Each lab must validate their FSH values to correspond with pregnancy rates. In our lab the Clomid challenge test is abnormal if on cycle day 2, 3, or 4  the FSH level is higher than 11 and the estradiol is higher than 75 and on cycle day 10 or 11 the FSH level is higher than 13.