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The Clomid (clomiphene
citrate ) Challenge Test
The clomiphene citrate (Clomid)
challenge test (CCCT) is a sensitive means to measure
ovarian
reserve and is often conducted if the FSH level
is 10-15 mIU/mL or the E2 is >65 pg/mL The
Clomid Challenge Test is routinely performed at
our clinic in women aged 38 years or older regardless
of how the cycle day 3 levels look. This will identify
patients with incipient ovarian dysfunction.
The Clomid challenge test should
also be considered in women of any age with otherwise
unexplained infertility as approximately 30% will show
abnormalities that adversely impact their prognosis
with fertility treatment.
Ovarian reserve, along with female
patient age, is an important predictor of treatment
success. The Clomid Challenge Test is Conducted as Follows:
Patients call
the office on Day 1 of the menstrual flow (not spotting).
If this is on the weekend, please call Monday morning.
- Patients will
come into the office to have blood drawn for an E2
(Estradiol) level and FSH (Follicle Stimulating Hormone
level) on Day 2, 3 or 4 of the menses (period).
- Patients begin
Clomid -100 mg per day on
Day 5 of menses. This will be two tablets, 50mg each,
which are taken together at the same time each day.
- Tablets are
taken on cycle Days 5-9, and patients return to the
office on cycle Day 10 or 11 (after 5 days of Clomid).
The FSH level will be repeated on Day 10 or 11.
- Patients are
notified by their coordinator or physician the blood
work (unless it is a weekend or holiday).
- Patients
must sign the Clomid Consent Form, which lists the
possible side effects, before starting the medication.
A level from 10-12.5 mIU/mL predicts
resistance to fertility
medications and a diminished prognosis. At 12.5-15
mIU/mL, the prognosis is poor but pregnancies do occur
with aggressive treatment. Levels greater than 15 mIU/mL
indicate that infertility treatment with the patient’s
own eggs is not likely to succeed and that egg donation
should be offered. Patients with any FSH level greater
than 10 mIU/mL should be referred to a fertility specialist for further evaluation.
A poor Clomid challenge test indicates
that it is unlikely that the couple will be successful
using in vitro
fertilization, IVF. Some clinics do not offer IVF
to couples failing the CCCT test and others offer it
but clearly explain the poor chance of success. Donor
egg IVF is the best option for these couples.
Clomid
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