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Fertility Tests- Hormonal and Clomid Challenge Test |
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Day 3 Hormonal Evaluation
Reproductive hormones such as FSH, LH, and estradiol are measured on day 3 of the menstrual cycle. An elevated FSH level (>10) may be indicative of impending ovarian failure or reduced ovarian reserve. “Ovarian reserve” correlates with a woman's ability to develop eggs that will develop properly and is usually age related. Younger women, with premature ovarian failure, can also experience reduced ovarian reserve.
 Estrogen levels increase as healthy follicles develop and are lower during the first part of the menstrual cycle. An abnormally elevated estrogen level on day three, or a high FSH/LH ratio, may also be indicative of reduced ovarian reserve.
Younger women may have lower FSH levels since their ovaries are “easier to stimulate”.
Ovulation Prediction
In the past, the basal body temperature measurement (BBT) was used to predict ovulation. The BBT requires charting the body temperature daily prior to rising out of bed in the morning. It measures the slight temperature increase that occurs prior to ovulation. A temperature tracking history of several months enables prediction of the future ovulatory time.
The BBT method has been abandoned in favor of urinary test kits which are much easier to use and more accurate. The urinary test kits measure the increase in the hormone LH (luteinizing hormone) that always occurs prior to successful ovulation. Unfortunately in women who have Polycystic Ovarian Syndrome and produce excess LH to begin with, may have up to 30% false positive results.
In these cases a pelvic ultrasound to identify the ovarian follicle is more useful.
Clomid Challenge Test
This test is a good measure of ovarian reserve and pregnancy potential. Some programs will not offer in vitro fertilization to women who have a “poor” Clomid Challenge Test response.
To perform this test, day 3 FSH and estradiol levels are measured and the patient takes 100 mg of Clomid on cycle days 5-9. The levels of FSH and estradiol are measured again on day 10 and if the FSH is elevated it is considered a “poor” response. Day 3 elevated FSH levels and an estradiol of over 80 pg/ml also indicates a “poor stimulation prognosis”.
Patients who fail the CCCT may not respond favorably to FSH injections for ovarian hyperstimulation. For this reason, the prognosis for IVF may be lower than expected.
Fertility Tests
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