Tests of Ovarian Function
Follicle Stimulating Hormone (FSH)
Developing follicles produce
estrogen which signals the brain (hypothalamus)
to increase or reduce the amount of FSH produced
by the pituitary gland. When "good" follicles are not developing,
estrogen levels are lower and more FSH is produced.
This leads to higher levels of FSH on day 3.
Egg quality, and ovarian reserve, naturally decline as women age
and approach menopause. Some women experience
this decline earlier in life (for unknown reasons) and
this is a common cause of fertility. Poor ovarian
reserve is indicated by an FSH of >11.4mIU/ml.
Clomiphene Citrate (Clomid) Challenge Test (CCCT)
The clomiphene citrate (clomid)
challenge test (CCCT) may also be used identify
patients with ovarian dysfunction. The CCCT is
conducted as follows: Patient calls the office
on Day 1 of the menstrual flow (not spotting).
If this is on the weekend, please call Monday
morning.
- Patient 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, 100mg 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 (after 5 days
of Clomid) to repeat the FSH level.
- Patients
must sign the Clomid Consent Form, which lists
the possible side effects, before starting
medication.
An abnormal 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.
Ovarian
Antral Follicle Count
This is performed by transvaginal
ultrasound. The total number of small (antral)
follicles in both ovaries are usually measured
during the first few days of the menstrual cycle.
Low follicles numbers is also an indicator of
reduced ovarian reserve. These tests along with the age of the patient
can predict the success of response to injectable drugs such as gonadotropins
and the outcome of infertility treatments.
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