Clomiphene Citrate Challenge Test

It has been recognized for quite some time that a woman's chances of conception decrease with age.

With aging there is an accumulation of damage within cells. Over time as cellular damage accumulates, organs and tissues work less effectively and eventually may cease to function altogether. Compared with other organ systems, the female reproductive system fails at a relatively early age (the average age of menopause is 51 years). However, changes that limit a woman's chances to reproduce start many years before that. This appears to be due to a decrease in number of oocytes, as well as an increased proportion of oocytes that have abnormal chromosomes. Treatment options for infertility become more limited as ovarian function wanes, as there is no treatment that can restore eggs or improve their quality. This process is discussed in detail in our brochure "The Effects of Age on Fertility".

Ovarian reserve is the term that we use to describe the reproductive potential of a woman's ovaries during the aging process. While age itself is an important determinant of ovarian reserve, not all women of the same age have the same reproductive potential. The medical evaluation of ovarian reserve is accomplished by tests that measure important components of the reproductive system

Clomiphene Citrate Challenge Test (CCCT)

The CCCT is a method to assess ovarian reserve by directly challenging the portions of the reproductive system directly involved in follicle development: the hypothalamus and pituitary gland in the brain and the ovaries. In the CCCT, blood work is drawn on cycle day 3 (FSH, LH, estradiol) to assess the basal state of these hormones. You will then take the clomiphene citrate for 5 days starting on cycle day 5. On cycle day 10 (the day after completing the clomiphene citrate), you will have the blood work re-drawn. We will usually have the results the same day. If the test is abnormal, the woman's ability to conceive using her own ovaries and deliver a child is extremely limited. We suggest that you have a consultation with your doctor if the test results are abnormal for an in-depth discussion of your options.

Clomiphene Citrate (Clomid, Serophene): Clomiphene citrate is an ovulation induction agent that has many uses including: (a) cause you to release and egg (ovulate) each month, (b) cause you to release more than one egg each month if you ovulate on your own, (c) help synchronize the lining of your uterus (endometrium). Clomiphene is a very safe drug, but like any form of treatment, it does have risks and occasionally there may be side effects.

Clomiphene Citrate Mechanism of Action: Clomiphene is an estrogen antagonist, that is, it opposes the actions of estrogen. It works by competing with estrogen for the estrogen-receptors in your brain (at the hypothalamus and pituitary gland). Your hypothalamus and pituitary gland interpret this as the body not having enough estrogen. This results in the pituitary gland releasing the hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which then go to the ovary to stimulate follicle growth and estrogen secretion. The estrogen, and another hormone called inhibin, feedback to the brain to regulate the FSH-secretion. Usually the follicles selected by the clomiphene continue to grow and ovulate a normal manner.

Side effects: Although most patients have no symptoms while on clomiphene, you may notice mood swings, abdominal discomfort, hot flashes or visual disturbances. These symptoms are usually brief and mild when present and do not require treatment. If you experience any unusual problems while taking clomiphene, please feel free to call us at the office numbers listed below.

Risks: The major risk of clomiphene citrate is the risk of conceiving more than one baby. The risk of having a multiple pregnancy is about 8-10%. Of the few multiple pregnancies, about 90% will be twins and 10% more than twins. However, for patients undergoing a CCCT, this risk is likely to be much lower. On occasion, the anti-estrogen effects of clomiphene can make the lining of the uterus too thin. This can be treated by medication or by simply stopping the clomiphene and moving on to other medications (e.g. the gonadotropins). Rare complications include twisting of an enlarged ovary ("torsion") and ovarian hyperstimulation syndrome. There is no increased risk of birth defects, miscarriage, or tubal (Ectopic) pregnancy compared to the general population. There are no other reported complications with pregnancy due to the medication, although, of course, no pregnancy can ever be guaranteed to be "perfect".

Precautions: You should not take clomiphene if you have significant ovarian cysts, think you are pregnant, have liver disease, or significant visual symptoms on the medicine.

How a Clomiphene Citrate Challenge Test Works.

Monitoring:

1. It is essential that the blood tests are done and the clomiphene taken on the appropriate days.

2. Please call the office when your period starts (day 1 of your cycle). If your period starts after 9:00 pm, day 1 is the next day. If your period starts on a weekend, please leave a message at 973-971-4600.

3. Come in to the Office on Cycle Day 3 to have your initial blood work done.

4. After the baseline tests, you will take the clomiphene for 5 days, starting on cycle day 5

5. Take the clomiphene citrate (100 mg, two 50 mg pills) on cycle days 5, 6, 7, 8, 9.

6. Return to the office on cycle day 10 to have blood work done. We will call you with the test results.

a. Note: Lab results are reported late in the afternoon after the physicians have reviewed them. You will be called at your home number by a nurse or physician and informed of the results.

If you have not been called with your results by 7:30 pm, please call the office the next day.

Cycle Day	Day	Date	Instructions
1			First day of period. Call the office to schedule blood work on Day 3
2
3			Come into office to have blood work (FSH, LH, estradiol) done
4
5			Start clomiphene citrate 100 mg
6			clomiphene citrate 100 mg
7			clomiphene citrate 100 mg
8			clomiphene citrate 100 mg
9			clomiphene citrate 100 mg
10			Come into office to have blood work (FSH, LH, estradiol) done
Other Instructions