Penn Fertility Care

Patient Resources

Reproductive Health Information

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.

  1. 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).
  2. 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.
  3. 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.
  4. 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.

Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.