Clomid (clomiphene) challenge i have recently been diagnosed with dimished ovarian reserve, my fsh levels are around 15. since we already know about my ovarian reserve, what benefit if any, is a clomid (clomiphene) challenge?

The : The Clomid (clomiphene) challenge test is one way to test ovarian reserve (egg supply, fertility potential). It is best used in patients that have had normal ovarian reserve testing to date and are planning future fertility treatment. An abnormal Clomid (clomiphene) challenge test result can predict poor response to fertility treatment. In your particular case, with a high fsh you may already be showing signs of diminished ovarian reserve, so I do not think it will give you further information. Certainly - I do not have all of the information in your case and i recommend reviewing with a reproductive endocrinolist that can review your entire case. I hope this helps!

A : A Clomiphene citrate challenge test (ccct) was designed to improve the accuracy of a single day 2-4 fsh level. When a person has a very high fsh such as 15, the ccct probably adds little to the prognostic value of the existing test. This is because the highest fsh level is the predictive one. So, if the test was repeated and the fsh was lower, we would not believe it and it would not improve your prognosis. If the fsh came back worse, that would worsen the prognosis but probably not change the recommendation of your doctor. I would not bother with a ccct if i were you.

I : I respect dr moffit's and dr shahine's answers, but i would like to offer another viewpoint. You almost certainly have diminished ovarian reserve, assuming the fsh of 15 was well-timed (done on day 2 or 3 with an estrogen level or Estradiol at the same time). There is no single perfect test of ovarian reserve (egg supply or fertility potential). Out of the tests available, ultrasound, baseline day 2/3 fsh, Clomid (clomiphene) challenge test, and antimullerian hormone (amh), the best and most validated tests in the medical literature are the Clomid (clomiphene) challenge test and the antral follicle count or afc (determined by a careful ultrasound, best performed by a fertility clinic). Fsh levels vary from month to month even in the same woman. Normal fsh levels one month may not be reassuring depending on a woman's age and other factors - if you already had a fsh of 15 and we get normal fsh levels in a different month on day 3 or day 10, your ovaries haven't got better - fsh tests have a high false negative rate, meaning they can be 'normal' when there's clearly a problem. That's one reason why we also look at ultrasound and amh levels too. When evaluating ovarian reserve i look at 6 factors 1. Your age 2. Whether or not you have signs of polycystic ovarian syndrome (pcos) 3. Ultrasound findings - ovarian volumes and antral follicle counts 4. Baseline fsh and Estradiol 5. Clomid (clomiphene) challenge test day 10 fsh and 6. Amh level age matters - if you are 45 with normal fsh and amh levels you have a low chance of conceiving and having an ongoing pregnancy with your own eggs, even with ivf. I think the Clomid (clomiphene) challenge test gives one more data point to the evaluation of your ovaries. Having said that, if your baseline day 2 or 3 fsh is now 20 or above i would advise you not to proceed with the Clomid (clomiphene) test as we already have our answer. If the baseline fsh is under 20 i would proceed with the Clomid (clomiphene) challenge test. If your baseline fsh is lower, let's say 12, then you take the clomid, (clomiphene) i think it can help to guide treatment choices if your day 10 level is 14 versus a day 10 fsh level of 25 or 30. Here, having clinic-specific outcome data can really help - at orh we can say that we don't get many ivf pregnancies when the baseline fsh is 20 or above or the day 10 fsh is 15 or above. Anyone with a fsh level of 15 has a higher chance of success (ongoing pregnancy and delivery) with egg donation. We may still proceed with an ivf attempt with a woman's own eggs even in the face of fsh above 20 on baseline of above 15 on day 10 if there are other factors favoring ivf such as significant tubal problems or a severe sperm factor where icsi is indicated and giving injectable meds with inseminations (iui) won't work. In others, after careful counseling, going straight to donor egg is the right answer. So i think the Clomid (clomiphene) challenge test may be useful in coming up with an individualized treatment plan which takes the details of your situation into account. Of note, the Clomid (clomiphene) challenge test is one of the first tests to be validated in terms of outcomes that really matter - pregnancy rates with treatment, not surrogate endpoints like the number of eggs retrieved with ivf. The Clomid (clomiphene) challenge test has been shown to have predictive value for both ivf and iui-based treatment, as well. See the link below for an important study. Best wishes.