When you are beginning the fertility process and are close to age 40 or if you have had unexplained fertility problems and doctors are searching further for answers, you will more than likely do a clomid challenge test (CCT) or clomiphene citrate challenge test (CCCT).  The CCT is used to assess ovarian reserve.  It can be used both as a diagnostic tool as well as a predictor for success in an IVF cycle.

When a woman is born, she is born with a lifetime supply of eggs.  This is kind of like a “what you got is what you get” phenomenon and a woman does not develop, grow, or produce new eggs throughout her lifetime.  Each month a follicle containing an egg will develop to maturity and be released (this is ovulation).

Ovarian reserve essentially describes the quality of the eggs that are being produced.  As a woman ages, her ovarian reserve typically diminishes.  However, even a young woman in her 20s can have a diminished ovarian reserve.  A diminished ovarian reserve indicates that a woman’s chances of getting pregnant decrease and a woman’s chances of having a miscarriage increases.

During the CCT, your Follicle Stimulating Hormone (FSH) levels and estradiol levels are tested on day 3 of your cycle.  You will then take Clomid (usually 100 mg/day) for days 5-9. On day 10 your FSH and estradiol levels will be tested again.

If your FSH levels are less than 10 on both days, then the test indicates that there is not a decreased ovarian reserve and everything appears normal.  If your FSH levels measure anywhere between 10-18 then it indicates that, while you don’t have what is considered a diminished ovarian reserve, your chances of getting pregnant decreases and your chances of having a miscarriage increases.  Any FSH levels over 18 indicate that you have a diminished ovarian reserve.  Your chances of getting pregnant substantially decrease and your chances of having a miscarriage substantially increase.

Some studies have shown that hormone treatments using progesterone and estrogen can decrease your chances of a miscarriage.  Only a few studies have even indicated that hormones can affect your chances of getting pregnant.

Some clinics will not proceed with IVF if you have a decreased ovarian reserve.  Most of them will discuss the odds of success with you and allow you to decide whether or not to proceed.  At that point you really have to weigh the odds and decide if you want to attempt an IVF, try IVF with hormone therapy or if you want to begin to explore your other options.

You essentially have two other options to choose from if you don’t want to proceed with IVF due to diminished ovarian reserve.  You could either try IVF with an egg donor or explore adoption as a way to build your family.  It is a feeling of being at a crossroads when you are faced with such a decision.  I would encourage you to take the time to explore every option, weigh the pros and cons and decide which route would be the best for you and your family.

This entry was posted on Wednesday, March 22nd, 2006 at 4:25 am and is filed under Fertility. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.