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
248-619-9030.
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 |
|
|
|
Our Main
Office: (248)-619-3100
