Clomiphene Challenge Test (CCCT)

What is the Clomiphene Citrate Challenge Test (CCCT)?
The CCCT is a diagnostic or “challenge” test of functional ovarian reserve. It is considered a “provocative” test that is more sensitive than day 3 blood tests alone. The CCCT measures the ability of the ovaries to respond to signals from the pituitary gland (called FSH or follicle stimulating hormone) which are stimulated by taking the fertility drug Clomiphene Citrate (Clomid or Serophene). It was developed as a screening tool for diminished ovarian reserve or “aging of the eggs and ovaries”.

Who should be given the Clomiphene Citrate Challenge Test?
The CCCT is usually recommended for women over 35 years of age before starting programs such as IVF or GIFT. It is also recommended for women at any age who demonstrate a less than normal response to fertility drug treatment suggesting possible diminished ovarian reserve.

Why is the Clomiphene Citrate Challenge Test neccessary?
The CCCT allows the identification of women who have evidence of diminished ovarian reserve. Patients with an abnormal CCCT have a dramatically reduced pregnancy success rate in all advanced infertility treatment programs except egg donation IVF. The CCCT helps identify the cause of infertility in some couples and allows them to use their resources for more successful options such as egg donation IVF or adoption.

How is the Clomiphene Citrate Challenge Test performed?
The CCCT is a relatively simple test. A blood test for FSH is drawn on day 3 of the cycle. After a vaginal ultrasound exam to make sure the ovaries are normal, two Clomiphene pills (100 mg) are taken daily each morning from day 5 to 9 of the cycle. A second blood test for FSH is drawn on day 10 of the cycle. Both the day 3 and the day 10 blood tests should be performed at the same laboratory.

Are there any risks of the Clomiphene Citrate Challenge Test?
Clomiphene has been used in the U.S. for the past thirty years and is considered a very safe medication. Possible temporary side effects include hot flushes, spots in front of the eyes or other minor visual disturbances, headaches, and mild mood changes. The majority of women who take Clomiphene have no significant side effects. Clomiphene increases the risk of functional ovarian cysts which resolve without treatment in the following month. Women who become pregnant on Clomiphene have a slightly increased risk of twins (one out of twenty pregnancies).