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Reproductive hormones such as FSH, LH, and estradiol are typically measured on day 3 of the menstrual cycle. These measurements allow the physician to access the patient's ovarian reserve, or ability to produce eggs that will fertilize and develop.
 Healthy developing follicles produce estrogen, which is monitored by the hypothalamus, a small gland at the base of the brain. In ‘young’ ovaries with adequate ovarian reserve, a minimal amount of FSH is required to stimulate the ovaries, and the early follicular FSH will be relatively low.
On the other hand, ovaries with compromised reserve will require more output (more FSH) from the pituitary in order to develop a follicle. Elevated FSH levels (>10 miu/ml) on day 3 are one indication of borderline or diminished ovarian reserve. Women with FSH levels above 15 miu/ml are candidates for our donor egg program in
Dallas.
The FSH level may be normal but an abnormally elevated estrogen level, or if the FSH/LH ratio is high, can also signal diminished ovarian reserve.
We also employ the clomiphene citrate challenge test (CCCT) as a predictor of ovarian response to fertility medications (and therefore success in achieving pregnancy). Women with highly abnormal CCCT may have a low chance of a successful pregnancy using their own eggs, and therefore may consider use of donated eggs with IVF for a high pregnancy success rate.
Thyroid hormones are produced by the thyroid gland and are frequently measured in the fertility evaluation. Although thyroid function is a key regulator of metabolic rate, even subtle abnormalities can affect fertility. Levels that are too low (hypothyroidism) can cause miscarriage and irregular ovulation. Levels that are too high (hyperthyroidism) can also cause irregular ovulation, fetal abnormalities, and premature labor.
Androgens are male hormones that are produced by the ovaries and adrenal glands. Elevated androgens may be associated with the presence of polycystic ovarian syndrome (PCOS). In this condition, elevated LH and insulin levels stimulate the ovary to produce abnormal amounts of male hormones which impede normal follicle growth and ovulation. Rarely, a tumor in the ovary or adrenal gland may lead to an excess of androgen levels.
The clomiphene citrate (Clomid) challenge
test (CCCT) is an effective measurement of ovarian
reserve and is often conducted if there is a suspicion of
reduced ovarian reserve. Oftentimes, it is performed in older
women regardless of their day 3 hormone evaluation results. Women with poor CCCT results are candidates for our Dallas, TX donor egg program. Donor egg success rates are typically high helping to control infertility treatment costs.
The steps in the Clomid Challenge are as follows:
- Patients FSH, and E2 levels are measured on days
2,3, or 4 of the menstrual cycle.
- Clomid tablets
are begun on day 5 of menses at a dose of 100 mg.
- Patients return to the office after 5 days of
Clomid and the FSH hormone level is measured again.
- A level of >10 mIU/ml on either day 3 or day
10 may indicate a poorer prognosis for ovarian stimulation with
fertility drugs.
- See our discussion of
Clomid
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