Day-3 Hormone Evaluation
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 a patient’s ability to produce quality eggs.
Healthy developing follicles produce estrogen, which is monitored by a small gland at the base of the brain called the hypothalamus. Young ovaries with adequate ovarian reserve require a minimal amount of FSH to become stimulated, and the early follicular FSH will be relatively low. On the other hand, ovaries with compromised reserve will require more FSH from the pituitary gland in order to develop a follicle. Elevated FSH levels (>10 mIU/ml) on Day 3 are one indication of borderline or diminished ovarian reserve. An abnormally elevated estrogen level or a high FSH/LH ratio can also signal diminished ovarian reserve.
We employ the clomiphene citrate challenge test (CCCT) as a predictor of ovarian response to fertility drugs. This allows us to measure the chances of success in achieving pregnancy. Women with abnormal CCCT results may have a low chance of becoming pregnant using their own eggs. They may have to consider IVF with donated eggs for a higher pregnancy success rate.
Thyroid hormones are produced by the thyroid gland and are frequently measured during a 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 androgen levels 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 on the ovary or adrenal gland may lead to an excess of androgens.
Clomiphene Citrate Challenge Test
The clomiphene citrate challenge test (CCCT) is an effective measurement of ovarian reserve and is often conducted if there is suspicion of reduced ovarian reserve. It is usually performed in older women regardless of their Day 3 hormone evaluation results. Women with poor CCCT results may be candidates for our donor egg program.
The steps in the Clomid Challenge are as follows:
- Patient’s 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 milligrams.
- Patients return to the office after five days of taking Clomid (Day 10) and the FSH hormone level is measured again.
- An FSH level of >10 mIU/ml on either Day 3 or Day 10 may indicate a poorer prognosis for ovarian stimulation with fertility drugs.