Clomid Challenge Test (CCCT): Everything You Need to Know

What the Results Mean, What’s Normal, Why It’s Done

two test tubes for the Clomid challenge test
Your doctor may recommend the Clomid challenge test before you start IVF. This test may help predict your odds for IVF failure. Maskot / Getty Images

The Clomid challenge is a fertility test sometimes performed before IVF treatment. The test is also known as a clomiphene citrate challenge test, or CCCT.

The test is meant to predict whether your body will respond favorably to fertility drugs and ovarian stimulation. Since IVF treatment is expensive – emotionally and physically – performing this test before you begin treatment may help you avoid disappointment, lost time, and lost money.

But not every doctor does a Clomid challenge. Here’s why your doctor may or may not order a Clomid challenge, how it’s done, and what the results mean.

Why Your Doctor May Order a Clomid Challenge Test

The Clomid challenge test is meant to evaluate the quality and quantity of eggs in the ovaries. When your doctor talks about testing your ovarian reserves, this is what he means. It’s a test of how healthy and how plentiful your eggs are.

The Clomid challenge test is only one of many ways to test ovarian reserves, and not everyone agrees it is the best option. (More on that below)

Some clinics perform a Clomid challenge on all their patients, but most only do the test if certain criteria are met. Your doctor may order a Clomid challenge if:

  • You are over a certain age. Usually over age 37, but some doctors order the test for all women over 35.
  • Your FSH levels were high. Part of your basic fertility testing included a basal FSH test, which looks at your levels of FSH hormone on day three of your menstrual cycle. If your results were borderline high or high, your doctor may want to do a Clomid challenge.

    Some doctors will do a Clomid challenge test during Clomid treatment. All it requires is more frequent blood work and possibly an ultrasound.

    Most of the time, though, a clinic does a Clomid challenge before starting IVF treatment and sometimes before IUI treatment.

    If the fertility drugs during IVF don’t stimulate your ovaries well enough to produce enough eggs for retrieval, your cycle will be canceled.

    All the money spent on the treatment to that point will be lost, not to mention the emotional strain.

    The Clomid challenge test is meant to determine whether your ovaries are likely to respond favorably, before you spend time and money on treatment.

    Why Your Doctor May NOT Order a Clomid Challenge Test

    Research has questioned whether the Clomid Challenge is really capable of predicting IVF failure. While some studies have found that the CCCT can predict the likelihood of IVF success, other studies have found the test to either be inclusive or not as good as other ovarian reserve testing.

    For example, some studies have found that FSH basal testing – which is just a blood test on day three of your cycle – is as accurate as the Clomid challenge at predicting IVF failure.

    Other studies have found that antral follicle count (ARC) is significantly more accurate at predicting ovarian reserves than the Clomid challenge. An antral follicle count involves a transvaginal ultrasound and doesn’t require taking any medications.

    While the Clomid challenge test requires you to take Clomid – a drug that does have side effects and risks –FSH basal testing and antral follicle count are significantly less risky.

    Another issue with the Clomid challenge is it causes anxiety in patients having the test, and this anxiety may not even be worth the results it gives (or doesn’t give.)

    For these reasons, some doctors choose not to perform a Clomid challenge test.

    How Is a Clomid Challenge Test Done?

    As always, you should follow the instructions given to you by your doctor.

    In general, a Clomid challenge test requires that you have a blood draw on day 2, 3 or 4 of your menstrual cycle. This will be sent to a lab, and they will look at your FSH and estradiol levels.

    Then, on days 5, 6, 7, 8, and 9, you will take 100 mg of clomiphene citrate. Usually this will be two 50 mg tablets taken at the same time, but ask your doctor if you’re not sure.

    Then, on day 10, you will have another blood draw to look at your FSH levels again.

    Some doctors also order a transvaginal ultrasound to count and measure any maturing follicles in the ovaries. 

    Will I Experience Any Side Effects?

    You may experience the same side effects as someone taking Clomid for fertility treatment. In fact, your doctor may perform the test during a cycle that they are also treating you for infertility.

    The only difference between being treated with Clomid for anovulation and having a Clomid challenge test is you have more blood work during a challenge.

    However, don’t assume you’ve already passed a Clomid challenge test just because you’ve taken Clomid before. Your doctor may not have done the additional blood work or ultrasounds at that time.

    Talk to your doctor about any usual symptoms you have during the test.

    Also keep in mind that if you have unprotected sex during the Clomid challenge, you can get pregnant and are at risk for conceiving twins.

    What Is a Normal Result for the Clomid Challenge Test?

    Normal results vary somewhat from lab to lab, so you will need to discuss your results with your doctor to know whether your results are considered normal or not in their clinic.

    According to one study, having an FSH level between 3.1 and 10.0 IU/I is considered to be in the normal range.

    An elevated FSH level was considered to be greater than 10.0 IU/I, with 24 IU/I being a very high FSH level.

    The higher your FSH results are during a Clomid challenge, the less likely IVF treatment will be successful for you.

    In one study, 76% of women who went through a Clomid challenge were considered to have normal results and good ovarian reserves, with 24% of women “failing” the Clomid challenge. Other studies have found a much smaller percentage of women are disqualified from IVF treatment after a Clomid challenge.

    Estradiol levels are also considered during a Clomid challenge. A normal Day 3 result is anything between 25-75 pg/ml. 

    Note that getting a normal result during a Clomid challenge doesn’t mean IVF will get you pregnant or that your ovaries will respond favorably to fertility drugs.

    With this test, the only result that has meaning is a poor result.

    Doing poorly on the Clomid challenge increases the odds that IVF will not be successful for you.

    Doing well on the Clomid challenge test doesn’t say much about whether you’ll get pregnant with IVF treatment.

    What Happens After a Clomid Challenge Test Failure?

    Usually, if your results are not good during a Clomid challenge test, your doctor will inform you that your odds for IVF treatment success are low.

    Most clinics will also take into consideration other ovarian reserve testing results along with your Clomid challenge results. Remember that not everyone agrees that the CCCT is the best test of ovarian reserves.

    The next step will depend on your doctor and you.

    Some clinics refuse to offer IVF treatment to women who fail the Clomid challenge. Or, they will only offer the patient egg donor IVF.

    With an egg donor, your ovarian reserves are not relevant.

    IVF with an egg donor has much higher success rates, even better success rates than women with good ovarian reserves going through IVF. But it is expensive, and not everyone wants to use an egg donor.

    Embryo donor IVF is also an option to consider, but your doctor may not mention it. Embryo donor IVF is less expensive than egg donor IVF, and may be even less costly than traditional IVF. So be sure to ask about it.

    If you don’t want to go the donor route, and your clinic turns you away and refuses to treat you, remember that this may partially be because they don’t want to tarnish their own IVF success rates.

    Some clinics specialize in helping women with poor ovarian reserves. Egg donor IVF may be the best choice for you, but it’s better if you work with a doctor who is experienced with your particular fertility challenges.

    If you want to proceed with traditional IVF, knowing that your odds for success are low, some doctors may be willing to offer the treatment to you.

    Whether this is in your best interest, however, is a matter of debate.

    Getting a second opinion before investing your time, money, and emotions into treatment is probably the best route to take.

    More to know:

    Sources:

    Adibi A, Mardanian F, Hajiahmadi S. “Comparison of Ovarian volume and Antral follicle count with Endocrine tests for prediction of responsiveness in ovulation induction protocols.” Adv Biomed Res. 2012;1:71. doi: 10.4103/2277-9175.102975. Epub 2012 Oct 31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544132/

    Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. “A systematic review of tests predicting ovarian reserve and IVF outcome.” Hum Reprod Update. 2006 Nov-Dec;12(6):685-718. Epub 2006 Aug 4. http://humupd.oxfordjournals.org/content/12/6/685.long

    Csemiczky G, Harlin J, Fried G. “Predictive power of clomiphene citrate challenge test for failure of in vitro fertilization treatment.” Acta Obstet Gynecol Scand. 2002 Oct;81(10):954-61. http://www.ncbi.nlm.nih.gov/pubmed/12366487

    Hendriks DJ, Mol BW, Bancsi LF, te Velde ER, Broekmans FJ. “The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review.” Fertil Steril. 2006 Oct;86(4):807-18. Epub 2006 Sep 7. http://www.ncbi.nlm.nih.gov/pubmed/16962116

    Ramalho de Carvalho B, Gomes Sobrinho DB, Vieira AD, Resende MP, Barbosa AC, Silva AA, Nakagava HM. “Ovarian reserve assessment for infertility investigation.” ISRN Obstet Gynecol. 2012;2012:576385. doi: 10.5402/2012/576385. Epub 2012 Jan 26. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302183/

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