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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

UTHSC Academic Office

Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733

(901) 347-8331
(901) 347-8188 fax
Directions to Office

Updated information is at
UTMG 2006

Click for information on:
Glenn Ann Martin, Ph.D.
Clinical Psychologist

 

FSH Testing

for Ovarian Aging
(CCT, Clomiphene Challenge Test)

Fertility Related Pages
[Infertility] [Evaluation] [Clomiphene] [Intrauterine Insemination] [PCOS]

Blood tests for follicle stimulating hormone (FSH) and Estradiol (E2) can be used to check ovarian reserves and for adequate egg function. When these tests are abnormal, fertility decreases and the chance of miscarriage increases. This test is most useful in women over 40 as a guide for IVF, but can be used in younger women to give an estimate of egg reserves. A test done on day 3 of a menstrual cycle is used as a basic screening test.  A complete Clomiphene Challenge Test (CCT) also measures FSH on day 10 of the cycle after 5 days of clomiphene (Clomid, Serophene).

Information on Premature Ovarian Failure (POF) is available at the Premature Ovarian Failure Support Group site at www.pofsupport.org.

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Protocol 

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Day 1 is the first day of bleeding

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Blood test on day 3
FSH (Control hormone from the brain)
Estradiol (Ovarian hormone)

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Clomiphene 100 mg (two 50 mg pills) day 5 to 9 by mouth

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Blood test on day 10
FSH (Control hormone from the brain)

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Research studies demonstrate:

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Healthy day 3 and day 10 FSH levels are less than 10. 

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Values of 10 to 18 are intermediate and are sometimes associated with lower fertility and higher miscarriage rates. 

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Pregnancies are rare and miscarriages increase with high FSH values more than 18.  The clinical name for this is diminished ovarian reserve (DOR).  The miscarriage rate has been 57% at age 35 and 90% at age 40 with DOR. DOR is often treated with donor eggs.  However, hormonal treatment with estrogen and progesterone has lowered the miscarriage rates to 30% and 50% in one study.  Successful pregnancies have occurred with values as high as 143 using hormonal treatment in one study.  The highest value in my practice has been 22.

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Live births have generally occurred when the day 3 FSH is less than 14, the estradiol less than 81, and the age less than 43 years. 

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References

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Buyalos RP; Daneshmand S; and Brzechffa PR.  Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy.  Fertil Steril 68:272-277, 1997

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Check JH, Check ML, Katsoff D. Three pregnancies despite elevated serum FSH and age. Human Reprod 2000

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Corson SL.  The simple screen can predict ART failure.  Ob/Gyn Management, pages 30-34, October, 1998.

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Levi AJ; Raynault MF; Bergh PA; Drews M R; Miller BT; Scott RT. Reproductive outcome in patients with diminished ovarian reserve. Fertil Steril. 76: 666-669, 2001.

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Trout SW; Seifer DB.  Do women with unexplained recurrent pregnancy loss have higher day 3 serum FSH and estradiol values? Fertil Steril 74: 335-337, 2000.

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