Recurrent Miscarriage/Clomid Challenge

[Anonymous]

I have had two miscarriages and it has just been discovered that I have low progesterone. My RE wants me to do a clomid challenge to look at my egg quality. Has anyone had to do this? If so, if you had poor egg quality, what was your next step? Did you use donor eggs?

[Anonymous]

I am curious to read replies.
How can they asses egg quality with this test? I thought it was to evaluate response to stimulation.
For example, I tested once for very high FSH but got pregnant that month. I did miscarry, but the embryo was genetically normal. So technically my egg was ok, right?
I don't see how egg quality can be assesed unless it is retrieved and studied? Or am I missing something?

[Anonymous]

Here is what I read about it:

Various tests have been described to measure ovarian reserve. The commonest test measures the FSH Level ( follicle stimulating hormone) in the blood - the basal ( day 3) FSH level. A high level suggests poor ovarian reserve; and a very high level ( more than 20 mIU/ml, though this varies from lab to lab ) is diagnostic of ovarian failure. A test that can provide earlier evidence of declining ovarian function is the clomiphene citrate challenge test ( CCCT). This is similar to a " stress test " of the ovary; and involves measuring a basal Day 3 FSH level; and a Day 10 FSH level, after administering 100 mg of clomiphene citrate from Day 5 to Day 9. If the sum of the FSH levels is more than 25, then this suggests poor ovarian function, and predicts that the woman is likely to have a poor ovarian response ( she will most probably grow few eggs, of poor quality) when superovulated. Remember that a high FSH level does not mean that you cannot get pregnant - it just means that your chances are dropping because your egg quality is impaired.

[Anonymous]

Check this link out:
http://100infertilityquestions.blogspot.com/2009/07/what-is-amh_6028.html

"Ovarian reserve is not truly a test of egg quality as a woman's age is the final arbitrator of egg quality."

[Anonymous]

The clomid challenge cannot identify egg quality. As PP stated, it is used to get an idea of your response to stim meds. If your FSH increases between days 3 and 10, then it can be a sign of diminished ovarian reserve - meaning that you don't have as many eggs available on average. Given the theory that your body pushes forward the best eggs first, the odds are that you have fewer good eggs left if you have a dimished reserve available. It does not mean that you have no good eggs left - it just means there might be fewer of them.

If you are young, then a high FSH reading or diminished ovarian reserve diagnosis should not be an indicator that you should not try to get pregnant with your own eggs, but rather you may not respond well to stim drugs and may have better luck with trying naturally or using low stim meds.

And, most importantly, if you are told you have bad eggs and need donor egg based on a single test, then I would run as fast as you can to a high FSH friendly RE for a second opinion.

[Anonymous]

Anonymous wrote:Here is what I read about it:

Various tests have been described to measure ovarian reserve. The commonest test measures the FSH Level ( follicle stimulating hormone) in the blood - the basal ( day 3) FSH level. A high level suggests poor ovarian reserve; and a very high level ( more than 20 mIU/ml, though this varies from lab to lab ) is diagnostic of ovarian failure. A test that can provide earlier evidence of declining ovarian function is the clomiphene citrate challenge test ( CCCT). This is similar to a " stress test " of the ovary; and involves measuring a basal Day 3 FSH level; and a Day 10 FSH level, after administering 100 mg of clomiphene citrate from Day 5 to Day 9. If the sum of the FSH levels is more than 25, then this suggests poor ovarian function, and predicts that the woman is likely to have a poor ovarian response ( she will most probably grow few eggs, of poor quality) when superovulated. Remember that a high FSH level does not mean that you cannot get pregnant - it just means that your chances are dropping because your egg quality is impaired.

The research I have seen does not take the sum of the FSH readings to determine poor ovarian function, but rather looks at the day 3 and day 10 level. If the cd3 level is over 15, then there is dimished function. And, if the level is normal on cd3, but increases on the cd10 reading and/or is over 15, then there are signs of diminished ovarian function.

[Anonymous]

Thanks this is very helpful. And I feel much better.