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Loss of eggs or oocytes is the basis for lower fertility and higher miscarriage rates seen in women as they age. This natural decline in ovarian oocytes is variable for different women. Therefore, one woman with a normal ovarian reserve may be more fertile at age 40 than another woman who is younger but has a reduced ovarian reserve.

1. Baseline Tests:

Menstrual cycle day 3 follicle stimulating hormone (FSH) and estradiol (E2) levels are reliable markers of ovarian reserve. A blood sample is obtained to assess these hormonal values. An FSH value above 10 mIU/ml or an E2 level above 100 pg/mL may be indicative of a reduced ovarian reserve.

2. Clomiphene Citrate Challenge Test (CCCT):

The CCCT is the most sensitive method of determining ovarian reserve. To perform this test, the ovulation inducing drug Clomiphene Citrate (Clomid) is utilized to see how the ovaries respond to stimulation. Clomiphene Citrate at a dose of 100mg is administered orally for five days (menstrual cycle days 5-9). Blood FSH levels are obtained before (day 3) and after (day 10) using Clomid. If either the day 3 or day 10 FSH level exceeds 10 mIU/mL the result is abnormal and indicative of reduced ovarian reserve.