Clomiphene is a non-steroidal estrogen analogue, it stimulates the hypothalamic-pituitary system by raising the blood levels of FSH and LH, the exposure or stimulation test with clomiphene citrate is used to determine if the woman has a good ovarian reserve (the amount of ovules that remain), and in men to differentiate the origin of hypogonadism, a very important aspect of fertility, pubertal development and sexual function.
Clomiphene citrate is a drug that is taken by mouth to induce ovulation (the maturation process of the egg) and the release of more than one egg in each cycle.
If there are several eggs, the chances of fertilization and pregnancy are increased. The specialist controls the effect of the medication on the ovaries using ultrasound techniques.
In the case of man, it is a question of differentiating whether the origin of a possible hypogonadism is of pituitary or hypothalamic origin.
It is also a test used to assess gonadal function in men who show signs of abnormal pubertal development.
Clomiphene citrate is also used to regulate ovulation prior to intrauterine or artificial insemination and for the treatment of oligozoospermia in men.
The clomiphene citrate challenge test is used to study various hormones involved in ovulation, such as FSH (follicle stimulating hormone or follitropin), LH (luteinizing hormone or lutropin) and estradiol or testosterone, as the case may be.
In the standard infertility assessment, levels of the hormones FSH, luteinizing (LH), and estradiol are measured on day 3. An elevated FSH level on day 3 is an indication that ovarian reserve is poor or that menopause is coming. Learn more about female hormone tests.
The Clomiphene Citrate Challenge Test (CCCT) provides an additional assessment of ovarian reserve. It is performed by measuring the levels of FSH and estradiol on day 3.
The patient takes 100 mg of Clomid on days 5-9 of the cycle, and her FSH is measured again on day 10.
The test is abnormal if the FSH values on day 3 or day 10 are elevated or if the estradiol on day 3 is greater than 80 pg / ml.
Poor CCCT, regardless of age, indicates that there will be a decreased response to injectable FSH in assisted reproductive technology cycles. Pregnancy success rates are very low in these women and there is a higher chance of miscarriage.
The results are available in less than a week and the specialist discusses them with the couple.
Stimulus: oral clomiphene citrate (omifin) 50 mg tablets)
Dose: 100mg / day for 5 days
Extraction times: Basal (8.30 hours before the stimulus)
Post: (8.30 am the day after the last dose)
Conditions prior to sampling:
You must attend fasting in the morning.
You will have a basal extraction before starting your medication.
If she is taking any hormonal medication, she should take it after the study is done.
This test assesses the integrity of the hypothalamic-pituitary-gonadal axis. Together with the LH-RH o triptorelin, test it allows to differentiate if the gonadotrophic deficit is of hypothalamic or pituitary origin.
In normal adult men, clomiphene induces a 50-200% increase in LH and a minor increase in FSH and testosterone.
In gonadotropin deficiency of hypothalamic or pituitary origin, the response is absent or diminished.
An absence of response, with a normal response to LH-RH or triptorelin, suggests hypothalamic etiology.
The elevation of Testosterone indicates that the Leydig cells are capable of responding to the stimulation of endogenous gonadotropins.
In anorexia nervosa and hyperprolactinemias, blocked responses are seen.
The response to clomiphene citrate appears only in Tanner’s stage III of pubertal development.
Clomiphene may also be effective in men who have a hormonal imbalance associated with a low sperm count, poor quality or poor motility (ability to move).
The lack of response suggests a gonadotropin deficiency due to a pituitary or hypothalamic disease.
Patients with anorexia nervosa may show no response.
Prepubertal children show no response, and children in early puberty may actually show a reduction in gonadotropin concentrations during testing.
-Homburg, Roy (August 2005). «Clomiphene citrate – end of an era? A mini-review »Human Reproduction (Oxford, England) 20 (8): 2043-2051.
-Reproductive function in the male John Miell, Zoe Davies, in Clinical Biochemistry: Metabolic and Clinical Aspects (Third Edition), 2014
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