Objective: 1. To assess the ovarian reserve in infertile women by clinical, biochemical and radiological evaluation. 2. Controlled Ovarian Stimulation in female infertility by clomiphene  citrate challenge test. 3. To monitor growth of ovarian follicle by ultrasonography and assess the response of ovarian stimulation in term of follicular development.  Study Design: It is a prospective interventional study of 170 cases with complain of infertility attending OPD of obstetrics and gynaecology Mahatma Gandhi Medical College and Hospital. After the enrolment, demographic data i.e. age, education, occupation were obtained and recorded. Detailed history including details of infertilityand complaints other than infertility, duration of active married life, menstrual history, obstetric history, occupational and past history were documented and systemic examination followed by per speculum and per vaginal examination was performed. Clinical parameters including age, body mass index, menstrual cycle length was recorded. Local examination was done for breast andb hirsutism. Grading of hirsutism was done according to Ferriman and Gallwey scoring system. Hysterosalpingography (HSG) or Video hysterolaproscopy (VHL)  was done to rule tubal factor infertility. BloodInvestigations including blood group, CBC, blood sugar, HIV, HBs antigen, VDRL were done. Husband semen analysis was done to rule out male factor infertility. Specific investigations like TSH, prolactin, day 3 FSH, LH, Estradiol, AFC were recorded. Patients who fulfilled the inclusion criteria were included in the study and all the details were recorded on preformed Proforma for all subjects. After preliminary interrogation and recording of details the subjects were called on second day of menstrual cycle, reviewed, baseline TVS done for AFC and tablet clomiphene citrate 100mg daily given from day 5 to day 9. Patients were instructed to take tablets daily and to inform immediately if any side effects like flushing, nausea, vomiting, visual disturbance, headache, diarrhoea, abdominal discomfort or pelvic mass or tenderness are seen. For the purpose of clomiphene citrate challenge test, Day 10  FSH level recorded and serial ultrasonography was done from day 7 to day 16 for monitoring of endometrial thickness, number and size of dominant follicle. All transvaginal sonography was done on the same machine. At each transvaginal ultrasonography (TVS) internal diameter of each visible follicle were measured in two dimensions. The endometrial thickness defined as the maximum distance between the echogenic interphase of myometrium which was measured in the plane through the central longitudinal axis of uterus. When at least one dominant follicle had a diameter of 18 mm. injection HCG 10,000 IU was given intra muscularly as ovulation triggering agent and women were instructed to have planned relation. TVS was repeated after 48 hours to look for evidence of ovulation i.e. disappearance of dominant follicle which was seen previously and presence of free fluid in cul-de-sac. If the follicle was   unruptured then ultrasound was repeated after 48 hours and 72 hours of the HCG injection to observe luteinized unruptured follicle (LUF). Women were instructed to follow up on the second day of next cycle or immediately after missed period. If the patient is not pregnant, tablet clomiphene citrate 100mg was given in next cycle and similar protocol was followed. Before starting the ovulation induction in the next cycle all subjects were taken for transvaginal ultrasonography on day 2 of periods to rule out the presence of any ovarian cyst. All subjects were followed up for total three cycles. Women who missed their period urinary pregnancy test was done and pregnancy were recorded. All the recorded data of all subjects for 3 cycles were recorded in MS XL sheet. Outcome was measured in the form of utility of clomiphene citrate challenge test as a marker of ovarian reserve. Result: The ovarian reserve testing helps us to give the estimation of pool of primordial follicles and it is a useful in detecting ovulation induction response. Any of the tests for ovarian reserve does not have sensitivity and specificity of 100% for the detection of poor ovarian reserve. So, clinical, biochemical and radiological parameters are combined in an effort to increase the prognostic reliability of each test. A scoring system is used by combination of age, BMI, AFC, FSH, estradiol, etc for the prediction of ovarian response more accurately than each of the parameters alone. In our study, CCCT is found as the most reliable test followed by basal AFC and basal FSH.

 Keywords: Ovarian Reserve; Ovulation; CCCT .