Korean J Obstet Gynecol.  1999 Apr;42(4):871-879.

Prediction of Ovarian Response to Controlled Ovarian Hyperstimulation by Means of Clomiphene Citrate Challenge Test in Intrauterine Insemination Program

Abstract


OBJECTIVE
This clinical study was performed to set up a cut-off value of clomiphene citrate challenge test[CCCT] as a predictor of the diminished ovarian reserve and fecundity and to assess the clinical usefulness of CCCT as a predictor of ovarian response in controlled ovarian hyperstimulation[COH]. Materials and
METHODS
From January, 1994 to September, 1998, CCCT was performed in 105 infertile patients undergoing COH with clomiphene citrate[CC] or exogenous gonadotropins for intrauterine insemination[IUI]. Diagnoses of infertility for inclusion were ovulatory factor, minimal and mild endometriosis, cervical factor, and unexplained infertility. Infertile patients whose basal serum FSH was more than 30 mIU/mL were excluded.
RESULTS
To define the abnormal ovarian response, the cut-off value of serum FSH measured on the tenth day of menstrual cycle[FSH10] was determined as 25.3 mIU/mL arbitrarily from 17 patients who conceived naturally after CCCT. Mean values of age, infertility duration, basal LH[LH3] and estradiol[E23], and CC-stimulated LH[LH10] and E2[E210] in normal CCCT group[n=95] were not significantly different from those in abnormal CCCT group[n=10]. Only basal FSH[FSH3] was lower significantly in normal CCCT group[p=0.003]. CC-stimulated FSH[FSH10] was well correlated with FSH3[r=0.656, p<0.001], but not with age, LH3, LH10, E23, and E210. Twenty pregnancies were obtained in COH cycles with natural coitus or IUI. The number of patients with abnormal CCCT was only 1[5.0%] in pregnant group and 9[10.6%] in nonpregnant group. Only mean value of FSH10 was lower significantly in pregnant group [p=0.042].
CONCLUSION
As serum FSH response to CC stimulation[FSH10] predicts ovarian reserve and fecundity better than age or basal serum FSH level[FSH3], CCCT might be a very useful clinical test as a predictor of ovarian response in COH, especially in infertile patients with no other abnormal findings that predict poor prognosis in COH.

Keyword

Controlled ovarian hyperstimulation[COH]; Intrauterine insemination[IUI]; Clomiphene citrate challenge test[CCCT]; Serum FSH; Age; Ovarian response; Fecundity; Predictor

MeSH Terms

Clomiphene*
Coitus
Diagnosis
Endometriosis
Female
Fertility
Gonadotropins
Humans
Infertility
Insemination*
Pregnancy
Prognosis
Clomiphene
Gonadotropins
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