A PROSPECTIVE EVALUATION OF CLOMIPHENE CITRATE CHALLENGE TEST SCREENING OF THE GENERAL INFERTILITY POPULATION

Objective: To assess the results of screening an unselected general in fertility population for diminished ovarian reserve with the clomiphen e citrate challenge test. Methods: Two hundred thirty-six couples were followed prospectively and studied for the relationship between clomi phene citrate challenge test screening and final diagnoses and long-te rm fertility rates. Results: Abnormal clomiphene citrate challenge tes ts were found in two of 61 (3%) of the patients younger than 30 years, in five of 72 (7%) aged 30-34, in seven of 68 (10%) aged 35-39, and i n nine of 35 (26%) aged 40 or older. An abnormal test predicted lower pregnancy rates; conception occurred in 92 of 213 (43%) of patients wi th normal results, but only two of 23 (9%) of patients with abnormal r esults (P < .004). Unexplained infertility (not considering the clomip hene citrate challenge test) was a common finding in patients with abn ormal clomiphene citrate challenge test results (12 of 23). This incid ence was significantly higher than that in patients with normal clomip hene citrate challenge test results (20 of 213) (P < .001). Conclusion s: Approximately 10% of the patients in the general infertility popula tion had abnormal clomiphene citrate challenge tests. The incidence of abnormal results increases with age beginning in the early 30s, occur s with a higher frequency in patients who would otherwise be diagnosed with unexplained infertility, and prognosticates decreased long-term pregnancy rates.