Predictors of chances to conceive in ovulatory patients during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility

The present prospective follow-up study was designed to identify whether cl inical, endocrine, or ultrasound characteristics assessed by standardized i nitial screening of normogonadotropic oligo/amenorrheic infertile patients could predict conception in 160 women who reached ovulation after clomiphen e citrate (CC) medication. Additional inclusion criteria were total motile sperm count of the partner above 1 million and a negative history for any t ubal disease. Daily CC doses of 50 mg (increasing up to 150 mg in case of a bsent ovarian response) from cycle days 3-7 were used. First conception (de fined as a positive urinary pregnancy test) was the end point for this stud y. A cumulative conception rate of 73% was reached within 9 CC-induced ovul atory cycles. Patients who did conceive presented more frequently with lowe r age (P < 0.0001) and amenorrhea (P < 0.05) upon initial screening. In a u nivariate analysis, patients with elevated initial serum LH concentrations (>7.0 IU/L) had a higher probability of conceiving (P < 0.01). In a multiva riate analysis, age and cycle history (oligomenorrhea vs. amenorrhea) were identified as the only significant parameters for prediction of conception. These observations suggest that there is more to be gained from CC ovulatio n induction in younger women presenting with profound oligomenorrhea or ame norrhea. Screening characteristics involved in the prediction of ovulation after CC medication in normogonadotropic oligo/amenorrheic patients (body w eight and hyperandrogenemia, as shown previously) are distinctly different from predictors of conception in ovulatory CC patients (age and the severit y of cycle abnormality). This disparity suggests that the FSH threshold (ma gnitude of FSH required for stimulation of ongoing follicle growth and ovul ation) and oocyte quality (chances for conception in ovulatory cycles) may be differentially regulated.