CLOMIPHENE CITRATE CHALLENGE TEST IN THE ASSESSMENT OF OVARIAN RESERVE BEFORE CONTROLLED OVARIAN HYPERSTIMULATION FOR INTRACYTOPLASMIC SPERM INJECTION

The objective of this study is to evaluate the performance of clomiphe ne citrate (CC) challenge test to predict diminished ovarian reserve b efore controlled ovarian hyperstimulation for intracytoplasmic sperm i njection (ICSI). The 198 women who underwent the CC challenge test ful filled the following criteria; over 35 years of age, removal of one ov ary or previous ovarian surgery, the presence of ovarian endometrioma or previous poor response to ovarian hyperstimulation. Of the patients tested, 141 were found to have a normal CC challenge test while 57 ha d an abnormal result. The cancellation rate of the;cycle with a poor r esponse was significantly higher in women with an abnormal test (36.8% ) than in those with a, normal test (19.8%) (P < 0.05). The sensitivit y of CC test for cycle cancellation was found to be 43% with a specifi city of 76%, positive and negative predictive values of 37 and 80%, re spectively. The estradiol values an hCG day, the number of retrieved o ocytes and metaphase II oocytes and the rate of transfer cycles were s ignificantly lower in females with an abnormal test. Women with normal test results had higher pregnancy rates per embryo transfer than thos e with abnormal test results (21.5 vs. 13.3%) and the predictive value of an abnormal test for failing to conceive was 93% (53/57) with a se nsitivity of 31%, specificity of 84% and negative predictive value of 15.6%. Of 57 women with an abnormal test result, 25 (43.8%) were abnor mal due only to an elevated day 10 or II value-of FSH, which could not be detected using only basal FSH screening. In this group, the cancel lation rate (48 vs. 19.8%, P < 0.01), the rate of transfer cycles (48 vs. 72.3%, P < 0.05) and the mean number of retrieved oocytes (4.9 +/- 2.5 vs. 6.4 +/- 3.1, P < 0.01) were all significantly different from normal lest group. Although the rate of pregnancies per started cycle (8 vs. 15.6%) did not show a statistically significant difference, thi s is most probably due to the low number of patients. In conclusion, a n abnormal CC challenge test is a good predictor of diminished ovarian reserve and it is better than a basal FSH concentration on day 3. It provides valuable information for both patients as to their chances of achieving a pregnancy and also for the medical team deciding on optio ns for stimulation protocols. (C) 1997 Elsevier Science Ireland Ltd.