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Korean Journal of Obstetrics & Gynecology 1999;42(4):871-879.
Published online January 1, 2001.
Prediction of Ovarian Response to Controlled Ovarian Hyperstimulation by Means of Clomiphene Citrate Challenge Test in Intrauterine Insemination Program.
S H Kim, S H Choi, B C Jee, C S Suh, Y M Choi, J K Kim, S Y Moon, J Y Lee
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.
Key Words: Controlled ovarian hyperstimulation[COH], Intrauterine insemination[IUI], Clomiphene citrate challenge test[CCCT], Serum FSH, Age, Ovarian response, Fecundity


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