title: Achieving and maintaining pregnancy after age 40.
abstract: Demographic data from the United States show the need for testing ovarian reserve in a population that is increasingly delaying reproduction. The childless rate for U.S. women over the age of 35 has nearly doubled to 25% since 1925. Yet, in 1994 approximately one-third of all first births were by women over the age of 35. The first-line treatment for the aging effect on the ovarian reservoir of oocytes is ovulation induction. Study results reveal that a delivery rate of only 2.4% was achieved at age 42, and in 119 cycles of therapy in women above that age there were no live births. The clomiphene citrate challenge test is one method of dynamic testing of ovarian reserve. It has the advantages of simplicity and reduced cost when compared with the gonadotropic stimulatory test. In one test group utilizing the clomiphene citrate challenge test only 4.8% conceived at any age following an abnormal test. As a prognostic test with an approximate 95% accuracy rate for negative predictive value it has much to offer. With oocyte donation becoming more widespread as an acceptable method of achieving pregnancy, clomiphene citrate challenge testing should be performed more frequently, in order to spare couples the emotional and financial sequelae of multiple attempts at ovulation induction and IVF when expected pregnancy rates fall below a level acceptable to both patient and physician.
authors.affiliation: Obstetrics and Gynecology, Thomas Jefferson University School of Medicine, Pennsylvania Hospital, Philadelphia, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Corson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D002996:Clomiphene; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D010050:Ovarian Function Tests; D011247:Pregnancy; D011255:Pregnancy Maintenance; D018566:Pregnancy, High-Risk; D012098:Reproduction
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene; D004958:Estradiol; D005640:Follicle Stimulating Hormone