title: Predictive usefulness of cycle day 10 follicle-stimulating hormone level in a clomiphene citrate challenge test for in vitro fertilization outcome in women younger than 40 years of age.
abstract: OBJECTIVE
  To determine the usefulness of the day 10 FSH level of a clomiphene citrate challenge test in predicting IVF outcome in women younger than 40 years of age.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Academic fertility center.
  
  
  METHODS
  Three hundred fifty-three women younger than 40 years of age undergoing 483 IVF cycles.
  
  
  METHODS
  Delivery rates.
  
  
  RESULTS
  An inverse relationship was observed between the likelihood of successful pregnancy and both cycle day 3 and cycle day 10 FSH levels. In women with a normal day 3 FSH level, elevated day 10 FSH levels predicted similarly poor IVF outcomes as for women with an abnormal day 3 FSH level. There was no specific threshold FSH level beyond which pregnancies failed to occur. Successful pregnancies were achieved with aggressive stimulation even in women with FSH levels greater than 20 mIU/mL.
  
  
  CONCLUSIONS
  The clomiphene citrate challenge test (CCCT) correlates with IVF outcomes in women younger than 40 years of age. Stimulated day 10 FSH levels are strongly predictive of decreased IVF success even when day 3 FSH levels are normal. Results of the CCCT are useful for patient counseling before the IVF cycle and for choosing the optimal gonadotropin regimen.
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. eyanushpolsky@partners.org
authors.forename: Elena H
authors.initials: EH
authors.lastname: Yanushpolsky
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.forename: Eugene
authors.initials: E
authors.lastname: Tikh
authors.forename: Catherine
authors.initials: C
authors.lastname: Racowsky
mesh_terms: D000328:Adult; D000367:Age Factors; D002996:Clomiphene / Q000494:pharmacology*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000592:standards; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008597:Menstrual Cycle / Q000502:physiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology*; D013997:Time Factors
chemical_list: D020845:Selective Estrogen Receptor Modulators; D002996:Clomiphene; D005640:Follicle Stimulating Hormone