Obstetric implications for and identification of women with a normal clomiphene citrate challenge test result who have a poor response to gonadotropins.
OBJECTIVE
To determine the incidence and obstetric implications and to identify prospectively women with a poor response to hMG with a normal clomiphene citrate challenge test (CCCT) result.


METHODS
Retrospective chart review.


METHODS
Tertiary fertility center.


METHODS
One hundred sixty-three women who underwent ovulation induction with hMG for IUI, and 266 women who underwent ovulation induction with GnRH analogue and hMG for IVF. All had a CCCT before stimulation. Seventy-five percent of IUI patients (123 of 163) and 89% of IVF patients (238 of 266) had normal CCCT results. A poor response to hMG was defined as a response less than the 90th percentile of women with an abnormal CCCT result (peak E(2) [pg/mL] level per ampule hMG used: 90th percentile </=30).


METHODS
Clomiphene citrate challenge test and ovulation induction for IUI or IVF.


METHODS
Response to gonadotropins and pregnancy outcome after treatment.


RESULTS
Thirty-five percent of IUI patients (43 of 123) and 52% of IVF patients (123 of 238) with a normal CCCT result had a poor response to hMG. Intrauterine insemination patients with a poor response to hMG had significantly lower delivery rates than IUI patients with a normal response (19% vs. 39%). In vitro fertilization patients with a poor response to hMG had similar delivery rates compared with IVF patients with a normal response (32% vs. 35%). For both groups of patients, an FSH >12 mIU/mL (IMx assay) on either day 3 or day 10 (normal </=14.5 IMx) was highly predictive of a poor response to hMG, the elevated FSH level being a much better predictor than the woman's age.


CONCLUSIONS
A poor response to hMG with a normal CCCT result (false negative) is a common event. A day-3 or day-10 FSH >12 mIU/mL (IMx assay) or 20 mIU/mL (converted to the original RIA) will identify approximately 80% (IUI) and approximately 94% (IVF) of the women who will experience a poor response to hMG. When identified, the data suggest that these patients will benefit significantly from the more aggressive IVF.
Bethesda Center for Reproductive Health and Infertility, Bethesda Hospital, Cincinnati, Ohio 45242, USA. hofmannge@aol.com
Glen E
GE
Hofmann
James
J
Sosnowski
Jane
J
Khoury
Leanna
L
Kearns
Jennifer
J
Thie
D000328:Adult; D000367:Age Factors; D002996:Clomiphene / Q000494:pharmacology*; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000494:pharmacology; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007231:Infant, Newborn; D007315:Insemination, Artificial / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008596:Menotropins / Q000008:administration & dosage*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D012372:ROC Curve; D012189:Retrospective Studies
D005300:Fertility Agents, Female; D002996:Clomiphene; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone