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.
Hofmann
Glen E
GE
Bethesda Center for Reproductive Health and Infertility, Bethesda Hospital, Cincinnati, Ohio 45242, USA. hofmannge@aol.com
Sosnowski
James
J
Khoury
Jane
J
Kearns
Leanna
L
Thie
Jennifer
J
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