The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review.
OBJECTIVE
To systematically review the value of the clomiphene citrate challenge test (CCCT) in the prediction of poor ovarian response and pregnancy in IVF.


METHODS
Systematic review.


METHODS
All studies that evaluated the CCCT in the prediction of poor ovarian response or pregnancy after IVF.


METHODS
Infertility population undergoing an IVF treatment.


METHODS
None.


METHODS
Poor ovarian response, nonpregnancy.


RESULTS
From the literature we identified and analyzed 12 studies on the CCCT according to preset criteria. In predicting poor response, the sensitivity and specificity of the CCCT varied from 35% to 93% and 47% to 98%, respectively. In predicting nonpregnancy, the sensitivity and specificity varied from 13% to 66% and 73% to 97%, respectively. Because of heterogeneity among studies, a summary receiver operating characteristics (ROC) curve could not be estimated. Back-to-back comparison of the CCCT with basal FSH was possible in six studies. In predicting poor response, the sensitivity of the CCCT increased to some extent, whereas specificity did not increase or even diminished. In predicting nonpregnancy, the CCCT also showed an increase in sensitivity, counteracted by a decrease in specificity.


CONCLUSIONS
Summary estimates of test accuracy for the CCCT in IVF are not possible, because of heterogeneity among individual studies. A subanalysis of studies comparing basal FSH and the full CCCT showed that the CCCT has hardly any additional value.
Hendriks
Dave J
DJ
Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands. hendriks.kuipers@casema.nl
Mol
Ben-Willem J
BW
Bancsi
Laszlo F J M M
LF
te Velde
Egbert R
ER
Broekmans
Frank J M
FJ
D000328:Adult; D002996:Clomiphene; D005260:Female; D005300:Fertility Agents, Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010050:Ovarian Function Tests / Q000379:methods*; D010053:Ovary / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D002996:Clomiphene