title: The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review.
abstract: 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.
authors.affiliation: Department of Reproductive Medicine, Division of Obstetrics, Neonatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands. hendriks.kuipers@casema.nl
authors.forename: Dave J
authors.initials: DJ
authors.lastname: Hendriks
authors.forename: Ben-Willem J
authors.initials: BW
authors.lastname: Mol
authors.forename: Laszlo F J M M
authors.initials: LF
authors.lastname: Bancsi
authors.forename: Egbert R
authors.initials: ER
authors.lastname: te Velde
authors.forename: Frank J M
authors.initials: FJ
authors.lastname: Broekmans
mesh_terms: 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
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene