Clinical and Laboratory Evaluation of Women with Abnormal Clomiphene Citrate Challenge Test

Abstract

Background: 
About one of each ten couples is subfertile. Ovulation disorders underline about  30%  of  female  subfertility. Ovarian  follicles  depletion  and  poor oocyte quality is known as diminishing ovarian reserve. 
This  study  was  conducted  with  the  aim  to  determine  the  clinical  and laboratory attributes of women with abnormal clomiphene citrate challenge test and diminished ovarian reserve.
Patients and methods: One hundred eight women of 22-50 years old were studied  including  those  with  primary,  secondary  infertility  or  recurrent pregnancy loss. All women were tested by Clomiphine Citrate Challenge (CCC) test after estimation of day 3 serum FSH, then the patients received 100 mg clomiphene citrate on day 5 to 9 and again serum FSH level was measured on day 10 of the cycle. Serum progesterone was also evaluated on cycle day 21 .
RESULTS: From a total of 108 women involved in the study, 72 women had normal CCC test and 36 abnormal CCC test. Out of 36 women, 11 had abnormal CCC test depending on day 10 of the cycle alone. Among women with  abnormal  CCC  test,  (91.6%)  were  over  the  age  35  years  versus (41.7%) in the normal group. The discripancy in the onset of menarche was statistically insignificant. Finally the pregnancy rate was 25% in normal group compared to 5% for abnormal group.
CONCLUSIONS: This study revealed that women with certain clinical and laboratory attributes need to be evaluated for ovarian reserve including: Women older than 35 year, Menstrual cycle span under 26 days especially in patients older than 35 years, Unexplained infertility, endometriosis or previous ovarian surgery.