OBJECTIVE: To systematically review the value of the clomiphene citrate challenge test (CCCT) in the prediction of poor ovarian response and pregnancy in IVF. DESIGN: Systematic review. SETTING: All studies that evaluated the CCCT in the prediction of poor ovarian response or pregnancy after IVF. PATIENT(S): Infertility population undergoing an IVF treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Poor ovarian response, nonpregnancy. RESULT(S): 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. CONCLUSION(S): 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.
OBJECTIVE: To systematically review the value of the clomiphene citrate challenge test (CCCT) in the prediction of poor ovarian response and pregnancy in IVF. DESIGN: Systematic review. SETTING: All studies that evaluated the CCCT in the prediction of poor ovarian response or pregnancy after IVF. PATIENT(S): Infertility population undergoing an IVF treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Poor ovarian response, nonpregnancy. RESULT(S): 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. CONCLUSION(S): 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: Kimiko A Broeze; Brent C Opmeer; Lucas M Bachmann; Frank J Broekmans; Patrick M M Bossuyt; Sjors F P J Coppus; Neil P Johnson; Khalid S Khan; Gerben ter Riet; Fulco van der Veen; Madelon van Wely; Ben W J Mol Journal: BMC Med Res Methodol Date: 2009-03-27 Impact factor: 4.615
Authors: Theodora C van Tilborg; Marinus J C Eijkemans; Joop S E Laven; Carolien A M Koks; Jan Peter de Bruin; Gabrielle J Scheffer; Ron J T van Golde; Kathrin Fleischer; Annemieke Hoek; Annemiek W Nap; Walter K H Kuchenbecker; Petra A Manger; Egbert A Brinkhuis; Arne M van Heusden; Alexander V Sluijmer; Arie Verhoeff; Marcel H A van Hooff; Jaap Friederich; Jesper M J Smeenk; Janet Kwee; Harold R Verhoeve; Cornelis B Lambalk; Frans M Helmerhorst; Fulco van der Veen; Ben Willem J Mol; Helen L Torrance; Frank J M Broekmans Journal: BMC Womens Health Date: 2012-09-18 Impact factor: 2.809