Despite a well conducted controlled ovarian hyperstimulation (COH) some patients will produce a very small number of follicles. This makes it necessary either to cancel the COH or, if follicle is present, to attempt an IVF procedure, which has a
very
limited chance of success. The detection of these patients before starting an expensive, time-consuming, and rather stressful procedure like IVF is certainly of great interest.
A poor response to COH cannot be anticipated on the basis of clinical parameters such as the patients' ages or the characteristics of their spontaneous menstrual cycles. Because ovarian age does not always correspond to chronological age and many
of
them have a normal ovulatory cycle. By contrast, the endocrine evaluation of these 'poor responders' has revealed that at least some of them present an abnormally elevated basal serum follicle stimulating hormone(FSH), which suggests that they
suffer
from incipient ovarian failure. But variations in FSH from cycle to cycle discourage clinicians from prognosticating stimulation outcome based on one FSH value alone.
We studied to assess ovarian reserve in poor responders by means of serum FSH levels after Clomiphene citrate(CC) administration before COH for IVF, from Jan, 1993 to April 1994. The group studied comprised 94 patients 115 cycles for IVF and who
applied
to patients 35 years or older, patients with extensive pelvic adhesion, ovarian endometriosis, or patients with only ovary patients elevated basal FSH level.
The abnormal CC challenge test resulted in 28.6%, 28.6% and 42.9% of the patients in the age groups younger than 30, 31~34, 35 and older, respectively(p<0.01). In the abnormal response group, the FSH levels were significantly higher before CC
administration compared with normal response group(p<0.001). The E2 level was no difference before CC in the two groups, the E2 level after CC was significantly higher with a normal response group(p<0.001).
The cancellation rate per cycle were 15.4% in abnormal response group, 3.2% in normal response group, the cancellation rate was higher in the abnormal response group(p<0.05). The number of oocyte retricved and embryos obtained in the normal
response
group were significantly higher than abnormal response group(p<0.05). Eighteen clinical pregnancies were obtained in the normal response group, however, no pregnancies in the abnormal reponse group. The percentage of oocytes of high quality(Grade
I, II)
was 73.7% in normal response group, 18.5% in abnormal response group. The oocytes quality in the normal response group was better than in the abnormal response group.
We concluded that the FSH response to CC administration combined with basal level of FSH was good prognostic value of subsequent COH for IVF. We may suggest that CC challenge test is used to evaluate ovarian reserve before IVF especially in
patients of
35 years or more and in all patients who have ovarian surgery or have ovarian endometriosis.
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