Jain Tarun, Soules Michael R, Collins John A
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Fertil Steril. 2004 Jul;82(1):180-5. doi: 10.1016/j.fertnstert.2003.11.045.
To compare the value of basal follicle-stimulating hormone (FSH) measurement vs. the clomiphene citrate challenge test (CCCT) in predicting the ability to achieve a pregnancy in women who are undergoing infertility treatment.
Meta-analysis.
All studies that evaluated either basal FSH or the CCCT for determining the likelihood of pregnancy.
PATIENT(S): Infertility population undergoing treatment, which was defined as patients undergoing ovulation induction, IUI, or in vitro fertilization (IVF).
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Diagnostic test characteristics were calculated and pooled using standard methods. Inability to achieve a pregnancy with treatment was considered as the "disease."
RESULT(S): Twelve studies on basal FSH (with 6296 patients, mean age 33.8) and seven studies on the CCCT (with 1352 patients, mean age 34.5) fit our criteria and were analyzed. For basal FSH and the CCCT, the sensitivities were 6.6% (95% confidence interval [CI] 5.9, 7.3%) and 25.9% (95% CI 23.0, 29.0%), respectively, and specificities were 99.6% (95% CI 99.1, 99.9%) and 98.1% (95% CI 96.5, 99.1%), respectively. For "disease" prevalence ranging from 40%-100%, for basal FSH and the CCCT, the positive predictive values ranged from 91.7%-100% and 90.1%-100%, respectively, and negative predictive values ranged from 61.5%-0.0% and 66.5%-0.0%, respectively.
CONCLUSION(S): Basal FSH and the CCCT are similar in predicting the ability to achieve a clinical pregnancy in women undergoing infertility treatment. With either test, a normal result is not useful, but an abnormal result virtually confirms that pregnancy will not occur with treatment.
比较基础促卵泡激素(FSH)测定与枸橼酸氯米芬激发试验(CCCT)在预测接受不孕症治疗的女性实现妊娠能力方面的价值。
荟萃分析。
所有评估基础FSH或CCCT以确定妊娠可能性的研究。
接受治疗的不孕症人群,定义为接受排卵诱导、宫腔内人工授精(IUI)或体外受精(IVF)的患者。
无。
使用标准方法计算并汇总诊断试验特征。治疗后未实现妊娠被视为“疾病”。
12项关于基础FSH的研究(6296例患者,平均年龄33.8岁)和7项关于CCCT的研究(1352例患者,平均年龄34.5岁)符合我们的标准并进行了分析。对于基础FSH和CCCT,敏感性分别为6.6%(95%置信区间[CI]5.9,7.3%)和25.9%(95%CI 23.0,29.0%),特异性分别为99.6%(95%CI 99.1,99.9%)和98.1%(95%CI 96.5,99.1%)。对于患病率在40%-100%之间的“疾病”,对于基础FSH和CCCT,阳性预测值分别为91.7%-100%和90.1%-100%,阴性预测值分别为61.5%-0.0%和66.5%-0.0%。
基础FSH和CCCT在预测接受不孕症治疗的女性实现临床妊娠的能力方面相似。无论采用哪种测试,正常结果都没有帮助,但异常结果几乎可以确认治疗后不会发生妊娠。