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A Clinical Trial to Determine the Effect of Lutropin Alfa on Embryo Quality and Implantation Rate in Advanced Reproductive Age

Primary Purpose

Infertility, Ovulation Induction

Status

Terminated

Phase

Phase 2

Locations

Spain

Study Type

Interventional

Intervention

Recombinant human luteinizing hormone (rhLH)

Recombinant follicle-stimulating hormone (rFSH)

About this trial

This is an interventional treatment trial for Infertility focused on measuring Infertility, Ovulation induction, Luveris, Controlled ovarian stimulation, Reproductive technologies, assisted

Eligibility Criteria

35 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

Pre-menopausal female subject aged greater than (>) 35 years
Subjects with baseline FSH serum level less than or equal to (<=) 10 IU/liter (l), LH and E2 levels within local normal range and plasma prolactin levels < 30 nanogram/milliliter (ng/ml)
Subjects with regular spontaneous menstrual cycles of 25-35 days
Subjects with infertility justifying IVF/ICSI-ET treatment
Subjects programmed for COS with r-FSH under GnRH agonist protocol
Sperm from current male partner suitable for IVF/ICSI according to local lab, unless sperm donor is foreseen
Subjects with presence of both ovaries
Subjects whose uterine cavity is able to sustain embryo implantation or pregnancy
Subjects with normal papanicolaou test (PAP) smear within previous 3 years
Subjects with body mass index (BMI) < 30 at stimulation start
Subjects who receive confirmation of not being pregnant by a negative beta-hCG test (urine or blood) prior to starting r-FSH administration
Subjects willing and able to comply with the protocol for the duration of the study
Subjects who have given informed consent prior to any study-related procedure not part of normal medical care

Exclusion Criteria:

Subjects or her male partners who are known to be human immunodeficiency virus, hepatitis B virus or hepatitis C virus positive
Subjects with any clinically significant systemic disease; tumors of the hypothalamus and pituitary gland; ovarian, uterine or mammary cancer; hormonal abnormality and/or medical, biochemical, hematological condition which in the judgment of the investigator may interfere with gonadotropin treatment
Subjects with more than 2 previous assisted reproductive technologies (ART) cycles
Subjects in which previous cycles were cancelled due to poor response (< 3 antral follicles after 15 day of stimulation)
Subjects with cryopreserved embryos from previous ART cycles
Subjects with unexplained gynecological bleeding
Subjects with polycystic ovaries, ovarian enlargement or cyst of unknown etiology
Subjects known to have any contraindication to being pregnant and/or carrying pregnancy to term
Subjects with known allergy to gonadotrophin preparations or any of the excipients
Subjects known to have any active substance abuse or history of drug, medication or alcohol abuse in the past 5 years
Subjects with previous entry into this study or simultaneous participation in another clinical drug trial
Subjects who have refused to or inability to comply with the protocol

Sites / Locations

FivMadrid, C/ Marqués de Urquijo, 26,

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

rFSH + rhLH

rFSH

Arm Description

Recombinant human luteinizing hormone (rhLH,Luveris®) injection 150 IU subcutaneously daily along with rFSH 300 IU subcutaneously daily from S1 to S4 and then rFSH dose can be adjusted depending on the ovarian response till r-hCG administration day.

rFSH injection 300 IU subcutaneously daily from S1 to S4 and then dose can be adjusted depending on the ovarian response till r-hCG administration day.

Outcomes

Primary Outcome Measures

Implantation Rate

Implantation rate was measured as the number of gestational sacs observed, divided by the number of embryos transferred.

Secondary Outcome Measures

Mean Number of Follicles Greater Than or Equal to 14 Millimeter (mm) on Recombinant Human Choriogonadotropin (r-hCG) Day

Mean Number of Oocytes Retrieved

Mean number of oocytes retrieved per reporting group on the day of OPU (34-38 hours post r-hCG day (end of stimulation cycle [approximately 28 days]) was calculated. Oocyte retrieval is a technique used in in-vitro fertilization in order to remove oocytes from the ovary of the female, enabling fertilization outside the body.

Number of Mature Oocytes Retrieved

Number of mature oocytes retrieved per reporting group on the day of OPU (34-38 hours post r-hCG day (end of stimulation cycle [approximately 28 days]) was calculated. Oocyte retrieval is a technique used in in-vitro fertilization in order to remove oocytes from the ovary of the female, enabling fertilization outside the body. The nuclear maturity was evaluated based on the presence of a germinal vesicle (GV) or whether oocytes were in metaphase I (Meta-I) or II (Meta-II) stage.

Number of Fertilized Oocytes (2 Pronuclei [PN])

Oocytes were fertilized using Intra-cytoplasmic Sperm Injection (ICSI) technique which is an in-vitro fertilization procedure in which a single sperm is injected directly into an egg under a microscope. The appearance of two 2PN is the first sign of successful fertilization as observed during in vitro fertilization, and is usually observed after ICSI. The zygote is then termed 2PN.

Number and Quality of Embryos

Embryos were graded according to Spanish Association for the Study of Reproductive Biology (ASEBIR) criteria into different categories: (A) optimal quality with maximum capacity for implantation, (B) good quality with a high capacity for implantation, (C) regular with low possibility of implantation and (D) poor quality with very little possibility of implantation.

Number of Participants With Biochemical Pregnancies

Biochemical pregnancy was defined as a pregnancy diagnosed only by the detection of hCG in serum or urine and that does not develop into a clinical pregnancy.

Number of Participants With Clinical Pregnancies

Clinical pregnancy was defined as pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. It includes ectopic pregnancy.

Total Dose of Recombinant Follicle Stimulating Hormone (r-FSH)

Estradiol (E2) Levels on r-hCG Day

Number of Ovarian Stimulation Days

Ovarian stimulation included from first rFSH injection (S1) until day on which r-hCG was administered (r-hCG day). This period was divided into 2 parts: the first period in which 300 International Unit (IU) rFSH dose was constant and which covered from S1 to Day 4 of stimulation period (S4); the second period in which the rFSH dose could be adjusted depending on the ovarian response and which began on S4 and finished on the day on which the criteria for administration of r-hCG to induce the final follicular maturation were met.

Number of Recombinant Human Choriogonadotropin (r-hCG) Cycles Cancelled Due to Poor Response

Poor response was defined as 3 or less follicles of greater than or equal to 12 mm developing following at least 7 days of study treatment.

Total Number of Births

Total number of births per reporting group was calculated.

Number of Participants With Adverse Events (AEs)

An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship.

Number of Participants With Ovarian Hyper Stimulation Syndrome (OHSS)

OHSS is a syndrome which can manifest with enlarged ovaries, advanced ascites with increased vascular permeability, pleural fluid accumulation, hemoconcentration, and increased blood clotting.

Number of Cycles Cancelled Due to Risk of Ovarian Hyper Stimulation Syndrome (OHSS)

OHSS is a syndrome which can manifest with enlarged ovaries, advanced ascites with increased vascular permeability, pleural fluid accumulation, hemoconcentration, and increased blood clotting.

Full Information

NCT ID

NCT01075815

First Posted

February 24, 2010

Last Updated

January 20, 2014

Sponsor

Merck KGaA, Darmstadt, Germany

Collaborators

Merck, S.L., Spain

1. Study Identification

Unique Protocol Identification Number

NCT01075815

Brief Title

A Clinical Trial to Determine the Effect of Lutropin Alfa on Embryo Quality and Implantation Rate in Advanced Reproductive Age

Official Title

Exploratory Study to Determine the Effect of Lutropin Alfa on Embryo Quality and Their Implantation in Women of Advanced Reproductive Age

Study Type

Interventional

2. Study Status

Record Verification Date

January 2014

Overall Recruitment Status

Terminated

Study Start Date

November 2008 (undefined)

Primary Completion Date

October 2010 (Actual)

Study Completion Date

October 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

Merck KGaA, Darmstadt, Germany

Collaborators

Merck, S.L., Spain

4. Oversight

Data Monitoring Committee

5. Study Description

Brief Summary

This is a multicentric, open, randomized, comparative trial aimed to assess the influence of recombinant luteinizing hormone (r-LH) supplementation during controlled ovarian stimulation (COS) in advanced reproductive age in terms of improved embryo competence which allows to transfer less embryos to avoid high grade multiple pregnancy without reducing the pregnancy rate.

Detailed Description

This study will be carried out by the Grupo de Interés de Salud Embrionaria (GISE) group (part of the Spanish Fertility Society) who uses strict criteria to select the embryos most suitable for successful transference. OBJECTIVES Primary objective: To determine the benefit of r-LH supplementation in COS prior to in-vitro fertilization (IVF)/intracytosolic sperm injection (ICSI) in advanced reproductive age, in terms of embryo competence to implant, as compared against no r-LH supplementation Secondary objectives: To evaluate the benefit of r-LH supplementation in COS, in terms of: follicular development length of the stimulation oocyte number and their maturity fertilization rate embryo number and quality gestational sacs abortion ongoing pregnancies local and systemic safety of r-LH administration The study will consist of 2 groups randomized in 1:1 ratio and each subject would be followed up until the confirmation of her pregnancy status. Each subject will be administered gonadotropin releasing hormone (GnRH) agonist subcutaneously daily from previous mid luteal phase to r-hCG administration as a standard practice to achieve down regulation. Each subject will also be administered recombinant follicle stimulating hormone (r-FSH) at a starting dose of 300 IU from S1 up to ovarian stimulation completion (r-hCG day) as a part of standard practice. In addition to the above concurrent therapies, one group will be administered experimental treatment (Luveris®) and the other group (control group) will not be administered any other drug (control treatment) during the stimulation period from stimulation start (S1) up to ovarian stimulation completion or stimulation cancellation respectively. Ovarian stimulation on an average takes 11 days and it is expected that stimulation period will not be extended beyond 15 days. A single injection of r-hCG will be administered intramuscularly or subcutaneously after the last injection of Luveris or r-FSH to achieve final follicular maturation. After, 34-36 hours of administration of r-hCG OPU will be done for oocyte retrieval and embryo transfer (ET) will be conducted within 5 days from OPU. Subjects will also be provided luteal support with natural progesterone and will be followed until delivery or miscarriage. Ultrasound and estradiol (E2) assessment of follicular growth will be conducted at various time points during the stimulation period with or without treatment adjustment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Infertility, Ovulation Induction

Keywords

Infertility, Ovulation induction, Luveris, Controlled ovarian stimulation, Reproductive technologies, assisted

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Parallel Assignment

Masking

None (Open Label)

Allocation

Randomized

Enrollment

76 (Actual)

8. Arms, Groups, and Interventions

Arm Title

rFSH + rhLH

Arm Type

Experimental

Arm Description

Arm Title

rFSH

Arm Type

Active Comparator

Arm Description

rFSH injection 300 IU subcutaneously daily from S1 to S4 and then dose can be adjusted depending on the ovarian response till r-hCG administration day.

Intervention Type

Drug

Intervention Name(s)

Recombinant human luteinizing hormone (rhLH)

Other Intervention Name(s)

Luveris®, Lutropin alfa

Intervention Type

Drug

Intervention Name(s)

Recombinant follicle-stimulating hormone (rFSH)

Primary Outcome Measure Information:

Title

Implantation Rate

Description

Implantation rate was measured as the number of gestational sacs observed, divided by the number of embryos transferred.

Time Frame

Day 35-42 post ovum pick-up (OPU) (34-38 hours post recombinant human choriogonadotropin day {end of stimulation cycle}[approximately 28 days])

Secondary Outcome Measure Information:

Title

Mean Number of Follicles Greater Than or Equal to 14 Millimeter (mm) on Recombinant Human Choriogonadotropin (r-hCG) Day

Time Frame

r-hCG day (end of stimulation cycle [approximately 28 days])

Title

Mean Number of Oocytes Retrieved

Description

Time Frame

34-38 hours post r-hCG day (end of stimulation cycle [approximately 28 days])

Title

Number of Mature Oocytes Retrieved

Description

Time Frame

34-38 hours post r-hCG day (end of stimulation cycle [approximately 28 days])

Title

Number of Fertilized Oocytes (2 Pronuclei [PN])

Description

Time Frame

34-38 hours post r-hCG day (end of stimulation cycle [approximately 28 days])

Title

Number and Quality of Embryos

Description

Time Frame

Day 2-3 post OPU (34-38 hours post r-hCG day {end of stimulation cycle}[approximately 28 days])

Title

Number of Participants With Biochemical Pregnancies

Description

Biochemical pregnancy was defined as a pregnancy diagnosed only by the detection of hCG in serum or urine and that does not develop into a clinical pregnancy.

Time Frame

2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

Title

Number of Participants With Clinical Pregnancies

Description

Clinical pregnancy was defined as pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. It includes ectopic pregnancy.

Time Frame

2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

Title

Total Dose of Recombinant Follicle Stimulating Hormone (r-FSH)

Time Frame

2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

Title

Estradiol (E2) Levels on r-hCG Day

Time Frame

r-hCG day (end of stimulation cycle [approximately 28 days])

Title

Number of Ovarian Stimulation Days

Description

Time Frame

S1 up to r-hCG day (end of stimulation cycle [approximately 28 days])

Title

Number of Recombinant Human Choriogonadotropin (r-hCG) Cycles Cancelled Due to Poor Response

Description

Poor response was defined as 3 or less follicles of greater than or equal to 12 mm developing following at least 7 days of study treatment.

Time Frame

Up to 2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

Title

Total Number of Births

Description

Total number of births per reporting group was calculated.

Time Frame

Up to 2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

Title

Number of Participants With Adverse Events (AEs)

Description

An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship.

Time Frame

Baseline up to 2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

Title

Number of Participants With Ovarian Hyper Stimulation Syndrome (OHSS)

Description

OHSS is a syndrome which can manifest with enlarged ovaries, advanced ascites with increased vascular permeability, pleural fluid accumulation, hemoconcentration, and increased blood clotting.

Time Frame

Baseline up to 2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

Title

Number of Cycles Cancelled Due to Risk of Ovarian Hyper Stimulation Syndrome (OHSS)

Description

OHSS is a syndrome which can manifest with enlarged ovaries, advanced ascites with increased vascular permeability, pleural fluid accumulation, hemoconcentration, and increased blood clotting.

Time Frame

Baseline up to 2 months after OPU (34-38 hours post r-hCG day {end of stimulation cycle} [approximately 28 days])

10. Eligibility

Sex

Female

Minimum Age & Unit of Time

35 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Pre-menopausal female subject aged greater than (>) 35 years Subjects with baseline FSH serum level less than or equal to (<=) 10 IU/liter (l), LH and E2 levels within local normal range and plasma prolactin levels < 30 nanogram/milliliter (ng/ml) Subjects with regular spontaneous menstrual cycles of 25-35 days Subjects with infertility justifying IVF/ICSI-ET treatment Subjects programmed for COS with r-FSH under GnRH agonist protocol Sperm from current male partner suitable for IVF/ICSI according to local lab, unless sperm donor is foreseen Subjects with presence of both ovaries Subjects whose uterine cavity is able to sustain embryo implantation or pregnancy Subjects with normal papanicolaou test (PAP) smear within previous 3 years Subjects with body mass index (BMI) < 30 at stimulation start Subjects who receive confirmation of not being pregnant by a negative beta-hCG test (urine or blood) prior to starting r-FSH administration Subjects willing and able to comply with the protocol for the duration of the study Subjects who have given informed consent prior to any study-related procedure not part of normal medical care Exclusion Criteria: Subjects or her male partners who are known to be human immunodeficiency virus, hepatitis B virus or hepatitis C virus positive Subjects with any clinically significant systemic disease; tumors of the hypothalamus and pituitary gland; ovarian, uterine or mammary cancer; hormonal abnormality and/or medical, biochemical, hematological condition which in the judgment of the investigator may interfere with gonadotropin treatment Subjects with more than 2 previous assisted reproductive technologies (ART) cycles Subjects in which previous cycles were cancelled due to poor response (< 3 antral follicles after 15 day of stimulation) Subjects with cryopreserved embryos from previous ART cycles Subjects with unexplained gynecological bleeding Subjects with polycystic ovaries, ovarian enlargement or cyst of unknown etiology Subjects known to have any contraindication to being pregnant and/or carrying pregnancy to term Subjects with known allergy to gonadotrophin preparations or any of the excipients Subjects known to have any active substance abuse or history of drug, medication or alcohol abuse in the past 5 years Subjects with previous entry into this study or simultaneous participation in another clinical drug trial Subjects who have refused to or inability to comply with the protocol

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Medical Responsible

Organizational Affiliation

Merck, S.L., Spain

Official's Role

Study Director

Facility Information:

Facility Name

FivMadrid, C/ Marqués de Urquijo, 26,

City

Madrid

ZIP/Postal Code

28008

Country

Spain

12. IPD Sharing Statement

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A Clinical Trial to Determine the Effect of Lutropin Alfa on Embryo Quality and Implantation Rate in Advanced Reproductive Age

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