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Clinical Evaluation of a Tubal Selective Delivery System

Primary Purpose

Infertility of Tubal Origin

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Tubal Selective Delivery System (TSDS)
Sponsored by
Oregon Health and Science University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional screening trial for Infertility of Tubal Origin

Eligibility Criteria

18 Years - 50 Years (Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria: Literate in English Able to understand and sign an IRB-approved informed consent form Willing to complete a pre-procedure questionnaire Regular menstrual cycles (24- 38 days) Good general health Able and willing to comply with all study tests, procedures, and assessment tools Uterine sound size between 6 - 10 cm Agree to use a non-hormonal method of contraception or avoid vaginal intercourse during the catheter evaluation cycle In compliance with cervical cancer screening guidelines per the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines without evidence of disease. Alternatively, the subject must have had a colposcopy performed within the appropriate screen time frame, and prior to the study catheter insertion that showed no evidence of dysplasia requiring treatment or further diagnostic procedures or follow-up for at least 6 months Exclusion Criteria: Currently pregnant as confirmed by positive high-sensitivity urine pregnancy test Currently using hormonal contraception. Must have at least one natural cycle (two menses) prior to participation if recently discontinued hormonal contraception. Currently using an intrauterine device (IUD). Must discontinue at least 30 days prior to Visit 2 Allergy or hypersensitive to radio-opaque contrast, ExEm foam, both doxycycline and azithromycin (allergy to one not exclusionary if can take the alternative), or lidocaine History or physical findings recognized as clinically significant by the investigator, such as symptoms of untreated or recent pelvic infection History of involuntary female infertility History of gynecologic surgery involving the uterus, fallopian tubes, or ovaries (except single cesarean section) History of prior permanent contraception procedure (any technique, abdominal laparoscopic, or hysteroscopic) Pelvic exam findings considered clinically-significant by the investigator such as uterine fibroids, pelvic tenderness, or prolapse Inability to tolerate placement of a tenaculum and/or uterine sound during screening exam Any congenital or acquired uterine anomaly that may complicate study drug placement, such as: Submucosal uterine leiomyoma Asherman's syndromes Pedunculated polyps Bicornuate uterus Didelphys or uterine septa Any distortions of the uterine cavity (e.g., fibroids), that, in the opinion of the investigator, are likely to cause issues during insertion, use or removal of the TSDS. Known anatomical abnormalities of the cervix such as severe cervical stenosis, prior trachelectomy or extensive conization that, in the opinion of the investigator would prevent cervical dilation and device placement Untreated or unresolved acute cervicitis or vaginitis Known or suspected human immunodeficiency virus (HIV) infection or clinical AIDS Screening transabdominal or transvaginal ultrasound findings with poor imaging quality, or anatomic abnormalities considered clinically important or likely to interfere with assessment of the test device, as assessed by the investigator

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Tubal Selective Delivery System

    Arm Description

    The same intervention will be used for all study subjects.

    Outcomes

    Primary Outcome Measures

    Clinical performance of catheter during insertion of device
    Clinician impression of catheter performance during insertion of device. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Clinician can place the insertion tube transcervically without dilation, and advance the obturator to expand the device without the use of imaging guidance. Acceptable: Cervical dilation required, but easy to advance the obturator to expand the device without the use of imaging guidance Fail: Unable to place the insertion tube
    Expansion of arms and dual catheters
    Expansion of arms and dual catheters in the two uterine cornua. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Arms extend into bilateral cornua following transcervical insertion after initial expansion. Ultrasound confirms extension but is not needed Acceptable: Ultrasound is required to position arms, but expansion is successful after one or two attempts. Fail: Clinician is unable to position arms into cornua.
    Inflation of dual balloons
    Inflation of the dual balloons. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Inflation of the dual balloons on first attempt by the clinician with no leakage or bad connections. This is confirmed by ultrasound. Acceptable: Inflation requires more than one attempt but is ultimately successful. Fail: Clinician is unable to inflate balloons due to high pressure or subject pain.
    Delivery of saline
    Delivery of saline. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Successful administration of saline at low pressure (confirmed by ultrasound) with no leakage or bad connections. Acceptable: Some leakage of saline, but clinician is able to observe flow in tubes. Fail: Clinician unable to administer saline due to high pressure/pain, leakage or bad connections.
    Delivery of ExEm foam
    Delivery of ExEm foam. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Delivery of foam at low pressure with confirmation of tubal patency via ultrasound and with no leakage or bad connections. Acceptable: Some leakage of ExEm in uterine cavity, but clinician is able to observe flow in tubes. Fail: Clinician unable to administer ExEm due to high pressure/pain, leakage or bad connections.
    Clinician impression of device removal
    Clinician impression of device removal. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Clinician can deflate balloons, collapse frame, and withdraw insertion tube without difficulty at the end of procedure without the use of imaging guidance.

    Secondary Outcome Measures

    Tolerability and ease of use - Provider experience evaluation
    The clinician placing the device will evaluate ease of use using a series of 100 mm visual analog scale (anchors: 0 extremely easy; 100 extremely difficult/impossible) to evaluate these questions: Was the device easy to insert transcervically? Was inflation of the balloons easy? Was deliver of saline easy? Was deliver of ExEm foam easy? Was removal easy?
    Tolerability and ease of use - Patient experience evaluation
    Participants will indicate maximum level of pain experienced during study procedures using 100 mm visual analogue scale (VAS) at various time points. We will compare pain with placement, treatment, and removal to several baseline assessments. VAS scales: Baseline expectation of pain, baseline pain immediately following speculum placement, baseline pain immediately prior to placement, pain associated with insertion, pain associated with balloon inflation, pain associated with administration of saline, pain associated with administration of ExEm foam, pain associated with complete device removal, pain 15 minutes after completion of procedure, overall satisfaction with procedure, willingness to recommend procedure to a friend.

    Full Information

    First Posted
    September 22, 2022
    Last Updated
    September 10, 2023
    Sponsor
    Oregon Health and Science University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05775913
    Brief Title
    Clinical Evaluation of a Tubal Selective Delivery System
    Official Title
    Development of an Intrauterine Selective Balloon Catheter System for Transcervical Delivery of Selected Agents to the Fallopian Tube
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    December 2023 (Anticipated)
    Primary Completion Date
    February 2024 (Anticipated)
    Study Completion Date
    May 2024 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Oregon Health and Science University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    A single center study to evaluate the performance and optimize the design of a novel intrauterine catheter system intended as a nonsignificant risk medical device to aid in evaluating tubal patency as part of the initial diagnostic workup for infertility.
    Detailed Description
    In this study, the investigators will perform transcervical placement of a novel tubal selective delivery catheter system in a controlled clinical setting, using ultrasound imaging to evaluate device performance in a short procedure that will not require sedation or general anesthesia (local anesthesia may be used). The investigator will confirm the position of the device, inflate the balloons, and administer a small volume (10 mL) of an FDA-approved contrast foam. The investigator will then remove the device at the end of the procedure. This study will evaluate performance of the device, ease of use, and patient experience. It will also evaluate the patient experience before, during, and after the procedure. This device is meant to be used to assess tubal patency as part of the initial diagnostic workup for infertility, and use of the device may reduce the need for HSG.

    6. Conditions and Keywords

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

    7. Study Design

    Primary Purpose
    Screening
    Study Phase
    Not Applicable
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    12 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Tubal Selective Delivery System
    Arm Type
    Experimental
    Arm Description
    The same intervention will be used for all study subjects.
    Intervention Type
    Device
    Intervention Name(s)
    Tubal Selective Delivery System (TSDS)
    Intervention Description
    A novel tubal selective delivery catheter system for selective delivery of administered agents to the fallopian tubes without entry of any portion of the catheter into the tubes.
    Primary Outcome Measure Information:
    Title
    Clinical performance of catheter during insertion of device
    Description
    Clinician impression of catheter performance during insertion of device. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Clinician can place the insertion tube transcervically without dilation, and advance the obturator to expand the device without the use of imaging guidance. Acceptable: Cervical dilation required, but easy to advance the obturator to expand the device without the use of imaging guidance Fail: Unable to place the insertion tube
    Time Frame
    Immediately post-procedure within 30 minutes
    Title
    Expansion of arms and dual catheters
    Description
    Expansion of arms and dual catheters in the two uterine cornua. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Arms extend into bilateral cornua following transcervical insertion after initial expansion. Ultrasound confirms extension but is not needed Acceptable: Ultrasound is required to position arms, but expansion is successful after one or two attempts. Fail: Clinician is unable to position arms into cornua.
    Time Frame
    During procedure immediately following attempt to position device
    Title
    Inflation of dual balloons
    Description
    Inflation of the dual balloons. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Inflation of the dual balloons on first attempt by the clinician with no leakage or bad connections. This is confirmed by ultrasound. Acceptable: Inflation requires more than one attempt but is ultimately successful. Fail: Clinician is unable to inflate balloons due to high pressure or subject pain.
    Time Frame
    During procedure immediate following attempt to inflate balloons
    Title
    Delivery of saline
    Description
    Delivery of saline. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Successful administration of saline at low pressure (confirmed by ultrasound) with no leakage or bad connections. Acceptable: Some leakage of saline, but clinician is able to observe flow in tubes. Fail: Clinician unable to administer saline due to high pressure/pain, leakage or bad connections.
    Time Frame
    During procedure immediate following attempt to administer saline
    Title
    Delivery of ExEm foam
    Description
    Delivery of ExEm foam. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Delivery of foam at low pressure with confirmation of tubal patency via ultrasound and with no leakage or bad connections. Acceptable: Some leakage of ExEm in uterine cavity, but clinician is able to observe flow in tubes. Fail: Clinician unable to administer ExEm due to high pressure/pain, leakage or bad connections.
    Time Frame
    During procedure immediate following attempt to administer ExEm foam
    Title
    Clinician impression of device removal
    Description
    Clinician impression of device removal. Performance is categorized as one of three levels: excellent, acceptable, or fail. The number of participants in each category will be reported, with categories defined as: Excellent: Clinician can deflate balloons, collapse frame, and withdraw insertion tube without difficulty at the end of procedure without the use of imaging guidance.
    Time Frame
    During procedure immediate following attempt remove device
    Secondary Outcome Measure Information:
    Title
    Tolerability and ease of use - Provider experience evaluation
    Description
    The clinician placing the device will evaluate ease of use using a series of 100 mm visual analog scale (anchors: 0 extremely easy; 100 extremely difficult/impossible) to evaluate these questions: Was the device easy to insert transcervically? Was inflation of the balloons easy? Was deliver of saline easy? Was deliver of ExEm foam easy? Was removal easy?
    Time Frame
    Immediately Post-procedure (within 30 minutes)
    Title
    Tolerability and ease of use - Patient experience evaluation
    Description
    Participants will indicate maximum level of pain experienced during study procedures using 100 mm visual analogue scale (VAS) at various time points. We will compare pain with placement, treatment, and removal to several baseline assessments. VAS scales: Baseline expectation of pain, baseline pain immediately following speculum placement, baseline pain immediately prior to placement, pain associated with insertion, pain associated with balloon inflation, pain associated with administration of saline, pain associated with administration of ExEm foam, pain associated with complete device removal, pain 15 minutes after completion of procedure, overall satisfaction with procedure, willingness to recommend procedure to a friend.
    Time Frame
    Pre-procedure, during procedure, immediately post-procedure, 15 minutes post-procedure

    10. Eligibility

    Sex
    Female
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    50 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Literate in English Able to understand and sign an IRB-approved informed consent form Willing to complete a pre-procedure questionnaire Regular menstrual cycles (24- 38 days) Good general health Able and willing to comply with all study tests, procedures, and assessment tools Uterine sound size between 6 - 10 cm Agree to use a non-hormonal method of contraception or avoid vaginal intercourse during the catheter evaluation cycle In compliance with cervical cancer screening guidelines per the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines without evidence of disease. Alternatively, the subject must have had a colposcopy performed within the appropriate screen time frame, and prior to the study catheter insertion that showed no evidence of dysplasia requiring treatment or further diagnostic procedures or follow-up for at least 6 months Exclusion Criteria: Currently pregnant as confirmed by positive high-sensitivity urine pregnancy test Currently using hormonal contraception. Must have at least one natural cycle (two menses) prior to participation if recently discontinued hormonal contraception. Currently using an intrauterine device (IUD). Must discontinue at least 30 days prior to Visit 2 Allergy or hypersensitive to radio-opaque contrast, ExEm foam, both doxycycline and azithromycin (allergy to one not exclusionary if can take the alternative), or lidocaine History or physical findings recognized as clinically significant by the investigator, such as symptoms of untreated or recent pelvic infection History of involuntary female infertility History of gynecologic surgery involving the uterus, fallopian tubes, or ovaries (except single cesarean section) History of prior permanent contraception procedure (any technique, abdominal laparoscopic, or hysteroscopic) Pelvic exam findings considered clinically-significant by the investigator such as uterine fibroids, pelvic tenderness, or prolapse Inability to tolerate placement of a tenaculum and/or uterine sound during screening exam Any congenital or acquired uterine anomaly that may complicate study drug placement, such as: Submucosal uterine leiomyoma Asherman's syndromes Pedunculated polyps Bicornuate uterus Didelphys or uterine septa Any distortions of the uterine cavity (e.g., fibroids), that, in the opinion of the investigator, are likely to cause issues during insertion, use or removal of the TSDS. Known anatomical abnormalities of the cervix such as severe cervical stenosis, prior trachelectomy or extensive conization that, in the opinion of the investigator would prevent cervical dilation and device placement Untreated or unresolved acute cervicitis or vaginitis Known or suspected human immunodeficiency virus (HIV) infection or clinical AIDS Screening transabdominal or transvaginal ultrasound findings with poor imaging quality, or anatomic abnormalities considered clinically important or likely to interfere with assessment of the test device, as assessed by the investigator
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Women's Health Research Unit Department of Ob/Gyn
    Phone
    503-494-3666
    Email
    whru@ohsu.edu
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jeffrey Jensen, MD
    Organizational Affiliation
    Oregon Health and Science University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Clinical Evaluation of a Tubal Selective Delivery System

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