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Efficacy of Growth Hormone Supplementation With Gonadotrophins in IVF/ICSI for Poor Responders

Primary Purpose

Infertility, Female

Status
Completed
Phase
Phase 4
Locations
Egypt
Study Type
Interventional
Intervention
Growth Hormones Somatropin Recombinant
Placebo saline solution
Sponsored by
ClinAmygate
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Infertility, Female focused on measuring Growth Hormone, IVF/ICSI, Poor Responders

Eligibility Criteria

25 Years - 38 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Age: 25 to 38 years old.
  • IVF previous poor responders: at least two failed cycles with < five oocytes or abnormal ORT e.g. antimullerian hormone < 1
  • Patients with unexplained infertility.
  • Normal follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and ovarian ultrasound.
  • Normal pelvic ultrasound including 3D ultrasound of the uterus with no detected hydrosalpinx.

Exclusion Criteria:

  • Refusal to participate in the study
  • Patients with known medical disease (e.g. severe hypertension or hepatic disease).
  • Altered karyotype in one or both partners.
  • History of chronic, autoimmune or metabolic diseases
  • Presence of endocrinopathies.

Sites / Locations

  • Al Azhar University Hospitals (Kasr Al-Aini)

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Growth Hormones Somatropin Recombinant

Placebo saline solution

Arm Description

Growth hormone (Somatropin) 4 IU/day subcutaneous from the 2nd day of the cycle and stopped 1 day before ovum pickup for the treatment group which consists of 70 women.

Control group consisting of 70 women who will receive subcutaneous placebo injection in the same dosing as the treatment group

Outcomes

Primary Outcome Measures

clinical pregnancy rate
The main outcome is clinical pregnancy per allocated woman, defined as the presence of at least one fetus with heart beat.

Secondary Outcome Measures

E2 levels
Human Chorionic Gonadotropin (HCG) is given to induce triggering of ovulation then ovum pick up is scheduled 36 hour after the injection.
Number of oocytes collected
Transvaginal ultrasound will be done starting from day 6 of COS for assessment of follicular development and assessment of endometrial thickness, serial E2 measurement will be scheduled to start on day 6 of COS repeating every other day
Metaphase I (MI) and Metaphase II (MII) oocyte number
Transvaginal ultrasound will be done starting from day 6 of COS for assessment of follicular development and assessment of endometrial thickness, serial E2 measurement will be scheduled to start on day 6 of COS repeating every other day
Number of Pronucleus
Transvaginal ultrasound will be done starting from day 6 of COS for assessment of follicular development and assessment of endometrial thickness, serial E2 measurement will be scheduled to start on day 6 of COS repeating every other day
Multiple pregnancy
Multiple pregnancy

Full Information

First Posted
November 22, 2018
Last Updated
June 21, 2019
Sponsor
ClinAmygate
Collaborators
National Research Centre, Egypt
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1. Study Identification

Unique Protocol Identification Number
NCT03759301
Brief Title
Efficacy of Growth Hormone Supplementation With Gonadotrophins in IVF/ICSI for Poor Responders
Official Title
Efficacy of Growth Hormone Supplementation With Gonadotrophins in IVF/ICSI for Poor Responders; a Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Completed
Study Start Date
December 20, 2018 (Actual)
Primary Completion Date
May 5, 2019 (Actual)
Study Completion Date
June 5, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
ClinAmygate
Collaborators
National Research Centre, Egypt

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this study is to assess the effectiveness of adjuvant growth hormone injection during controlled ovarian stimulation, in poor responder women undergoing intracytoplasmic sperm injection (ICSI) procedures.
Detailed Description
Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (and there is no other reason, such as breastfeeding or postpartum amenorrhoea). Primary infertility is infertility in a couple who have never had a child. Secondary infertility is a failure to conceive following a previous pregnancy. Subfertility, usually defined as the absence of conception after one year of regular intercourse, subfertility is a common problem affecting as many as one in six couples. According to the European Society of Human Reproduction and Embryology (ESHRE) recommendations, couples with an estimated live birth rate of 40% or higher per year are encouraged to continue aiming for a spontaneous pregnancy . Treatment methods for infertility may be grouped as medical, complementary and alternative treatments. Some methods may be used in concert with other methods. Drugs may be used for both women and men. If conservative medical treatments fail to achieve a full term pregnancy, the physician may suggest the patient undergo assisted reproductive fertilization (ART). Methods for ART include artificial insemination (IUI), gamete intrafallopian transfer (GIFT), zygot intrafallopian transfer (ZIFT) or ICSI. Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an oocyte. During the past decade, ICSI has been applied increasingly around the world to alleviate problems of severe male infertility because too few motile and morphologically normal sperm were present in the ejaculate of the male partner. Although there have been several improvements in techniques of ART during the last three decades clinical pregnancy and live-birth rates remain at approximately 30-40%. Increasing these rates is desirable for couples undergoing ART, as treatment failure is a source of psychological distress, and the most common cause of drop-out before achieving pregnancy.The most common interventions to improve ART outcome are the use of maximized controlled ovarian stimulation (COS), transference of multiple embryos into the uterus and cryopreservation of surplus oocytes/embryos. However, the first two of these interventions might increase the risk of ovarian hyperstimulation syndrome and multiple pregnancy. In-vitro fertilization (IVF) protocols are constantly under review in an attempt to decrease hormone (gonadotrophin) requirement, improve follicular recruitment, whilst primarily to increase live birth rates. Implantation failure is thought to result from impairment of embryo development and/or from abnormal uterine receptivity. Some protocols have considered the role of growth hormone in IVF. Growth hormone is a biological peptide hormone, synthesized, stored and secreted by somatotroph cells located in the anterior pituitary gland. Growth hormone can be synthetically produced using recombinant DNA technology and is licensed to be used in the human population. There is currently no consensus as to the route, dose or timing of growth hormone administration in IVF protocols. Poor Ovarian Response (POR) is defined by the Bologna criteria, with an incidence between 9 and 24% of all cycles of IVF, usually it indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. It has been recognized that, in order to define the poor response in IVF, at least two of the following three features must be present: (i) advanced maternal age or any other risk factor for POR; (ii) a previous POR; and (iii) an abnormal ovarian reserve test (ORT). Two episodes of POR after maximal stimulation are sufficient to define a patient as poor responder in the absence of advanced maternal age or abnormal ORT. By definition, the term POR refers to the ovarian response, and therefore, one stimulated cycle is considered essential for the diagnosis of POR. However, patients of advanced age with an abnormal ORT may be classified as poor responders since both advanced age and an abnormal ORT may indicate reduced ovarian reserve and act as a surrogate of ovarian stimulation cycle outcome. In this case, the patients should be more properly defined as 'expected poor responder'. If this definition of POR is uniformly adapted as the 'minimal' criteria needed to select patients for future clinical trials, more homogeneous populations will be tested for any new protocols. Finally, by reducing bias caused by spurious POR definitions, it will be possible to compare results and to draw reliable conclusions. How the intervention might work? The administration of growth hormone may potentiate the effect of exogenous gonadotrophins. Growth hormone is reported to modulate the action of follicular stimulating hormone on granulosa cells by up-regulating the local synthesis of insulin-like growth factor-I (IGF-1). This interest has been stimulated by animal studies which suggest that growth hormone may increase the intra-ovarian production of the IGF-1. IGF-1 displays growth hormone dependence both in-vivo and in-vitro The interaction between growth hormone and IGF-1 is of significance since IGF-1 has been shown to play an important part in ovarian function in both animal and human models. The addition of IGF-1 to gonadotrophins in granulosa cell cultures increased gonadotrophin action on the ovary by several mechanisms including augmentation of aromatase activity, 17 beta-oestradiol and progesterone production and luteinising hormone receptor formation. IGF-1 has also been found to stimulate follicular development, oestrogen production and oocyte maturation. Improving the outcomes of ICSI by the use of growth hormone adjuvant therapy is important particularly in those women who are considered poor responders. The aim of this study is to establish the role of growth hormone in ICSI.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Infertility, Female
Keywords
Growth Hormone, IVF/ICSI, Poor Responders

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderOutcomes Assessor
Allocation
Randomized
Enrollment
156 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Growth Hormones Somatropin Recombinant
Arm Type
Active Comparator
Arm Description
Growth hormone (Somatropin) 4 IU/day subcutaneous from the 2nd day of the cycle and stopped 1 day before ovum pickup for the treatment group which consists of 70 women.
Arm Title
Placebo saline solution
Arm Type
Placebo Comparator
Arm Description
Control group consisting of 70 women who will receive subcutaneous placebo injection in the same dosing as the treatment group
Intervention Type
Drug
Intervention Name(s)
Growth Hormones Somatropin Recombinant
Other Intervention Name(s)
Cetrorelix
Intervention Description
Growth Hormones Somatropin Recombinant 4 IU/day subcutaneous from the 2nd day of the cycle and stopped 1 day before ovum pickup
Intervention Type
Drug
Intervention Name(s)
Placebo saline solution
Other Intervention Name(s)
Cetrorelix
Intervention Description
same volume as growth hormone ampule used
Primary Outcome Measure Information:
Title
clinical pregnancy rate
Description
The main outcome is clinical pregnancy per allocated woman, defined as the presence of at least one fetus with heart beat.
Time Frame
3 weeks
Secondary Outcome Measure Information:
Title
E2 levels
Description
Human Chorionic Gonadotropin (HCG) is given to induce triggering of ovulation then ovum pick up is scheduled 36 hour after the injection.
Time Frame
Day 1 of COS, the same day of Human Chorionic Gonadotropin (HCG) injection
Title
Number of oocytes collected
Description
Transvaginal ultrasound will be done starting from day 6 of COS for assessment of follicular development and assessment of endometrial thickness, serial E2 measurement will be scheduled to start on day 6 of COS repeating every other day
Time Frame
Day 6 of COS
Title
Metaphase I (MI) and Metaphase II (MII) oocyte number
Description
Transvaginal ultrasound will be done starting from day 6 of COS for assessment of follicular development and assessment of endometrial thickness, serial E2 measurement will be scheduled to start on day 6 of COS repeating every other day
Time Frame
Day 6 of COS
Title
Number of Pronucleus
Description
Transvaginal ultrasound will be done starting from day 6 of COS for assessment of follicular development and assessment of endometrial thickness, serial E2 measurement will be scheduled to start on day 6 of COS repeating every other day
Time Frame
Day 6 of COS
Title
Multiple pregnancy
Description
Multiple pregnancy
Time Frame
6 weeks from last period

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
38 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age: 25 to 38 years old. IVF previous poor responders: at least two failed cycles with < five oocytes or abnormal ORT e.g. antimullerian hormone < 1 Patients with unexplained infertility. Normal follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and ovarian ultrasound. Normal pelvic ultrasound including 3D ultrasound of the uterus with no detected hydrosalpinx. Exclusion Criteria: Refusal to participate in the study Patients with known medical disease (e.g. severe hypertension or hepatic disease). Altered karyotype in one or both partners. History of chronic, autoimmune or metabolic diseases Presence of endocrinopathies.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mohamed M Shafeek, MSc
Organizational Affiliation
Al-Azhar University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Al Azhar University Hospitals (Kasr Al-Aini)
City
Cairo
Country
Egypt

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
34808697
Citation
Sood A, Mohiyiddeen G, Ahmad G, Fitzgerald C, Watson A, Mohiyiddeen L. Growth hormone for in vitro fertilisation (IVF). Cochrane Database Syst Rev. 2021 Nov 22;11(11):CD000099. doi: 10.1002/14651858.CD000099.pub4.
Results Reference
derived
PubMed Identifier
33495008
Citation
Mohammad EH, Abou El Serour AG, Mohamed EAH, Abbasy AH, Zaatar M, Rageh KA, Shafeek MM, Issak ER. Efficacy of growth hormone supplementation with ultrashort GnRH antagonist in IVF/ICSI for poor responders; randomized controlled trial. Taiwan J Obstet Gynecol. 2021 Jan;60(1):51-55. doi: 10.1016/j.tjog.2020.10.003.
Results Reference
derived

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Efficacy of Growth Hormone Supplementation With Gonadotrophins in IVF/ICSI for Poor Responders

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