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The Outcome of Two Protocols Used to Prepare Endometrium for Frozen Embryo Transfer

Primary Purpose

Infertility, Infertility, Female, Infertility, Male

Status
Completed
Phase
Phase 4
Locations
Egypt
Study Type
Interventional
Intervention
Estradiol Valerate
Progesterone
Aromatase inhibitor
Sponsored by
Rahem Fertility Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Infertility

Eligibility Criteria

18 Years - 37 Years (Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:Inclusion criteria:

  • Women aged from18 - 37 years old undergoing FET using good quality blastocysts vitrified on day 5(3 BB and more) (according to Gardner and Schoolcraft 1999) (8).
  • Participants having at least one good quality blastocyst (3BB and more) available for transfer after warming.
  • Participants having trilaminar endometrium of 9 mm after E2 preparation.

Exclusion Criteria:

  • Women younger than 18 or older than 37 years old.
  • Women who have uterine abnormality or pathology.
  • Women who will not meet the inclusion criteria.
  • Women who will refuse to participate in in the study.

Sites / Locations

  • Rahem Fertility Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

HRT Plus Aromatase Inhibitor

HRT Only

Arm Description

Hormone replacement treatment (HRT) will be used in all cases. Exogenous estradiol will be started on day 2 or 3 of the cycle. In all participants, 2 mg oral estradiol valerate, will be administered three times daily. Ultrasound evaluation of endometrium will be performed 10 to 12 days after starting E2. Trilaminar endometrium of 9 mm will be the targeted cutoff . If not yet ready, E2 supplementation will be continued with serial US assessment until the desired cutoff is achieved. Thereafter, participants will be randomized to two groups: Group A (HRT plus AI): will be given aromatase inhibitor for 5 days only (2.5 mg twice daily), along with the oral 6 mg E2. Then, daily intramuscular (IM) P in oil (100 mg IM P) will be started in addition to the daily dose of oral 6 mg E2. In both groups, embryos will be warmed on the 6th day of P supplementation. Before undergoing FET, endometrial thickness will be re-evaluated. IM P and 6mg E2 will be continued thereafter.

Hormone replacement treatment (HRT) will be used in all cases. Exogenous estradiol will be started on day 2 or 3 of the cycle. In all participants, 2 mg oral estradiol valerate, will be administered three times daily. Ultrasound evaluation of endometrium will be performed 10 to 12 days after starting E2. Trilaminar endometrium of 9 mm will be the targeted cutoff . If not yet ready, E2 supplementation will be continued with serial US assessment until the desired cutoff is achieved. Thereafter, participants will be randomized to two groups Group B (HRT only): will be administered daily intramuscular (IM) P in oil (100 mg IM P) in addition to the daily dose of oral 6 mg E2. In both groups, embryos will be warmed on the 6th day of P supplementation. Before undergoing FET, endometrial thickness will be re-evaluated. IM P and 6mg E2 will be continued thereafter.

Outcomes

Primary Outcome Measures

Ongoing Pregnancy Rate
visualization of fetal cardiac pulsation by ultrasound

Secondary Outcome Measures

endometrial compaction
change in endometrial thickness
clinical pregnancy rate
visualization of fetal cardiac pulsation by ultrasound
Live birth rate
The birth of at least one newborn that exhibits any sign of life
Implantation rate
The number of gestational sacs observed divided by the number of embryos transferred expressed as a percentage, %
Number of participants with Hypertensive disorders of pregnancy
gestational hypertension or preeclampsia
Number of participants with Large for gestational age
A birth weight greater than the 90th centile of the sex-specific birth weight for a given gestational age reference.
Rate of Congenital anomalies
Structural or functional disorders that occur during intra-uterine life and can be identified prenatally, at birth or later in life.

Full Information

First Posted
August 1, 2020
Last Updated
April 20, 2022
Sponsor
Rahem Fertility Center
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1. Study Identification

Unique Protocol Identification Number
NCT04507022
Brief Title
The Outcome of Two Protocols Used to Prepare Endometrium for Frozen Embryo Transfer
Official Title
A Randomized Controlled Study to Compare the Outcome of Two Protocols Used to Prepare the Endometrium for Frozen Embryo Transfer
Study Type
Interventional

2. Study Status

Record Verification Date
October 2020
Overall Recruitment Status
Completed
Study Start Date
August 12, 2020 (Actual)
Primary Completion Date
February 5, 2021 (Actual)
Study Completion Date
February 5, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Rahem Fertility Center

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
This is a RCT to test the outcome of two protocols used for preparation of the endometrium for frozen blastocyst embryo transfer
Detailed Description
Receptive endometrium and a good quality embryo at the blastocyst developmental stage are prerequisites for a successful implantation to occur. Blastocyst freezing techniques and survival have witnessed huge improvements in the last years. Trials to improve the outcome of frozen embryo transfer (FET) are not to be stopped. The transfer of a good quality blastocyst represents a vital part of the process. Optimization of endometrial receptivity and implantation is an everlasting challenge. Hormone replacement therapy (HRT) is now proven to be successful for preparation of the endometrium to receive the vitrified warmed embryos. Most HRT protocols give estradiol (E2) first to reach a satisfactory endometrial thickness, then followed by progesterone to mimic the natural cycles. E2 is mostly given for 10 to 14 days and this duration might be prolonged to reach a satisfactory endometrial thickness without adversely affecting the outcome. Trans-vaginal ultrasound assessment of the endometrial thickness before the start of P supplementation has been traditionally used to predict FET cycle outcome. Clinical pregnancy rates (CPR) and live birth rates (LBR) were found to decrease for each millimetre of endometrial thickness below 7 mm. Endometrial thickness however of 9 mm was reported to be among major factors affecting LBR after FET in a large set of data. Further, there is a recent concept that endometrial compaction (decreased thickness) between the end of estrogen phase and the day of ET has favorable impact on the outcome of FET. Different modalities were proposed to enhance endometrial compaction. One of these modalities was to decrease the dose of estrogen so as to change the estrogen- progesterone ratio as well as help in preventing further endometrial growth. Aromatase inhibitor (AI) can be used to decrease estrogen before starting P supplementation. Additionally, there were also reports that their use had been associated with improved implantation. It appears interesting to combine the easy scheduled HRT protocol with aromatase inhibitor to maximize FET outcome. This proposed protocol has not been tested before. In current study, HRT plus AI will be compared with HRT only. In both groups, daily intramuscular P will be given for luteal support as it was shown to give the highest ongoing pregnancy rate in FET cycles. We did a secondary follow up analysis of some exploratory outcomes (not preregistered). These outcomes were analyzed after publication and they include Live birth rate, implantation rate, hypertensive disorders of pregnancy, large for gestation and congenital anomalies. The results of these outcomes are planned to be presented elsewhere. For openness and transparency, we felt the importance to report this follow up in the registry.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
112 (Actual)

8. Arms, Groups, and Interventions

Arm Title
HRT Plus Aromatase Inhibitor
Arm Type
Experimental
Arm Description
Hormone replacement treatment (HRT) will be used in all cases. Exogenous estradiol will be started on day 2 or 3 of the cycle. In all participants, 2 mg oral estradiol valerate, will be administered three times daily. Ultrasound evaluation of endometrium will be performed 10 to 12 days after starting E2. Trilaminar endometrium of 9 mm will be the targeted cutoff . If not yet ready, E2 supplementation will be continued with serial US assessment until the desired cutoff is achieved. Thereafter, participants will be randomized to two groups: Group A (HRT plus AI): will be given aromatase inhibitor for 5 days only (2.5 mg twice daily), along with the oral 6 mg E2. Then, daily intramuscular (IM) P in oil (100 mg IM P) will be started in addition to the daily dose of oral 6 mg E2. In both groups, embryos will be warmed on the 6th day of P supplementation. Before undergoing FET, endometrial thickness will be re-evaluated. IM P and 6mg E2 will be continued thereafter.
Arm Title
HRT Only
Arm Type
Active Comparator
Arm Description
Hormone replacement treatment (HRT) will be used in all cases. Exogenous estradiol will be started on day 2 or 3 of the cycle. In all participants, 2 mg oral estradiol valerate, will be administered three times daily. Ultrasound evaluation of endometrium will be performed 10 to 12 days after starting E2. Trilaminar endometrium of 9 mm will be the targeted cutoff . If not yet ready, E2 supplementation will be continued with serial US assessment until the desired cutoff is achieved. Thereafter, participants will be randomized to two groups Group B (HRT only): will be administered daily intramuscular (IM) P in oil (100 mg IM P) in addition to the daily dose of oral 6 mg E2. In both groups, embryos will be warmed on the 6th day of P supplementation. Before undergoing FET, endometrial thickness will be re-evaluated. IM P and 6mg E2 will be continued thereafter.
Intervention Type
Drug
Intervention Name(s)
Estradiol Valerate
Intervention Description
2mg three times daily
Intervention Type
Drug
Intervention Name(s)
Progesterone
Intervention Description
100 mg daily intramuscular
Intervention Type
Drug
Intervention Name(s)
Aromatase inhibitor
Intervention Description
2.5 mg twice daily for 5 days
Primary Outcome Measure Information:
Title
Ongoing Pregnancy Rate
Description
visualization of fetal cardiac pulsation by ultrasound
Time Frame
at 12 weeks of gestation
Secondary Outcome Measure Information:
Title
endometrial compaction
Description
change in endometrial thickness
Time Frame
from the end of estradiol phase to the day of embryo transfer up to 11 days
Title
clinical pregnancy rate
Description
visualization of fetal cardiac pulsation by ultrasound
Time Frame
6 weeks gestation
Title
Live birth rate
Description
The birth of at least one newborn that exhibits any sign of life
Time Frame
24 weeks
Title
Implantation rate
Description
The number of gestational sacs observed divided by the number of embryos transferred expressed as a percentage, %
Time Frame
6 weeks gestation
Title
Number of participants with Hypertensive disorders of pregnancy
Description
gestational hypertension or preeclampsia
Time Frame
20 weeks gestation till postpartum
Title
Number of participants with Large for gestational age
Description
A birth weight greater than the 90th centile of the sex-specific birth weight for a given gestational age reference.
Time Frame
from gestation till delivery]
Title
Rate of Congenital anomalies
Description
Structural or functional disorders that occur during intra-uterine life and can be identified prenatally, at birth or later in life.
Time Frame
during pregnancy and after birth (one month after birth)

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
37 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:Inclusion criteria: Women aged from18 - 37 years old undergoing FET using good quality blastocysts vitrified on day 5(3 BB and more) (according to Gardner and Schoolcraft 1999) (8). Participants having at least one good quality blastocyst (3BB and more) available for transfer after warming. Participants having trilaminar endometrium of 9 mm after E2 preparation. Exclusion Criteria: Women younger than 18 or older than 37 years old. Women who have uterine abnormality or pathology. Women who will not meet the inclusion criteria. Women who will refuse to participate in in the study.
Facility Information:
Facility Name
Rahem Fertility Center
City
Zagazig
State/Province
Sharkia
ZIP/Postal Code
44519
Country
Egypt

12. IPD Sharing Statement

Citations:
PubMed Identifier
29025055
Citation
Mackens S, Santos-Ribeiro S, van de Vijver A, Racca A, Van Landuyt L, Tournaye H, Blockeel C. Frozen embryo transfer: a review on the optimal endometrial preparation and timing. Hum Reprod. 2017 Nov 1;32(11):2234-2242. doi: 10.1093/humrep/dex285.
Results Reference
background
PubMed Identifier
31029432
Citation
Sekhon L, Feuerstein J, Pan S, Overbey J, Lee JA, Briton-Jones C, Flisser E, Stein DE, Mukherjee T, Grunfeld L, Sandler B, Copperman AB. Endometrial preparation before the transfer of single, vitrified-warmed, euploid blastocysts: does the duration of estradiol treatment influence clinical outcome? Fertil Steril. 2019 Jun;111(6):1177-1185.e3. doi: 10.1016/j.fertnstert.2019.02.024. Epub 2019 Apr 24.
Results Reference
background
PubMed Identifier
30239738
Citation
Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Hum Reprod. 2018 Oct 1;33(10):1883-1888. doi: 10.1093/humrep/dey281.
Results Reference
background
PubMed Identifier
32266278
Citation
Pan Y, Hao G, Wang Q, Liu H, Wang Z, Jiang Q, Shi Y, Chen ZJ. Major Factors Affecting the Live Birth Rate After Frozen Embryo Transfer Among Young Women. Front Med (Lausanne). 2020 Mar 24;7:94. doi: 10.3389/fmed.2020.00094. eCollection 2020.
Results Reference
background
PubMed Identifier
31248618
Citation
Haas J, Smith R, Zilberberg E, Nayot D, Meriano J, Barzilay E, Casper RF. Endometrial compaction (decreased thickness) in response to progesterone results in optimal pregnancy outcome in frozen-thawed embryo transfers. Fertil Steril. 2019 Sep;112(3):503-509.e1. doi: 10.1016/j.fertnstert.2019.05.001. Epub 2019 Jun 24.
Results Reference
background
PubMed Identifier
29338855
Citation
Devine K, Richter KS, Widra EA, McKeeby JL. Vitrified blastocyst transfer cycles with the use of only vaginal progesterone replacement with Endometrin have inferior ongoing pregnancy rates: results from the planned interim analysis of a three-arm randomized controlled noninferiority trial. Fertil Steril. 2018 Feb;109(2):266-275. doi: 10.1016/j.fertnstert.2017.11.004. Epub 2018 Jan 17.
Results Reference
background
PubMed Identifier
22246449
Citation
Miller PB, Parnell BA, Bushnell G, Tallman N, Forstein DA, Higdon HL 3rd, Kitawaki J, Lessey BA. Endometrial receptivity defects during IVF cycles with and without letrozole. Hum Reprod. 2012 Mar;27(3):881-8. doi: 10.1093/humrep/der452. Epub 2012 Jan 13.
Results Reference
background
PubMed Identifier
10369209
Citation
Gardner DK, Schoolcraft WB. Culture and transfer of human blastocysts. Curr Opin Obstet Gynecol. 1999 Jun;11(3):307-11. doi: 10.1097/00001703-199906000-00013.
Results Reference
background

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The Outcome of Two Protocols Used to Prepare Endometrium for Frozen Embryo Transfer

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