Poor Ovarian Response Clinical Trial
Official title:
A Randomized Controlled Study of Different Trigger Modes of Antagonist Regimen in Patients With Low Ovarian Reserve
Verified date | January 2021 |
Source | Nanjing University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Assisted reproductive technology (ART), especially controlled ovarian stimulation (COS), significantly increased clinical pregnancy rates among infertile patients. However, about 9% to 24% of patients had poor ovarian response to gonadotropins (GNS) stimulation, which was called poor ovarian response (POR). In recent years, the diagnosis and treatment of patients with low fertility is the challenge for reproductive medicine. To better demonstrate the effectiveness of various interventions and distinguish the different subgroups of patients, 2016 POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) standard changed low reaction into low prognosis of patient-oriented individual strategies to obtain eggs. For patients in group 3 and group 4 classified by POSEIDON, ovarian reserve function decline, follicular development desynchrony and low numbers of oocytes obtained lead to poor prognosis. In 2020, the prognosis based on Delphi method of assisted reproductive technology to treat low crowd diagnosis expert opinion in China recommended to give these patients conventional cosine solutions such as antagonist. In the first cycle, follicle stimulating hormone (FSH) starting dose of 225 ~ 300 iu is suggested to achieve plenty of ovarian stimulation for standards and maximize the benefits of superovulation. Because of the particularity of luteal support in the antagonist regimen, it is of great clinical significance to explore the trigger mode and combination mode of luteal support in the antagonist regimen for patients with poor prognosis.
Status | Recruiting |
Enrollment | 310 |
Est. completion date | December 31, 2021 |
Est. primary completion date | October 31, 2021 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 21 Years to 42 Years |
Eligibility | Inclusion Criteria: - Age less than or equal to 42 years old, AFC<5 and or AMH<1.2ng/ml ? Adopt antagonist program for controlled ovulation hyperstimulation (COH); patients with fresh cycle transplantation; - Accept conventional IVF or intracytoplasmic sperm injection (ICSI); - The ART treatment cycle is less than 3 times. Exclusion Criteria: - Abnormal chromosome karyotype; - Severe endometriosis; - Abnormal thyroid function; ? Pregnancy contraindications; ? Past history of ovarian tumors or after receiving radiotherapy |
Country | Name | City | State |
---|---|---|---|
China | Reproductive Medicine Center, The affiliated Drum Towel Hospital of Nanjing University Medical School | Nanjing | Jiangsu |
Lead Sponsor | Collaborator |
---|---|
Nanjing University |
China,
Belova EV, Emtseva VP, Obolenskii IuA. [Characteristics of autonomic and hormonal reactions during the performance of different types of intellectual work]. Fiziol Cheloveka. 1988 May-Jun;14(3):482-5. Russian. — View Citation
Deepika K, Rathore S, Garg N, Rao K. Empty follicle syndrome: Successful pregnancy following dual trigger. J Hum Reprod Sci. 2015 Jul-Sep;8(3):170-4. doi: 10.4103/0974-1208.165152. — View Citation
Ding N, Liu X, Jian Q, Liang Z, Wang F. Dual trigger of final oocyte maturation with a combination of GnRH agonist and hCG versus a hCG alone trigger in GnRH antagonist cycle for in vitro fertilization: A Systematic Review and Meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:92-98. doi: 10.1016/j.ejogrb.2017.09.004. Epub 2017 Sep 14. Review. — View Citation
Eftekhar M, Mojtahedi MF, Miraj S, Omid M. Final follicular maturation by administration of GnRH agonist plus HCG versus HCG in normal responders in ART cycles: An RCT. Int J Reprod Biomed. 2017 Jul;15(7):429-434. — View Citation
Eser A, Devranoglu B, Bostanci Ergen E, Yayla Abide Ç. Dual trigger with gonadotropin-releasing hormone and human chorionic gonadotropin for poor responders. J Turk Ger Gynecol Assoc. 2018 Jun 4;19(2):98-103. doi: 10.4274/jtgga.2017.0045. Epub 2018 Mar 8. — View Citation
Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L; ESHRE working group on Poor Ovarian Response Definition. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011 Jul;26(7):1616-24. doi: 10.1093/humrep/der092. Epub 2011 Apr 19. — View Citation
Gold JI, Stocker AA. Visual Decision-Making in an Uncertain and Dynamic World. Annu Rev Vis Sci. 2017 Sep 15;3:227-250. doi: 10.1146/annurev-vision-111815-114511. Epub 2017 Jul 17. Review. — View Citation
Gonen Y, Balakier H, Powell W, Casper RF. Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab. 1990 Oct;71(4):918-22. — View Citation
Griesinger G, Diedrich K, Devroey P, Kolibianakis EM. GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis. Hum Reprod Update. 2006 Mar-Apr;12(2):159-68. Epub 2005 Oct 27. — View Citation
Griesinger G, Kolibianakis EM, Papanikolaou EG, Diedrich K, Van Steirteghem A, Devroey P, Ejdrup Bredkjaer H, Humaidan P. Triggering of final oocyte maturation with gonadotropin-releasing hormone agonist or human chorionic gonadotropin. Live birth after frozen-thawed embryo replacement cycles. Fertil Steril. 2007 Sep;88(3):616-21. Epub 2007 Apr 23. — View Citation
Griesinger G, Meldrum D. Introduction: Management of the luteal phase in assisted reproductive technology. Fertil Steril. 2018 May;109(5):747-748. doi: 10.1016/j.fertnstert.2018.02.009. — View Citation
Griffin D, Benadiva C, Kummer N, Budinetz T, Nulsen J, Engmann L. Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders. Fertil Steril. 2012 Jun;97(6):1316-20. doi: 10.1016/j.fertnstert.2012.03.015. Epub 2012 Apr 3. — View Citation
Griffin D, Feinn R, Engmann L, Nulsen J, Budinetz T, Benadiva C. Dual trigger with gonadotropin-releasing hormone agonist and standard dose human chorionic gonadotropin to improve oocyte maturity rates. Fertil Steril. 2014 Aug;102(2):405-9. doi: 10.1016/j.fertnstert.2014.04.028. Epub 2014 May 17. — View Citation
Lawrenz B, Coughlan C, Fatemi HM. Individualized luteal phase support. Curr Opin Obstet Gynecol. 2019 Jun;31(3):177-182. doi: 10.1097/GCO.0000000000000530. Review. — View Citation
Li S, Zhou D, Yin T, Xu W, Xie Q, Cheng D, Yang J. Dual trigger of triptorelin and HCG optimizes clinical outcome for high ovarian responder in GnRH-antagonist protocols. Oncotarget. 2018 Jan 4;9(4):5337-5343. doi: 10.18632/oncotarget.23916. eCollection 2018 Jan 12. — View Citation
Lin MH, Wu FS, Hwu YM, Lee RK, Li RS, Li SH. Dual trigger with gonadotropin releasing hormone agonist and human chorionic gonadotropin significantly improves live birth rate for women with diminished ovarian reserve. Reprod Biol Endocrinol. 2019 Jan 4;17(1):7. doi: 10.1186/s12958-018-0451-x. — View Citation
Lin MH, Wu FS, Lee RK, Li SH, Lin SY, Hwu YM. Dual trigger with combination of gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles. Fertil Steril. 2013 Nov;100(5):1296-302. doi: 10.1016/j.fertnstert.2013.07.1976. Epub 2013 Aug 28. — View Citation
Lu X, Hong Q, Sun L, Chen Q, Fu Y, Ai A, Lyu Q, Kuang Y. Dual trigger for final oocyte maturation improves the oocyte retrieval rate of suboptimal responders to gonadotropin-releasing hormone agonist. Fertil Steril. 2016 Nov;106(6):1356-1362. doi: 10.1016/j.fertnstert.2016.07.1068. Epub 2016 Aug 1. — View Citation
Nakano R, Mizuno T, Kotsuji F, Katayama K, Wshio M, Tojo S. "Triggering" of ovulation after infusion of synthetic luteinizing hormone releasing factor (LRF). Acta Obstet Gynecol Scand. 1973;52(3):269-72. — View Citation
Oliveira SA, Calsavara VF, Cortés GC. Final Oocyte Maturation in Assisted Reproduction with Human Chorionic Gonadotropin and Gonadotropin-releasing Hormone agonist (Dual Trigger). JBRA Assist Reprod. 2016 Dec 1;20(4):246-250. doi: 10.5935/1518-0557.20160047. Review. — View Citation
Orvieto R. Triggering final follicular maturation--hCG, GnRH-agonist or both, when and to whom? J Ovarian Res. 2015 Aug 21;8:60. doi: 10.1186/s13048-015-0187-6. — View Citation
Poseidon Group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number), Alviggi C, Andersen CY, Buehler K, Conforti A, De Placido G, Esteves SC, Fischer R, Galliano D, Polyzos NP, Sunkara SK, Ubaldi FM, Humaidan P. A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertil Steril. 2016 Jun;105(6):1452-3. doi: 10.1016/j.fertnstert.2016.02.005. Epub 2016 Feb 26. — View Citation
Schachter M, Friedler S, Ron-El R, Zimmerman AL, Strassburger D, Bern O, Raziel A. Can pregnancy rate be improved in gonadotropin-releasing hormone (GnRH) antagonist cycles by administering GnRH agonist before oocyte retrieval? A prospective, randomized study. Fertil Steril. 2008 Oct;90(4):1087-93. Epub 2007 Nov 26. — View Citation
Youssef MA, Van der Veen F, Al-Inany HG, Mochtar MH, Griesinger G, Nagi Mohesen M, Aboulfoutouh I, van Wely M. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev. 2014 Oct 31;(10):CD008046. doi: 10.1002/14651858.CD008046.pub4. Review. — View Citation
Zhou X, Guo P, Chen X, Ye D, Liu Y, Chen S. Comparison of dual trigger with combination GnRH agonist and hCG versus hCG alone trigger of oocyte maturation for normal ovarian responders. Int J Gynaecol Obstet. 2018 Jun;141(3):327-331. doi: 10.1002/ijgo.12457. Epub 2018 Feb 21. — View Citation
Zilberberg E, Haas J, Dar S, Kedem A, Machtinger R, Orvieto R. Co-administration of GnRH-agonist and hCG, for final oocyte maturation (double trigger), in patients with low proportion of mature oocytes. Gynecol Endocrinol. 2015 Feb;31(2):145-7. doi: 10.3109/09513590.2014.978850. Epub 2014 Nov 11. — View Citation
* Note: There are 26 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Clinical pregnancy rate in each transplantation cycle | number of pregnant cases are confirmed by ultrasound/ total number of transplanted | 6 weeks | |
Secondary | Rate of cancelled cycle | number of cancelled cycles/ number of total cycles | 6 weeks | |
Secondary | Number of mature eggs | number of matured oocytes | 6 weeks | |
Secondary | Number of high-quality embryos | number of D3 high quality embryos (=7 scores) | 6 weeks | |
Secondary | Implantation rate | number of gestational sacs/ number of transplanted embryos | 6 weeks | |
Secondary | Early abortion rate | number of miscarriage cases/ number of pregnant cases confirmed by ultrasound | 6 weeks | |
Secondary | Cumulative pregnancy rate per stimulation cycle | number of pregnant cases which are confirmed by ultrasound/ total number of stimulation cycle | 6 weeks |
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT03433768 -
Androgen Receptor mRNA Expression is Positively Associated With Live Birth in Women Undergoing IVF Independently of the Type of Ovarian Response
|
N/A | |
Recruiting |
NCT05601193 -
Ovarian PRP Injection in Women With POR
|
N/A | |
Suspended |
NCT03021915 -
Single Center, Prospective Controlled Pilot Study of the OvaPrime Procedure
|
N/A | |
Completed |
NCT04013984 -
Acupuncture for Treatment of Patients With Poor Ovarian Response
|
N/A | |
Completed |
NCT03447184 -
Long-term Endogenous Androgen Priming in Bologna Criteria Poor Responder Patients - A Pilot Study
|
||
Completed |
NCT01816321 -
Corifollitropin Alfa Followed by Menotropin for Poor Ovarian Responders Trial
|
Phase 3 | |
Recruiting |
NCT04310293 -
Novel Therapy for Poor Responders Management
|
N/A | |
Completed |
NCT05703308 -
Menstrual Blood Stem Cells in Poor Ovarian Responders
|
Phase 3 | |
Terminated |
NCT00878124 -
How Dose Coenzyme Q10 Supplementation During Infertility Treatment Effects Pregnancy Outcome
|
N/A | |
Not yet recruiting |
NCT06089395 -
The Effect of Jiajian Guishen Granules on the Modulation of Ovarian Function in Patients With Poor Ovarian Response(POR)
|
Early Phase 1 | |
Completed |
NCT01732094 -
Corifollitropin Alfa Followed by hpHMG in a Long GnRH Agonist Protocol for the Treatment of Poor Ovarian Responders
|
Phase 2 | |
Completed |
NCT01732068 -
Treatment of Poor Ovarian Responders With Corifollitropin Alfa Followed by hpHMG in a Short GnRH Agonist Protocol
|
Phase 2 | |
Recruiting |
NCT04024722 -
Improving in Vitro Fertilization in Women With Poor Ovarian Response
|
N/A | |
Completed |
NCT03994614 -
the Effect of Transcutaneous Electrical Acupoint Stimulation on the Quality of Oocyte on Poor Ovarian Response(POR)
|
N/A | |
Recruiting |
NCT03830697 -
A Trial Study on Acupuncture Treatment of Poor Ovarian Response
|
N/A | |
Recruiting |
NCT02801591 -
Effect of Recombinant Human Growth Hormone Injection on the Clinical Outcome of POR in Patients Undergoing IVF/ET
|
N/A | |
Recruiting |
NCT04273256 -
Myo-inositol for the Management of Poor Ovarian Responders: A Prospective Randomized Controlled Trial
|
Phase 2/Phase 3 | |
Recruiting |
NCT02993588 -
Impact of Melatonin on IVF/ICSI Outcomes in Prospective Poor Responders
|
Phase 2/Phase 3 | |
Terminated |
NCT02418572 -
Testosterone TRANSdermal Gel for Poor Ovarian Responders Trial
|
Phase 3 |