Pre-IVF Treatment With a GnRH Antagonist in Women With Endometriosis

Infertility Clinical Trial

— PREGnant  

Official title:

Pre-IVF Treatment With a GnRH Antagonist in Women With Endometriosis - A Prospective Clinical Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04173169
• Other study ID #: 2000027121
• Secondary ID: 1R01HD100336-01
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: March 15, 2022
• Est. completion date: May 31, 2025

Study information

• Verified date: April 2024
• Source: Yale University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A Phase 3 clinical trial of oral GnRH antagonist pre-treatment for women with endometriosis who are undergoing IVF, with a primary outcome of live birth rate. The investigators' central hypothesis is that in infertile woman with endometriosis undergoing in vitro fertilization-embryo transfer (IVF-ET), live birth rates will improve in those pretreated with GnRH antagonist compared to those not pretreated with GnRH antagonist.

Description:

Infertility is a common complication of endometriosis; while IVF successfully treats endometriosis-associated infertility, pregnancy rates are diminished compared to other etiologies of infertility. The study's long- term objectives are to better identify and treat endometriosis related infertility. The investigators' central hypothesis is that in infertile woman with endometriosis undergoing in vitro fertilization-embryo transfer (IVF-ET), live birth rates will improve in those pretreated with GnRH antagonist compared to those not pretreated with GnRH antagonist. The use of gonadotropin releasing hormone (GnRH) agonist prior to IVF has been suggested to improve success, however studies have been small and rarely reported live birth rates. Further, use of this approach is limited by the long treatment time required. Recent approval of an oral GnRH antagonist for endometriosis provides a novel option for women with endometriosis who are undergoing IVF. This agent avoids parenteral administration and the prolonged delay in initiation of action as was seen with GnRH agonists. There have been no studies on the efficacy of GnRH antagonists for the treatment of endometriosis-related infertility. The investigators propose a clinical trial of oral GnRH antagonist pre-treatment for women with endometriosis who are undergoing IVF, with a primary outcome of live birth rate. Participants will include those who agree to be randomized and those who do not want to be randomized. Those who agree to be randomized will be randomly assigned to either the elagolix group or placebo group. Those who do not want to be randomized can choose either the active treatment elagolix and follow the same procedures as those agreeing to be randomized or continue their ongoing or planned IVF and follow standard of care (SOC) (SOC IVF) if they do not want to delay the IVF procedure.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 112
• Est. completion date: May 31, 2025
• Est. primary completion date: May 31, 2025
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years to 40 Years

Eligibility

Inclusion Criteria:

1. Women who plan to undergo IVF for treatment of infertility.

2. Age =18 and <40 years at time of egg retrieval or signing informed consent.

3. Documentation of diagnosis of endometriosis by surgical visualization of endometriosis (laparoscopy or laparotomy) or diagnosis by pathology within the last 10 years before the initial trial entry visit or documentation of ovarian endometrioma >2 cm or two or more smaller endometriomas that total >2 cm in diameter. If entry is based on the presence of an endometrioma, transvaginal ultrasound evaluation must document the same unambiguous endometrioma on two separate occasions in more than one menstrual cycle. Images will be printed or transmitted electronically and read centrally by investigators at Yale to assure uniform diagnostic criteria (classic ground glass appearance) are applied.

4. Body mass index (BMI) of 18-40 kg/m2 (both inclusive) at screening.

5. AMH > 0.5ng/ml, within 12 months of a fresh IVF cycle start. For frozen embryo transfers (FET) , AMH level eligibility criteria may not be met as long as the patient has at least one good quality blastocyst stored for the FET.

6. No known uterine cavity abnormalities at time of screening. Uterine cavity assessment by sonohysterogram or hysteroscopy within 12 months of embryo transfer indicating absence of focal intracavitary pathology and hence establishing adequate cavity at the time of embryo transfer. Ultrasound or MRI features suggestive of adenomyosis will be acceptable for inclusion. Type 3 fibroids are allowed up to 4cm size.

7. Presence of at least one ovary with no clinically significant abnormalities other than endometrioma. For eligible women with evidence of a hemorrhagic ovarian cyst, a repeat US will be needed in a subsequent menstrual cycle to ensure persistent cyst for patient to be deemed eligible.

8. Negative urine or cervical swab for gonorrhea and chlamydia within 12 months of screening.

9. Willing and able to comply with trial procedures, including reporting of obstetrical outcomes after delivery.

Exclusion Criteria:

1. Use of depot GnRH agonists within 6 months of study start. Use of subcutaneous antagonists or nasal agonist within 2 months of study start unless part of regular IVF or previous IUI cycle°.

2. Use of depot medroxyprogesterone acetate (MPA) (injectable) or birth control implants (e.g., Implanon® or Nexplanon®) within 6 months of study start°.

3. Continuous use of oral progestins (MPA, NETA) within 1 month of study start°.

4. Use of aromatase inhibitors, danazol or hormonal contraceptives (Including combined oral contraceptive pill, progestin-only pill, transdermal patch or contraceptive ring, or double barrier contraception) within 1 month of study start.

5. Pregnancy greater than 8 weeks in length within the last 6 months.

6. Number of previous IVF/ICSI attempts =3 unsuccessful (negative pregnancy test).

7. Presence of hydrosalpinx measuring >2cm on ultrasound, untreated endometrial polyps or intrauterine adhesions.

8. Abnormal cytology on a cervical screening based on the American College of Obstetricians and Gynecologists (ACOG) guidelines and patient age. (CIN1 or HPV allowed to participate in the study, CIN2 excluded unless treated and cleared, CIN3 excluded).

9. History of malignancy within 5 years of the start of screening, except for treated basal cell carcinoma and squamous cell carcinoma of the skin.

10. Any thoughts of suicide in the last 12 months per self-report, or documented in the electronic medical record (EMR).

11. Hypersensitivity to the study drugs.

12. Planned surgical treatment of endometriosis or planned surgery in the abdominal-pelvic area within the duration of the trial.

13. Untreated abnormal prolactin or TSH

14. Any conditions that preclude pregnancy.

15. Patients with a known history of a low-trauma fracture or other risk factors for osteoporosis or bone loss.

16. Patients with cirrhosis or abnormal LFTs per self report or documented in the electronic medical record (EMR).

• Exclusion criteria number 1,2, and 3 are not required to be met by individuals in the standard of care arm of the study. The study team will collect the information regarding whether the subject has used these drugs in the aforementioned time frame using the concomitant medication log and the individual will be allowed to participate in the study under the standard of care arm only.

Related Conditions & MeSH terms

• Endometriosis
• Infertility

Intervention

Drug:
• Elagolix 200 MG
Elagolix tablet

Other:
• Placebo or SOC IVF
Sugar pill manufactured to mimic Elagolix 200mg

Locations

Country	Name	City	State
United States	University of Colorado Department of Obstetrics & Gynecology	Aurora	Colorado
United States	Johns Hopkins, Division of Reproductive Science and Women's Health Research	Baltimore	Maryland
United States	Northwestern University Department of Obstetrics and Gynecology	Chicago	Illinois
United States	Duke Fertility	Morrisville	North Carolina
United States	Yale School of Medicine Dept.of Ob/Gyn & Reproductive Sciences	New Haven	Connecticut

Sponsors (5)

Lead Sponsor	Collaborator
Yale University	Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Northwestern University, University of Colorado, Denver, University of North Carolina

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Live birth rate	Live birth rate per participant is defined as live birth at =24 weeks of gestation.	Up to 15 months
Secondary	Fertilization rate	Fertilization rate per participant is defined as the rate of [two pronuclei (2PN)]/[total number of oocytes injected or inseminated]	Up to 9 months
Secondary	Number of embryos transferred	Number of embryos transferred per participant	Up to 9 months
Secondary	Implantation rate	Implantation rate per participant is defined as the rate of (number of gestation sacs visible by Ultrasound) / (Number of Embryo Transfer),	Up to 9 months
Secondary	Biochemical pregnancy rate	Biochemical pregnancy rate per participant is defined as positive pregnancy test following embryo transfer	Up to 9 months
Secondary	Clinical pregnancy rate	Clinical pregnancy rate per participant is defined as ultrasound evidence of intrauterine gestational sac with fetal cardiac activity	Up to 10 months
Secondary	Miscarriage rate	Miscarriage rate among those who achieved pregnancy. Miscarriage is defined as pregnancy loss prior to viability scan and including those confirmed on ultrasound scan up to =23+6 weeks of gestation gestation.	Up to 10 months
Secondary	Overall pregnancy complication rate	Overall pregnancy complication rate among those who achieved pregnancy. Overall pregnancy complication including any of the following: preterm delivery, preeclampsia, incidence of abnormal placentation (placenta previa, accreta, increta, percreta, abruption), bleeding in pregnancy (antepartum or postpartum)	Up to 15 months
Secondary	Gestation age at delivery	Gestation age (weeks) at delivery per infant delivered	Up to 15 months
Secondary	Infant birth weight	Infant birth weight (gram) per infant delivered.	Up to 15 months