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IVF patients frequently experience physical, emotional or physicological burden; this is particularly relevant in the case of oocyte donors, since young women undergo a procedure that is of no health benefit to them. One of the phases of the treatment that contributes most to this situation is ovarian stimulation; as it involves the administration of daily injections which, in addition to the discomfort of administration, causes anxiety to the patient about its correct administration and possible side effects and to physicians concerns about patient compliance.
Advances in pharmacology and knowledge of ovarian pathophysiology have led to the development of new protocols that simplify and reduce drug administration, decrease the potential risk of misapplication and contribute to an improved patient experience. In this context, Corifollitropin α, a long-acting recombinant FSH (rFSH) molecule, provides with a single subcutaneous injection similar results as daily administration of rFSH during a week.
On the other hand, conventional stimulation protocols used in ART resort to using a GnRH analogue (agonist or antagonist) to prevent early luteinization, which is defined as the presence of a progesterone value of > 1.5 ng/ml on the day of induced ovulation. Nevertheless, its use presents some disadvantages, such as it being sometimes complex to achieve desensitization or consistent hypothalamic block, risk of OHS when ovulation is triggered with HCG or its cost. Hence the interest in exploring new options to prevent a premature peak in LH. Nowadays, the oral administration of progestagens (progesterone-primed ovarian stimulation [PPOS]) during the follicular phase of ovarian stimulation (OS) has emerged as an attractive alternative to conventional protocols for preventing early luteinization. Moreover, PPOS produces a similar or even better, in some subgroups, response to OS (length of treatment, number of MII, cancelation rate, etc.), reproductive outcomes (pregnancy rate, live birth rate, etc) and safety (rate of ovarian hyperstimulation [OHSS] or congenital malformations).
Thus, PPOS would seem to be an effective option for personalized protocols, particularly when fresh embryo transfer (FET) is not to be performed, a circumstance that is likely to rise in frequency given the progressive increase in women's age at childbearing; for example, in oocyte donation, or in fertility preservation (FP) and preimplantation genetic testing for aneuploidy (PGT-A). However, very little data are available regarding cycle outcome following Corifollitropin α and PPOS as pituitary suppressor.
The present study, a prospective RCT, was designed to evaluate cycle characteristics (MII oocytes as the primary objective) and endocrinologic profiles of oocyte donors receiving Corifollitropin α and MPA as co-treatment compared with those receiving a daily dose of rFSH (follitropin β) as a control.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Elonva | Experimental | Patients will undergo controlled ovarian stimulation with Corifolitropin α (Elonva), 100-150 micrograms (100 in< 60kg and 150 ≥ 60 kg) + Progevera 10 mg. |
|
| Puregon | Active Comparator | Patients will undergo controlled ovarian stimulation with Folitropin β (Puregon) + Progevera 10 mg. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Corifolitropin Alfa | Drug | Patients will receive a single dose of Colifolitropin alfa, then will receive daily dose of Folitropin Beta since triggering criteria are met. |
|
| Measure | Description | Time Frame |
|---|---|---|
| To compare the number of total oocytes obtained after controlled ovarian stimulation with α-Corifolitropin vs. β-Folitropin in donors in whom medroxyprogesterone acetate (MPA) was used to prevent early luteinization. | Number of total oocytes and oocytes metaphase II | 2 years |
| To compare the number of metaphase II (MII) oocytes obtained after controlled ovarian stimulation with α-Corifolitropin vs. β-Folitropin in donors in whom medroxyprogesterone acetate (MPA) was used to prevent early luteinization. | Quantification of total oocytes in metaphase II | 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of early luteinization | Quantification of cycle cancellation due to lack of response and failure to obtain MII oocytes in puncture. | 2 years |
| Medication tolerance: pain, abdominal distension, ovarian hyperstimulation syndrome (OHSS), etc. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| JUAN GILES, PhD | Contact | +34 963.05.90.00 | juan.giles@ivirma.com | |
| LAURA CARACENA | Contact | +34687031978 | 11054 | Laura.caracena@ivirma.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| IVI Valencia | Recruiting | Valencia | Valencia | 46015 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 12858870 | Result | Kalfoglou AL. Navigating conflict of interest in oocyte donation. Am J Bioeth. 2001 Fall;1(4):W1. doi: 10.1162/152651601317139333. No abstract available. | |
| 23352098 | Result | Requena A, Cruz M, Collado D, Izquierdo A, Ballesteros A, Munoz M, Garcia-Velasco JA. Evaluation of the degree of satisfaction in oocyte donors using sustained-release FSH corifollitropin alpha. Reprod Biomed Online. 2013 Mar;26(3):253-9. doi: 10.1016/j.rbmo.2012.11.015. Epub 2012 Dec 5. |
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Single-center, randomized, open-label, parallel-group, low-intervention, single-center clinical trial.
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|
| Folitropin Beta | Drug | Patient will receive daily dose of Folitropin Beta since triggering criteria are met. |
|
|
Quantification of pain, abdominal distension, ovarian hyperstimulation syndrome (OHSS) using a specifically designed questionarie for this strudy.
| 2 years |
| Controlled ovraian stimulation duration | Quantification of total days of estimulation | 2 years |
| Total cost of each stimulation type. | Quantification of cost. | 2 years |
| Ivi Valencia | Recruiting | Valencia | Valencia | 46015 | Spain |
|
| 20483664 | Result | Corifollitropin alfa Ensure Study Group. Corifollitropin alfa for ovarian stimulation in IVF: a randomized trial in lower-body-weight women. Reprod Biomed Online. 2010 Jul;21(1):66-76. doi: 10.1016/j.rbmo.2010.03.019. Epub 2010 Mar 28. |
| 26003273 | Result | Boostanfar R, Shapiro B, Levy M, Rosenwaks Z, Witjes H, Stegmann BJ, Elbers J, Gordon K, Mannaerts B; Pursue investigators. Large, comparative, randomized double-blind trial confirming noninferiority of pregnancy rates for corifollitropin alfa compared with recombinant follicle-stimulating hormone in a gonadotropin-releasing hormone antagonist controlled ovarian stimulation protocol in older patients undergoing in vitro fertilization. Fertil Steril. 2015 Jul;104(1):94-103.e1. doi: 10.1016/j.fertnstert.2015.04.018. Epub 2015 May 21. |
| ID | Term |
|---|---|
| D007247 | Infertility, Female |
| D007246 | Infertility |
| ID | Term |
|---|---|
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |
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| ID | Term |
|---|---|
| C571802 | follitropin beta |
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