Suppression of Endogenous Luteinizing Hormone (LH) Surge With Progesterone vs GnRH Antagonist in Freeze-all IVF Cycles. A Prospective Equivalence Study With Repeated Ovarian Stimulation Cycles.
Overview
- Phase
- Not Applicable
- Intervention
- GnRh antagonist
- Conditions
- Infertility
- Sponsor
- Institut Universitari Dexeus
- Enrollment
- 44
- Locations
- 1
- Primary Endpoint
- Number of euploid embryos as compared between the 2 ovarian stimulation cycles
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
To examine whether the number of euploid embryos following ovarian stimulation with micronized progesterone is equivalent as compared with the number of embryos after ovarian stimulation with the use of a GnRH antagonist in patients undergoing ovarian stimulation for IVF or intracytoplasmatic sperm injection (ICSI).
Detailed Description
The pre-ovulatory surges of GnRH and LH are activated by increased concentrations of circulating estradiol, but ovulation is blocked when progesterone concentrations are elevated, due to a central inhibition of the GnRH surge. Although traditionally GnRH has been traditionally considered the drug of choice to control endogenous LH in controlled ovarian stimulation (COS) cycles, recently, micronized progesterone has been shown to be an effective oral alternative for preventing premature LH surges during COS in women undergoing IVF/ICSI treatments, with excellent results, whereas their safety during pregnancy is well-established. This novel protocol, has several advantages (good tolerance, user convenience, and cost reduction), that are very attractive when it comes to establishing a convenient user regimen in combination with a ''freeze all'' strategy. However, the comparative efficacy of this novel protocol with the more universal use of GnRH-antagonist protocol for the treatment of IVF patients in terms of embryo ploidy has never been evaluated up to date. The current study aims, for the first time, to examine whether the number of euploid embryos following ovarian stimulation with micronized progesterone is equivalent as compared with the number of embryos after ovarian stimulation with the use of a GnRH antagonist in patients undergoing ovarian stimulation for IVF/ICSI. If efficacy would prove to be similar, with no impact on the chromosomal constitution of embryos, there will be obvious advantages for the preferential use of micronized progesterone over the antagonist protocol: oral administration is preferred over subcutaneous injection, and total cost of medication would be lower. This would be particularly interesting for the future in all "freeze all" protocols such as women undergoing ovarian stimulation for fertility preservation, preimplantation genetic screening and oocyte donation programs.
Investigators
Nikolaos Polyzos
Clinical and Scientific Director of Dexeus Mujer
Institut Universitari Dexeus
Eligibility Criteria
Inclusion Criteria
- •Infertile patients
- •Age 36-40 years old
- •BMI 18-30 kg/m2
- •Undergoing preimplantation genetic screening cycles
- •Planned to undergo at least two treatment cycles, to accumulate embryos to increase the chance of obtaining euploid embryos for transfer
- •Willing to participate in the study
Exclusion Criteria
- •Severe male factor requiring TESE (testicular sperm extraction)
- •Low ovarian reserve (AMH \< 1.2 ng/ml)
- •Administration of any other drug potentially interfering with the treatment.
Arms & Interventions
GnRH antagonist
In the antagonist cycle, LH suppression will be accomplished by subcutaneous (SC) injections of 0.25 mg of Cetrorelix or Ganirelix starting in the presence of follicles \>14mm or E2 levels \>400 pg/ml and continuing until ovulation triggering.
Intervention: GnRh antagonist
Micronized progesterone
In the progesterone cycle, endogenous LH suppression will be accomplished by oral administration of micronized progesterone (200 mg) once a day at bed time, from stimulation day 1 and continuing until ovulation triggering.
Intervention: Micronized progesterone
Outcomes
Primary Outcomes
Number of euploid embryos as compared between the 2 ovarian stimulation cycles
Time Frame: 15-45 days following oocyte retrieval procedure
Number of euploid embryos between oocytes received from the antagonist GnRh protocol or the micronized progesterone protocol.
Secondary Outcomes
- Number of mature oocytes(9-20 days from initiation of ovarian stimulation)
- Incidence of premature LH rise(9-20 days from initiation of ovarian stimulation)
- Ultrasound ovarian follicles diameter measurement(9-20 days from initiation of ovarian stimulation)
- Endocrine profile at specific intervals(Stimulation day 0, day 6, day 8, day of final oocyte maturation and day +1 after oocyte maturation (actual day may vary between 9-15))
- Duration of stimulation(9-20 days from initiation of ovarian stimulation)
- Fertilization rate(1 day after oocyte retrieval)
- Total dose of gonadotropins(9-20 days from initiation of ovarian stimulation)