Randomized Trial Assessing Quinagolide Vaginal Ring for Endometriosis-related Pain
- Conditions
- Endometriosis-related Pain
- Interventions
- Registration Number
- NCT03692403
- Lead Sponsor
- Ferring Pharmaceuticals
- Brief Summary
To evaluate the efficacy of three doses of quinagolide administered as an extended-release vaginal ring compared to placebo on reduction of moderate to severe endometriosis-related pain
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 22
- Pre-menopausal females aged ≥18 years at time of signing informed consent(s) with regular menstrual cycles.
- Body mass index (BMI) of 18-42 kg/m2 (both inclusive) at screening.
- Initial confirmation of endometriosis by laparoscopy or laparotomy within the last 10 years before the run-in visit or visualization of persistent endometrioma by repeat ultrasound.
- Transvaginal ultrasound documenting a uterus with no clinically significant abnormalities and presence of at least one ovary with no clinically significant abnormalities (with the exception of endometrioma) at the run-in visit.
- Eligible participants experienced moderate to severe endometriosis-related pain, which was defined as at the run-in visit, the participant having an NRS score of ≥5 for the worst endometriosis related pain during the past menstrual cycle and at randomization, the participant having a mean daily NRS score of ≥4 for the worst endometriosis related pain during each run-in menstrual cycle.
- History of no relief of endometriosis related pain after any medical therapy or surgery. However, history of partial pain relief, discontinuation due to side effects are not exclusionary.
- Known bone diseases (e.g. osteoporosis, Paget's disease and osteomalacia) affecting bone resorption or bone formation markers.
- Any significant abnormal findings of heart examinations before randomization.
- History of mental illness including occurrence of acute psychosis, bipolar disorders and schizophrenia (except for well-controlled anxiety and/or depression with no changes to interventions for 6 months prior to start of run-in)
- History of impulse control disorders including pathological gambling, compulsive buying, hypersexuality, and binge eating or being identified with potential impulse control disorder by the questionnaire for impulsive-compulsive disorders (a score ≥2 for any sub-questions of Question 3 or a score ≥1 for any sub-questions of Question 4) prior to randomization.
- History of orthostatic hypotension or recurrent syncope.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Quinagolide 720 µg Quinagolide 720 µg Vaginal ring containing Quinagolide 720 μg, with daily target release rate of 9 μg Quinagolide 1080 µg Quinagolide 1080 µg Vaginal ring containing Quinagolide 1080 μg, with daily target release rate of 13.5 μg Quinagolide 360 µg Quinagolide 360 µg Vaginal ring containing Quinagolide 360 μg, with daily target release rate of 4.5 μg Placebo Placebo Vaginal ring containing matching placebo
- Primary Outcome Measures
Name Time Method Changes in the Mean Daily Numerical Rating Scale (NRS) Scores for the Worst Endometriosis-related Pain. At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary. NRS is an 11-point scale, with 0 indicating no pain and 10 indicating the worst imaginable pain.
Changes from baseline to cycle 4.
- Secondary Outcome Measures
Name Time Method Changes in the Mean Daily Numerical Rating Scale (NRS) Scores for the Worst Non-menstrual Pelvic Pain. From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary. NRS is an 11-point scale, with 0 indicating no pain and 10 indicating the worst imaginable pain.
Changes over 4 menstrual cyclesChanges in the Mean Weekly Scores of the Endometriosis Health Profile-30 (EHP-30) Pain Impact Domain. From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed weekly by participants in an e-Diary. EHP-30 is a quality-of-life questionnaire. Score ranges from 0-100 and lower score denotes improvement.
Changes over 4 menstrual cycles.Percentage of Days With Mild and/or Strong Rescue Analgesics Used From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary
Responder Rate From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed as ≥30%, ≥50% and ≥70% reduction from the baseline in mean daily NRS score for the worst endometriosis-related pain, dysmenorrhea and non-menstrual pelvic pain and for the worst endometriosis-related pain impact
Changes in Patient Global Impression of Severity (PGIS) Scores At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by the PGIS scale completed by participants. PGIS is a 6-point scale depicting a participant's rating of their current conditions from "good" to "bad".
It ranges from 0 (none) to 5 (very severe).Plasma Concentration of Quinagolide and Metabolites Within 5 days after first ring insertion and at around 1 month, 3 months, 3.5 months and 4 months after baseline (each cycle is approximately 28 days) Assessed by blood samples collection
Serum Levels of Mid-luteal Phase Progesterone At baseline and cycle 4 (around 3.5 months, each cycle is approximately 28 days) Assessed by blood samples collection
Number of Subjects With Serum Mid-luteal Progesterone Levels ≥25 Nmol/L (7.9 ng/ml) At baseline and cycle 4 (around 3.5 months, each cycle is approximately 28 days) Assessed by blood samples collection
Changes in the Mean Daily Numerical Rating Scale (NRS) Scores for the Worst Impact of Endometriosis-related Pain on the Subject's Ability to Function. From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary. NRS is an 11-point scale, with 0 indicating no pain and 10 indicating the worst imaginable pain.
Changes over 4 menstrual cycles.Changes in Bone Turnover Markers, Determined by Bone Resorption Marker Serum C-terminal Crosslinking Telopeptide of Type 1 Collagen (s-CTx) From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by blood samples collection. Changes from baseline to cycle 4
Changes in Bone Turnover Markers, Determined by Bone Formation Marker Serum Procollagen Type I N Propeptide (s-PINP) From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by blood samples collection. Changes from baseline to cycle 4
Changes in Vaginal Bleeding Pattern - Number of Days With Bleeding Related to Period From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) The participants recorded daily if they had any vaginal bleeding during the past 24 hours, in an e-diary. Of the participants who had a bleeding, the participant recorded if this was menstrual bleeding: "Yes" (I had a vaginal bleeding that was menstrual bleeding) or "No" (I had a vaginal bleeding that was not menstrual bleeding). The numbers represent the cumulative number of days with vaginal bleeding, summed across all participants.
In some cases, there are missing data as not every participant completed the e-diary for 100% of study days.Total and Average Doses of Mild and/or Strong Rescue Analgesics Used From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary
Changes in the Endometriosis Health Profile-30 (EHP-30) Scores From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by the EHP-30 quality-of-life questionnaire completed by participants. Score ranges from 0-100 with lower score denoting improvement.
Serum Levels of Estradiol At baseline and cycle 4 (around 3.5 months, each cycle is approximately 28 days) Assessed by blood samples collection
Serum Levels of Thyrotropin (TSH) At baseline and cycle 4 (around 3.5 months, each cycle is approximately 28 days) Assessed by blood samples collection
Changes in the Mean Daily Numerical Rating Scale (NRS) Scores for the Worst Dyspareunia on Days With Sexual Intercourse. From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary. NRS is an 11-point scale, with 0 indicating no pain and 10 indicating the worst imaginable pain.
Changes over 4 menstrual cycles.Frequency of Avoiding Sexual Intercourse Due to Expected Pain From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) The participants recorded daily if they had sexual intercourse, in an e-diary. For the days when participants did not have intercourse, the participant recorded if the reason for not having intercourse was because they expected pain: "Yes" (I did not have intercourse this day, because I expected pain) or "No" (I did not have intercourse this day, but this was not because I expected pain). The numbers represent the cumulative number of days with no intercourse, summed across all participants.
In some cases, there are missing data as not every participant completed the e-diary for 100% of study days.Changes in the Mean Daily Numerical Rating Scale (NRS) Scores for the Worst Endometriosis-related Pain. From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary. NRS is an 11-point scale, with 0 indicating no pain and 10 indicating the worst imaginable pain.
Changes over 4 menstrual cyclesChanges in the Mean Daily Numerical Rating Scale (NRS) Scores for the Worst Endometriosis-related Pain on Days With Menstrual Bleeding and for the Worst Endometriosis-related Pain on Days With no Menstrual Bleeding At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary. NRS is an 11-point scale, with 0 indicating no pain and 10 indicating the worst imaginable pain.
Days with menstrual bleeding (dysmenorrhea). No menstrual bleeding (non-menstrual pelvic pain) Changes from baseline to cycle 4Changes in the Mean Daily Numerical Rating Scale (NRS) Scores for the Worst Dysmenorrhea. From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed daily by participants in an e-Diary. NRS is an 11-point scale, with 0 indicating no pain and 10 indicating the worst imaginable pain.
Changes over 4 menstrual cyclesChanges in Vaginal Bleeding Pattern. From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) The participants recorded daily if they had any vaginal bleeding during the past 24 hours, in an e-diary. Of the participants who had a bleeding, the participant recorded the assessed bleeding volume as either spotting (tiny amount of blood on underwear or panty liners), light bleeding (requiring 1-3 sanitary pads or tampons per day), moderate bleeding (requiring 4-6 sanitary pads or tampons per day), or heavy bleeding (requiring more than 6 sanitary pads or tampons per day). The numbers represent the cumulative number of days with vaginal bleeding, summed across all participants.
In some cases, there are missing data as not every participant completed the e-diary for 100% of study days.Changes in the Mean Individual and Total Symptom and Sign Severity Scores At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by the Biberoglu and Behrman (B\&B) scale which is a 4-point scale with 0=none and 3=severe.
The scores are the mean individual scores.
The B\&B scale consists of two parts. The first part of the B\&B scale evaluates symptoms of endometriosis (i.e. pain). There are 3 subscales: pelvic pain(A, 0=none and 3=severe), dysmenorrhea (B, 0=none and 3=severe), and dyspareunia(C, 0=none and 3=severe). The total pelvic pain score is the sum of the three scores, i.e. A+B+C, which can range from 0 to 9. The second part of the B\&B scale evaluates signs of endometriosis. There are 2 subscales pelvic tenderness (D, 0=none and 3=severe) and induration (E, 0=none and 3=severe) based on findings from a pelvic examination. The total physical pain score is the sum of the two scores, i.e. D+E, which can range from 0 to 6. The total symptom and sign severity score is the sum of all five scores, i.e. A+B+C+D+E, which can range from 0 to 15.
The values are the change from baseline to cycle 4.Patient Global Impression of Change (PGIC) Scores At cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by the PGIC scale completed by participants. PGIC is a 7-point scale depicting a patient's rating of their overall improvement from "good" to "bad".
Serum Levels of Prolactin At baseline and cycle 4 (around 3.5 months, each cycle is approximately 28 days) Assessed by blood samples collection
Serum Levels of Insulin-like Growth Factor-1 (IGF-1) At baseline and cycle 4 (around 3.5 months, each cycle is approximately 28 days) Assessed by blood samples collection
Changes in ECG Parameters Including PR Interval at Cycle 4 At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by 12-lead ECG
Changes in ECG Parameters Including QRS Duration at Cycle 4 At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by 12-lead ECG
Changes in ECG Parameters Including QT Interval at Cycle 4 At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by 12-lead ECG
Changes in ECG Parameters Including QTcF Interval at Cycle 4 At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by 12-lead ECG
Proportion of Subjects With Abnormal Clinically Significant Echocardiography Findings Indicating Valvular Heart Disease At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by echocardiography.
Each echocardiography was to be assessed as normal or abnormal according to American College of Cardiology/American Heart Association guidelines for valvular heart disease. If abnormal, the level of valvular regurgitation and valvular stenosis was specified as mild, moderate or severe and valvular structure was evaluated as well.
Measured at cycle 4.Proportion of Subjects Identified With Potential Impulse Control Disorders At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by the questionnaire for impulsive-compulsive disorders completed by participants.
Measured at cycle 4.Frequency and Intensity of Adverse Events From signing informed consent through study completion, around 8 months Assessed by an Adverse Events Log completed by the Investigator
Changes in Circulating Levels of Clinical Chemistry Parameters: Albumin At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Alkaline Phosphatase At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Alanine Aminotransferase At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Aspartate Aminotransferase At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Bicarbonate At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Calcium At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Creatinine At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Glucose At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Direct Bilirubin At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Bilirubin At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Gamma Glutamyl Transferase At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Lactate Dehydrogenase At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Chloride At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Basophils Absolute At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Platelets At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Erythrocytes At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Urinalysis Parameters (Protein, Glucose, Bilirubin, pH, Nitrite, Ketone, Urobilinogen, Blood, Leukocytes, and Specific Gravity) At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by urine sample collection (dip-stick test). Overall Urinalysis Result.
Proportion of Subjects With Markedly Abnormal Changes in Circulating Levels of Clinical Haematology Parameters At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Proportion of Subjects With Markedly Abnormal Changes in Urinalysis Parameters At baseline and at menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by urine samples collection
Frequency and Intensity of Ring Acceptability Parameters: Insertion of the Vaginal Ring From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by a questionnaire completed by participants, addressing ring insertion
Frequency and Intensity of Ring Acceptability Parameters: Felt the Ring From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by a questionnaire completed by participants, addressing any feeling of the ring while the ring is in the body.
Changes in Circulating Levels of Clinical Chemistry Parameters: Cholesterol At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Hematocrit At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Leukocytes At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Potassium At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Phosphate At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Protein At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Sodium At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Hemoglobin At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Lymphocytes Absolute At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Lymphocytes At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Ery. Mean Corpuscular Hemoglobin At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Urate At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Chemistry Parameters: Urea Nitrogen At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Basophils At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Eosinophils Absolute At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Eosinophils At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Ery. Mean Corpuscular HGB Concentration At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Ery. Mean Corpuscular Volume At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Monocytes Absolute At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Neutrophils Absolute At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Proportion of Subjects With Markedly Abnormal Changes in Circulating Levels of Clinical Chemistry Parameters At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Frequency and Intensity of Ring Acceptability Parameters: Removal of the Vaginal Ring From baseline to menstrual cycle 4 (around 4 months, each cycle is approximately 28 days) Assessed by a questionnaire completed by participants, addressing ring removal.
Changes in Circulating Levels of Clinical Haematology Parameters: Monocytes At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Changes in Circulating Levels of Clinical Haematology Parameters: Neutrophils At baseline and at menstrual cycle 4 (around 4 months) Assessed by blood samples collection
Trial Locations
- Locations (43)
Johns Hopkins Outpatient Center
🇺🇸Baltimore, Maryland, United States
Northwestern Memorial Hospital
🇺🇸Chicago, Illinois, United States
Arkansas Primary Care Clinic
🇺🇸Little Rock, Arkansas, United States
Medical Center for Clinical Research
🇺🇸San Diego, California, United States
Vista Health Research
🇺🇸Miami, Florida, United States
Carolina's Women's Research and Wellness Center
🇺🇸Durham, North Carolina, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Cypress Medical Research Center
🇺🇸Wichita, Kansas, United States
Wasatch Clinical Research
🇺🇸Salt Lake City, Utah, United States
Physician Care Clinical Research
🇺🇸Sarasota, Florida, United States
Meridien Research
🇺🇸Saint Petersburg, Florida, United States
Miami Dade Medical Research Institute
🇺🇸Miami, Florida, United States
Advance Clinical Research
🇺🇸Meridian, Idaho, United States
OB/Gyn Associates
🇺🇸Silver Spring, Maryland, United States
Valley OB/GYN Clinic, PC
🇺🇸Saginaw, Michigan, United States
The Iowa Clinic
🇺🇸Ankeny, Iowa, United States
Main Line Fertility Center
🇺🇸Bryn Mawr, Pennsylvania, United States
Rapha Institute For Clinical Research
🇺🇸Fayetteville, North Carolina, United States
Corpus Christi Women's Clinic
🇺🇸Corpus Christi, Texas, United States
South Florida Research Center
🇺🇸Miami, Florida, United States
Onyx Clinical Research
🇺🇸Flint, Michigan, United States
Omega Research Consultants
🇺🇸DeBary, Florida, United States
Advances in Health, Inc.
🇺🇸Houston, Texas, United States
Center of Reproductive Medicine LLC
🇺🇸Webster, Texas, United States
Tidewater Clinical Research, Inc.
🇺🇸Norfolk, Virginia, United States
SUNY Downstate Medical Center
🇺🇸Brooklyn, New York, United States
Florida Research Center
🇺🇸Miami, Florida, United States
UConn Health Lowell P Weicker Jr Clinical Research Center
🇺🇸Farmington, Connecticut, United States
Advanced Research Institute
🇺🇸New Port Richey, Florida, United States
OB•GYN Associates of WNY
🇺🇸West Seneca, New York, United States
PMG Research of Charlotte
🇺🇸Charlotte, North Carolina, United States
Penn State Health - Milton S. Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Omni Fertility Clinical Research LLC
🇺🇸Shreveport, Louisiana, United States
Marchand Institute for Minimally Invasive Surgery
🇺🇸Mesa, Arizona, United States
Southern Clinical Research Associates
🇺🇸Metairie, Louisiana, United States
Southern Illinois University
🇺🇸Springfield, Illinois, United States
Yale Fertility Center
🇺🇸New Haven, Connecticut, United States
Lyndhurst Clinical Research
🇺🇸Winston-Salem, North Carolina, United States
Unified Women's Clinical Research d/b/a Lyndhurst Clinical Research
🇺🇸Winston-Salem, North Carolina, United States
Clinical Trials of South Carolina
🇺🇸Charleston, South Carolina, United States
OB/GYN Specialists of Richmond
🇺🇸Richmond, Virginia, United States
Austin Area Ob, Gyn and Fertility
🇺🇸Austin, Texas, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States