Nimodipine to Prevent LH Surge During Ovulation Induction: Blinded Placebo-controlled RCT (NIMO)
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Purpose
The main purpose of this study is to test the effectiveness of nimodipine in preventing a luteinizing hormone (LH) surge in women undergoing ovulation induction with clomiphene citrate. It is important to prevent the premature LH surge in controlled ovarian stimulation to allow adequate recruitment of follicles, proper maturation of a dominant follicle before ovulation, and effectively time insemination with semen to allow fertilization of a mature egg to occur.
The investigators are also conducting this study to determine medication side effect profile (including lightheadedness or dizziness from low blood pressure or rapid heart rate, headache, and nausea), patient treatment compliance, and clinical pregnancy (positive pregnancy test and ultrasound evidence of fetal heart rate). Finally, LH and follicle stimulating hormone (FSH) serum levels will be measured to determine effect of nimodipine on these hormones.
As a calcium channel blocker, nimodipine has been shown to block calcium mediated release of gonadotropin releasing hormone in animal and preliminary human studies. The investigators hypothesize that nimodipine, a calcium channel blocker, will prevent or delay the LH surge during controlled ovarian stimulation cycles using clomiphene citrate in subfertile patients undergoing assisted reproduction with intrauterine insemination (IUI).
| Condition | Intervention |
|---|---|
|
Unexplained Infertility Polycystic Ovarian Syndrome Ovulatory Dysfunction (Absence of or Irregular Ovulation With Unknown Cause) |
Drug: clomiphene citrate Drug: Placebo Drug: Nimodipine |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator) Primary Purpose: Treatment |
| Official Title: | Using Nimodipine, a Calcium Channel Blocker, to Prevent LH Surge in Women Undergoing Controlled Ovarian Stimulation and Intrauterine Insemination: a Double-blinded, Randomized Controlled Study |
- LH surge [ Time Frame: The presence or absence of an LH surge after start of intervention ] [ Designated as safety issue: No ]Compare the change between placebo treated and nimodipine treated patients by the presence or absence of an LH surge on intervention Day 1 and Day 2. LH surge will be determined by serum LH levels at least two times the baseline serum LH (baseline serum LH = (cycle day 3 serum [LH] + cycle day 7 serum [LH])/2).
- Side effect profile [ Time Frame: Starting day 0 of intervention to pregnancy test (approximately 15 days) ] [ Designated as safety issue: Yes ]Medication side effect profile including: symptomatic hypotension (Note: vital signs will be recorded), symptomatic tachycardia (Note: vital signs will be recorded), headache, nausea. These will be self-reported with constructed questionnaire.
- Gonadotropin levels [ Time Frame: Intervention day 0 to ovulation (approximately 1-7 days) ] [ Designated as safety issue: No ]Calculated changes in serum LH, FSH, and estradiol levels between patients in nimodipine and placebo arms
| Estimated Enrollment: | 90 |
| Study Start Date: | September 2012 |
| Estimated Study Completion Date: | December 2014 |
| Estimated Primary Completion Date: | September 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Placebo Comparator: Placebo
Medication given will be 8 total doses of placebo orally 4 times a day for 8 total doses in pre-filled liquid containing syringes
|
Drug: clomiphene citrate
Other Name: Clomid
Drug: Placebo
|
|
Active Comparator: Nimodipine
Nimodipine 30mg liquid orally 4 times a day for 8 total doses in pre-filled syringes
|
Drug: clomiphene citrate
Other Name: Clomid
Drug: Nimodipine
Other Name: Nimotop
|
Eligibility| Ages Eligible for Study: | 25 Years to 40 Years |
| Genders Eligible for Study: | Female |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Age 25-40 years at the time of enrollment
- Both ovaries intact by history and ultrasound assessment
- Early follicular phase (day 2-4) serum FSH level <20 mIU/mL
- Diagnosis of subfertility with a recommended treatment of COH and IUI
- Providing written informed consent in English
Exclusion Criteria:
- Body mass index (BMI) >38 kg/m2
- Early follicular phase (day 2-4) serum FSH level ≥20 mIU/mL
- History of overstimulated cycle defined as >3 mature follicles of ≥17 mm
- Abnormal uterine cavity and/or tubal disease (as evidenced by sonohysterogram or hysterosalpingogram)
- Diagnosis of infertility with a clear indication for in-vitro fertilization, such as bilateral tubal occlusion
- Severe male factor infertility: Total Motile Sperm Count < 2x106 post washing (sperm deemed inadequate for IUI preparation)
- Any ovarian or abdominal abnormality that may interfere with adequate TV ultrasound evaluation
- Absence of one or both ovaries
- Any contraindication to being pregnant or carrying a pregnancy to term
- Unexplained gynecological bleeding
- Any medical condition that would jeopardize the patient or the integrity of the data obtained including:
- Prior reaction or side effects from previous calcium channel blocker use
- Any medical condition that may interfere with the absorption, distribution, metabolism or excretion of nimodipine such as hepatic disease, hypertension, seizure, concurrent infection, depression, reflux (see #12 below).
- Mental health status resulting in cognitive or emotional impairment that would preclude study participation
- The concurrent use of any of the following drugs: [These medications have been shown to effect the availability of the medication or worsen hypotension symptoms]
- Antihypertensives (eg. ACE inhibitors, alpha-adrenergic blocking agents,methyldopa, beta-blockers, diuretics, PDE5 inhibitors, and other calcium antagonists)
- Antiepileptics (eg. phenobarbital, phenytoin, carbamazepine or valproic acid)
- Macrolide antibiotics (eg, erythromycin)
- Azole antimycotics (eg, ketoconazole)
- HIV protease inhibitors (eg, ritonavir)
- Antidepressants (eg, nefazodone and fluoxetine)
- Cimetidine
- Patient unable to communicate adequately with the investigators and to comply with the requirements of the study
- Unwillingness to give written informed consent
Contacts and Locations| Contact: Khanh-Ha D Nguyen, MD MPH | 781-484-6500 | knguyen@bostonivf.com |
| Contact: Alan S Penzias, MD | 781-484-6500 | apenzias@bostonivf.com |
| United States, Massachusetts | |
| Boston IVF | Recruiting |
| Waltham, Massachusetts, United States, 02451 | |
| Contact: Kristin L. Rooney, BA 781-434-6424 krooney@bostonivf.com | |
| Sub-Investigator: Khanh-Ha D Nguyen, MD MPH | |
| Principal Investigator: | Alan S Penzias, MD | Beth Israel Deaconess Medical Center / Boston IVF |
More Information
Publications:
| Responsible Party: | Alan Penzias, Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Boston IVF |
| ClinicalTrials.gov Identifier: | NCT01672801 History of Changes |
| Other Study ID Numbers: | 2012P-000186 |
| Study First Received: | August 22, 2012 |
| Last Updated: | October 5, 2012 |
| Health Authority: | United States: Food and Drug Administration |
Additional relevant MeSH terms:
|
Genital Diseases, Male Infertility Polycystic Ovary Syndrome Genital Diseases, Female Ovarian Cysts Cysts Neoplasms Ovarian Diseases Adnexal Diseases Gonadal Disorders Endocrine System Diseases Calcium Channel Blockers Nimodipine Clomiphene Membrane Transport Modulators |
Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Cardiovascular Agents Therapeutic Uses Estrogen Antagonists Estrogen Receptor Modulators Hormone Antagonists Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs Fertility Agents, Female Fertility Agents Reproductive Control Agents Selective Estrogen Receptor Modulators Antihypertensive Agents Vasodilator Agents |
ClinicalTrials.gov processed this record on May 22, 2013