Can GnRH Agonist Trigger Prevent Ovarian Hyperstimulation Syndrome?

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01714648
Recruitment Status : Terminated (Terminated: recruiting or enrolling participants has halted prematurely and will not resume; participants are no longer being examined or treated)
First Posted : October 26, 2012
Last Update Posted : August 4, 2015
Merck Sharp & Dohme Corp.
Information provided by (Responsible Party):
Dr. Shahar Kol, Elisha Hospital

Brief Summary:
Ovarian hyperstimulation syndrome (OHSS) is a major complication of ovarian stimulation for IVF if hCG is used to trigger final oocyte maturation. The investigators propose that using GnRH agonist as a trigger will eliminate OHSS, even in high-risk patients.

Condition or disease Intervention/treatment Phase
Ovarian Hyperstimulation Syndrome Drug: Triptorelin 0.2 mg Phase 4

Detailed Description:

Administration of hCG (10.000 or 5.000 IU) is essential in IVF protocols to trigger final oocyte maturation after ovarian stimulation. In high responder patients with potential risk of developing OHSS, hCG is usually withheld and the treatment cycle is cancelled without obtaining (cryopreserved) embryos for replacement.

An alternative approach to trigger final oocyte maturation is to administer a GnRH agonist instead of hCG. This method is not possible following a long GnRH agonist protocol which causes down-regulation of the GnRH receptor. However, following GnRH antagonist treatment the GnRH receptor remains receptive to competitive binding by a GnRH agonist.

It has been well-described in earlier IVF trials that a bolus of GnRH agonist will displace the GnRH antagonist from the GnRH receptors in the pituitary inducing an endogenous LH (and FSH) surge resulting in the maturation of oocytes and good quality embryos. In addition, the risk of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) becomes minimal due to the rapid demise of the corpora lutea. Following luteolysis, fresh embryo transfer would require alternative luteal phase support to secure good clinical outcome. Alternatively, good quality embryos obtained after GnRH agonist triggering can be cryopreserved and replaced in following frozen-thawn embryo transfer (FTET) cycles. Thus, also eliminating late onset OHSS due to pregnancy.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: An Uncontrolled, Open-label Feasibility Study to Demonstrate That a GnRH Agonist (Decapeptyl) Can be Safely Administered to Trigger Final Oocyte Maturation in High Responder Patients to Mitigate the Risk of OHSS
Study Start Date : November 2012
Actual Primary Completion Date : January 2014
Actual Study Completion Date : January 2014

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: OHSS high risk patients
Triptorelin 0.2 mg
Drug: Triptorelin 0.2 mg
A single bolus of 0.2 mg triptorelin given 34-36 hours before oocyte retrieval.
Other Name: Decapeptyl 0.2 mg

Primary Outcome Measures :
  1. Number of Participants with Adverse Events as a Measure of Safety: The adverse event is the development of OHSS following oocyte retrieval. [ Time Frame: 12 day from GnRH agonist trigger day. ]
    OHSS usually occurs a few days following oocyte retrieval, and is not a threat once menses start.

Secondary Outcome Measures :
  1. Ongoing pregnancies following FTET cycles of cryopreserved embryos obtained following one treatment cycle of follitropin beta. [ Time Frame: One month from embryo transfer date ]

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Ages Eligible for Study:   18 Years to 42 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • A female patient who needs IVF to become pregnant.
  • Regular menstrual cycle.
  • Antral follicular count (AFC) > 18
  • Following treatment with follitropin beta more than 18 follicles ≥ 11 mm will develop.

Exclusion Criteria:

  • Hypersensitivity to the active substance or to any of the medications used.
  • Tumors of the ovary, breast, uterus, pituitary or hypothalamus.
  • Pregnancy.
  • Abnormal (not menstrual) vaginal bleeding without a known/diagnosed cause.
  • Primary ovarian failure.
  • Ovarian cysts or enlarged ovaries.
  • A history of Ovarian Hyperstimulation Syndrome (OHSS).
  • A previous COS cycle that resulted in more than 30 follicles > 11 mm measured by ultrasound examination.
  • Fibroid tumours of the uterus incompatible with pregnancy.
  • Malformations of the reproductive organs incompatible with pregnancy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01714648

IVF Unit, Elisha Hospital
Haifa, Israel, 31064
Sponsors and Collaborators
Elisha Hospital
Merck Sharp & Dohme Corp.
Principal Investigator: Shahar Kol, MD Elisha Hospital, Haifa, Israel

Responsible Party: Dr. Shahar Kol, Principal Investigator, Elisha Hospital Identifier: NCT01714648     History of Changes
Other Study ID Numbers: MSD-ELISHA1
8328-086 ( Other Grant/Funding Number: MSD Database number 50036 )
First Posted: October 26, 2012    Key Record Dates
Last Update Posted: August 4, 2015
Last Verified: August 2015

Keywords provided by Dr. Shahar Kol, Elisha Hospital:

Additional relevant MeSH terms:
Ovarian Hyperstimulation Syndrome
Pathologic Processes
Ovarian Diseases
Adnexal Diseases
Genital Diseases, Female
Gonadal Disorders
Endocrine System Diseases
Triptorelin Pamoate
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Luteolytic Agents
Contraceptive Agents, Female
Contraceptive Agents
Reproductive Control Agents
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents