Gonadotropin Type in Ovarian Stimulation

• ClinicalTrials.gov Identifier: NCT02437032
• Recruitment Status: Completed
• First Posted: May 7, 2015
• Last Update Posted: May 7, 2015
• Sponsor: IVI Madrid
• Information provided by (Responsible Party): Antonio Requena, IVI Madrid

Study Description

Brief Summary:

A key challenge facing reproductive biologists is the integration of the knowledge about oocyte-secreted factors into coherent physiological mechanisms of how oocytes govern folliculogenesis, cumulus cell function, and oocyte and embryo development. Although key oocyte-secreted factors have been identified, understanding their modes of action is complicated by multiple interactions between maternal and oocyte signaling molecules, as well as the constantly changing state of physical interactions between the oocyte and its companion somatic cells during folliculogenesis. Thus, the investigators study aimed to determine if there is any relationship between different gonadotropin preparations and oocyte-secreted factor secretion, the endocrine pattern in follicular fluid, and the apoptotic rate in cumulus cells during controlled ovarian stimulation.

Condition or disease	Intervention/treatment	Phase
Infertility	Drug: recombinant FSH; Drug: Urinary FSH; Drug: hMG	Phase 4

Detailed Description:

The follicular environment is primarily influenced by the type of gonadotropin the follicle is exposed to during the follicular phase. The role of gonadotropins has been especially important in improving the efficiency of in vitro fertilization. Several studies comparing the use of human menopausal gonadotropin (hMG) with recombinant follicle-stimulating hormone (rFSH) have found significant differences in the endocrinological profile and the follicular dynamics. These differences have been related to the human chorionic gonadotropin (hCG)-driven luteinizing hormone (LH) activity added to hMG. Moreover, differences in the proportion of acid residues in FSH molecules should be considered.

On the other hand, the main physiological regulatory hormones of follicular survival are the gonadotropins. Suppression of serum gonadotropins leads to massive apoptosis of granulosa cells in developing follicles resulting in atresia; whereas, gonadotropin treatment of early antral and pre-ovulatory follicles prevents this unplanned apoptosis. However, studies using cultured rat granulosa cells have shown that treatments with FSH or LH/hCG are ineffective in preventing spontaneous apoptosis, suggesting neighboring theca cells and local factors produced in the ovary are important for regulation of follicle growth and atresia.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 100 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Type of Gonadotropin During Controlled Ovarian Stimulation Affects the Endocrine Profile in Follicular Fluid and Apoptotic Rate in Granulose Cells
• Study Start Date: April 2009
• Actual Primary Completion Date: September 2012
• Actual Study Completion Date: December 2012

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Group 1: recombinant FSH; An oral contraceptive pill (Microgynon30®, Bayer Hispania, Spain) was taken for a maximum of 21 days, starting on day 1-2 of the menses of the previous cycle. After a wash-period of five days after the last pill, donors started to receive daily doses of 150-300 UI of rFSH (Gonal-F®, Merck-Serono, Spain; n=30) depending on their age, body mass index (BMI) and ovarian response in previous cycles. Daily doses of 0.25 mg gonadotropin- releasing hormone antagonist cetrorelix (Cetrotide®, Merck-Serono, Spain) were started on day six of stimulation in each group. When at least three or more leading follicles reached a mean diameter of ≥18 mm, hCG (Ovitrelle®, 250 µg; Merck-Serono, Spain) was administered subcutaneously	Drug: recombinant FSH; Controlled ovarian stimulation with 150-300 UI recombinant FSH; Other Name: Gonal-F
Active Comparator: Group 2:urinary FSH; An oral contraceptive pill (Microgynon30®, Bayer Hispania, Spain) was taken for a maximum of 21 days, starting on day 1-2 of the menses of the previous cycle. After a wash-period of five days after the last pill, donors started to receive daily doses of 150-300 UI of urinary FSH (uFSH) (Fostipur®, Angelini, Spain; n=30) depending on their age, body mass index (BMI) and ovarian response in previous cycles. Daily doses of 0.25 mg gonadotropin- releasing hormone antagonist cetrorelix (Cetrotide®, Merck-Serono, Spain) were started on day six of stimulation in each group. When at least three or more leading follicles reached a mean diameter of ≥18 mm, hCG (Ovitrelle®, 250 µg; Merck-Serono, Spain) was administered subcutaneously.	Drug: Urinary FSH; Controlled ovarian stimulation with 150-300 UI urinary FSH; Other Name: Fostipur
Active Comparator: Group 3: with hMG; An oral contraceptive pill (Microgynon30®, Bayer Hispania, Spain) was taken for a maximum of 21 days, starting on day 1-2 of the menses of the previous cycle. After a wash-period of five days after the last pill, donors started to receive daily doses of 150-300 UI of hMG (HMG-Lepori®, Angelini, Spain; n=30) depending on their age, body mass index (BMI) and ovarian response in previous cycles. Daily doses of 0.25 mg gonadotropin- releasing hormone antagonist cetrorelix (Cetrotide®, Merck-Serono, Spain) were started on day six of stimulation in each group. When at least three or more leading follicles reached a mean diameter of ≥18 mm, hCG (Ovitrelle®, 250 µg; Merck-Serono, Spain) was administered subcutaneously, and transvaginal oocyte retrieval was performed 36 h later.	Drug: hMG; Controlled ovarian stimulation with 150-300 UI hMG; Other Name: hMG-Lepori

Outcome Measures

Primary Outcome Measures :

1. GDF-9 and BMP-15 secretion [ Time Frame: 3 years ]
   To measure GDF-9 (ng/ml) and BMP-15 (micrograms/microliter)

Secondary Outcome Measures :

1. Steroids levels in follicular fluid (estradiol, progesterone, testosterone, FSH) [ Time Frame: 3 years ]
   To measure estradiol (pg/ml), progesterone (ng/ml), FSH (mUI/ml) and testosterone (ng/ml)
2. Apoptotic rate in cumulus cells [ Time Frame: 3 years ]
   To measure early and late apoptotic rate (%)

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 35 Years (Adult)
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• 18-35 years old
• regular menstrual cycles
• no hereditary or chromosomal diseases normal karyotype negative for sexually transmitted diseases
• at least seven antral follicles per ovary

Exclusion Criteria:

• PCO

Contacts and Locations

Sponsors and Collaborators

IVI Madrid

Investigators

• Principal Investigator: Antonio Requena, PhD, MD; IVI Madrid

More Information

Publications of Results:

Gilchrist RB, Lane M, Thompson JG. Oocyte-secreted factors: regulators of cumulus cell function and oocyte quality. Hum Reprod Update. 2008 Mar-Apr;14(2):159-77. doi: 10.1093/humupd/dmm040. Epub 2008 Jan 5. Review.

Smitz J, Andersen AN, Devroey P, Arce JC; MERIT Group. Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients. Hum Reprod. 2007 Mar;22(3):676-87. Epub 2006 Nov 16.

Orisaka M, Orisaka S, Jiang JY, Craig J, Wang Y, Kotsuji F, Tsang BK. Growth differentiation factor 9 is antiapoptotic during follicular development from preantral to early antral stage. Mol Endocrinol. 2006 Oct;20(10):2456-68. Epub 2006 Jun 1.

• Responsible Party: Antonio Requena, PhD, MD, IVI Madrid
• ClinicalTrials.gov Identifier: NCT02437032
• Other Study ID Numbers: MAD-GV-04-2009-01
• First Posted: May 7, 2015
• Last Update Posted: May 7, 2015
• Last Verified: May 2015

Keywords provided by Antonio Requena, IVI Madrid:

GDF-9; BMP-15; Steroids; Apoptosis rate; Endocrinology

Additional relevant MeSH terms:

Infertility; Menotropins; Fertility Agents, Female; Fertility Agents; Reproductive Control Agents; Physiological Effects of Drugs