Impact of Local Biopsy to the Endometrium Prior to Controlled Ovarian Stimulation on Clinical Pregnancy

NCT ID: NCT01064193

Last Updated: 2015-04-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

190 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2015-02-28

Brief Summary

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In vitro fertilization (IVF) is the only available solution for many couples with various forms of infertility. The embryo implantation step in the IVF procedure is a complex multistage process and represents the majority of the causes of the IVF failure. Several approaches have been evaluated to improve implantation rates but none has demonstrated its superiority. However, endometrial receptivity is important for pregnancy and several studies suggest that local injury to the endometrium of IVF patients improves the rates of embryo implantation, clinical pregnancy and live birth.

Detailed Description

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They are possible mechanisms by which endometrial sampling may increase receptivity and improve clinical pregnancy rate of IVF-ET. First, local injury to proliferative phase endometrium might induce the decidualization of the endometrium, and increase its implantation rate. Second, local injury to the endometrium might provoke the wound healing, involving a mass secretion of different cytokines and growth factor, which are beneficial for embryo implantation. Last, the injury might make the endometrium maturation.

This study proposes to evaluate the efficiency of an endometrial injury in the first controlled ovarian hyperstimulation cycle on the rate of clinical pregnancy, in assisted reproductive technologies. This study will compare 2 groups of patients. The first group will undergo biopsy of the endometrium before the IVF; the second will undergo the IVF alone. Inclusions will be conducted on 33 months; the patients will be in the study for a period of 36 weeks. The total duration of the study is 39 months

Conditions

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Primary or Secondary Infertility

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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group 1 : IVF with biopsy

fresh IVF-embryo transfer treated with long protocol or antagonist protocol for the controlled ovarian hyperstimulation plus local injury to the endometrium of patients one menstrual cycle before the IVF

Group Type EXPERIMENTAL

biopsy

Intervention Type PROCEDURE

The endometrium biopsy will be done as the same time as the GnRH treatment. The biopsy is realised with a Pipette de Cornier® (CDD international, PROMIDED France) following the laboratory protocol:

* Apply antiseptic solution (povidone-iodine, Dakin®) on the cervix and vagina. In most cases, using Pozzi forceps is not necessary.
* Insert carefully the pipelle de Cornier® in the uterus through the cervix.
* Withdraw the piston to create a negative pression
* Move the pipelle de cornier® in and out while twisting. Take care to no remove the pipelle form the uterus (suction lost). Twist the pipelle de Cornier® to cover an angle of 360°. Make several "in and out" cycle in order to collect a complete sample of the endometrium.
* Withdraw the pipelle de Cornier® when filled with tissue
* Reinsert internal piston to deposit sample in cup filled with a fixative.

group 2

fresh IVF-embryo transfer treated with long protocol or antagonist protocol for the controlled ovarian hyperstimulation alone

Group Type ACTIVE_COMPARATOR

IVF

Intervention Type PROCEDURE

fresh IVF-embryo transfer treated with long protocol for the controlled ovarian hyperstimulation

Interventions

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biopsy

The endometrium biopsy will be done as the same time as the GnRH treatment. The biopsy is realised with a Pipette de Cornier® (CDD international, PROMIDED France) following the laboratory protocol:

* Apply antiseptic solution (povidone-iodine, Dakin®) on the cervix and vagina. In most cases, using Pozzi forceps is not necessary.
* Insert carefully the pipelle de Cornier® in the uterus through the cervix.
* Withdraw the piston to create a negative pression
* Move the pipelle de cornier® in and out while twisting. Take care to no remove the pipelle form the uterus (suction lost). Twist the pipelle de Cornier® to cover an angle of 360°. Make several "in and out" cycle in order to collect a complete sample of the endometrium.
* Withdraw the pipelle de Cornier® when filled with tissue
* Reinsert internal piston to deposit sample in cup filled with a fixative.

Intervention Type PROCEDURE

IVF

fresh IVF-embryo transfer treated with long protocol for the controlled ovarian hyperstimulation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* primary or secondary infertility
* first or second IVF attempt
* aged ≥18 and ≤38 years
* regular menstrual cycles
* FSH≤ 12IU/L
* Informed consent signed

Exclusion Criteria

* ovocyte donor
* pathology of the uterus or annexes
* Body mass index (BMI)\> 35
* ongoing vaginal infection
* undetermined vaginal bleeding
* contraindication to the Cornier pipette or to these treatments : Gonal F®, Puregon®, Ovitrelle®, Utrogestan®,
* women included in another study on medically assisted procreation
* any administrative or legal supervision
Minimum Eligible Age

18 Years

Maximum Eligible Age

38 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Bordeaux

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Antoine Benard, Doctor

Role: STUDY_CHAIR

University Hospital Bordeaux, France

Sandrine Blancpain, Doctor

Role: PRINCIPAL_INVESTIGATOR

University Hospital Bordeaux, France

Locations

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CHU de Bordeaux, Hôpital Saint André, service de chirurgie gynécologie et médecine de la reproduction

Bordeaux, , France

Site Status

Cabinet Médical de gynécologie

Pessac, , France

Site Status

CHU de Toulouse, service de médecine et biologie de la reproduction

Toulouse, , France

Site Status

Countries

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France

References

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Bourgain C, Devroey P. The endometrium in stimulated cycles for IVF. Hum Reprod Update. 2003 Nov-Dec;9(6):515-22. doi: 10.1093/humupd/dmg045.

Reference Type BACKGROUND
PMID: 14714588 (View on PubMed)

Richter KS, Bugge KR, Bromer JG, Levy MJ. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril. 2007 Jan;87(1):53-9. doi: 10.1016/j.fertnstert.2006.05.064. Epub 2006 Nov 1.

Reference Type BACKGROUND
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Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril. 2003 Jun;79(6):1317-22. doi: 10.1016/s0015-0282(03)00345-5.

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Raziel A, Schachter M, Strassburger D, Bern O, Ron-El R, Friedler S. Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure. Fertil Steril. 2007 Jan;87(1):198-201. doi: 10.1016/j.fertnstert.2006.05.062.

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Revelli A, Dolfin E, Gennarelli G, Lantieri T, Massobrio M, Holte JG, Tur-Kaspa I. Low-dose acetylsalicylic acid plus prednisolone as an adjuvant treatment in IVF: a prospective, randomized study. Fertil Steril. 2008 Nov;90(5):1685-91. doi: 10.1016/j.fertnstert.2007.08.037. Epub 2007 Dec 11.

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Reference Type BACKGROUND
PMID: 17509593 (View on PubMed)

Silver MM, Miles P, Rosa C. Comparison of Novak and Pipelle endometrial biopsy instruments. Obstet Gynecol. 1991 Nov;78(5 Pt 1):828-30.

Reference Type BACKGROUND
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Gellersen B, Brosens IA, Brosens JJ. Decidualization of the human endometrium: mechanisms, functions, and clinical perspectives. Semin Reprod Med. 2007 Nov;25(6):445-53. doi: 10.1055/s-2007-991042.

Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 16978615 (View on PubMed)

Homburg R, Pap H, Brandes M, Huirne J, Hompes P, Lambalk CB. Endometrial biopsy during induction of ovulation with clomiphene citrate in polycystic ovary syndrome. Gynecol Endocrinol. 2006 Sep;22(9):506-10. doi: 10.1080/09513590600921366.

Reference Type BACKGROUND
PMID: 17071535 (View on PubMed)

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Balasch J, Vanrell JA, Marquez M, Gonzalez-Merlo J. Endometrial biopsy inadvertently taken in the cycle of conception. Int J Gynaecol Obstet. 1984 Apr;22(2):95-9. doi: 10.1016/0020-7292(84)90020-1.

Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 17681303 (View on PubMed)

Cornier E. The Pipelle: a disposable device for endometrial biopsy. Am J Obstet Gynecol. 1984 Jan 1;148(1):109-10. doi: 10.1016/s0002-9378(84)80043-5. No abstract available.

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Golan A, Ron-el R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989 Jun;44(6):430-40. doi: 10.1097/00006254-198906000-00004. No abstract available.

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Reference Type DERIVED
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Other Identifiers

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CHUBX 2009/12

Identifier Type: -

Identifier Source: org_study_id

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