Pilot Study on the Effects of FSH Treatment on the Epigenetic Characteristics of Spermatozoa in Infertile Patients With Severe Oligozoospermia
NCT ID: NCT02605070
Last Updated: 2018-03-02
Study Results
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Basic Information
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TERMINATED
PHASE3
30 participants
INTERVENTIONAL
2015-11-30
2017-06-13
Brief Summary
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Detailed Description
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Main objective: To determine the genomic imprint (epigenetic modification) in a series of male infertility patients with alterations in their spermiogram (oligozoospermia) compared to a group of fertile patients in order to evaluate the effect of FSH administration on these modifications and on male infertility.
Secondary objectives
* To assess the main characteristics of the spermiograms of infertility patients before and after FSH treatment.
* To assess modifications in the hormones involved in sperm formation in infertility patients before and after treatment.
* To analyze the results of assisted reproduction treatments in patients receiving FSH treatment.
Conditions
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Study Design
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NON_RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Infertility group
Patients referred will be evaluated to participate in the study and then asked to take part.In this visit,the normal protocol for infertility patients will be followed and at least 2 spermiograms and a blood test analyzing the following parameters:FSH, LH,Estradiol,Total testosterone,SHBG, Albumin,Calculation of bioavailable testosterone,Prolactin.If these tests have not been performed,a second baseline visit will be scheduled.Should the patient meet all the inclusion criteria and after the patient has signed an informed consent form agreeing to participate in the study,the physician will prescribe the medication and schedule visits.Before initiating the treatment, they will provide a semen sample.This sample will be sent to the Center for Reproductive Biology,where the sample will be subjected to epigenetic analysis.The patient will be given samples of Bravelle.It is administered subcutaneously.The dose will be 150 IU 3times a week for 3months
Bravelle
Bravelle will be provided to all patients in the treatment group by the principal investigator (PI) or another member of the research team.
From week nine on, the patients will undergo a physical examination on three different occasions to assess the appearance of any adverse reactions during treatment. It will be up to the patient to communicate the appearance of signs or symptoms which could be associated with the use of the drug.
At week 12 the patient will be scheduled for another visit to perform a semen study and to measure new hormone levels. To this end, a blood test will be carried out (FSH, LH, estradiol, total testosterone, SHBG, and albumin to calculate the amount of bioavailable testosterone). A semen sample will also be obtained to carry out a spermiogram according to WHO guidelines; part of this sample will be used for epigenetic analysis.
Fertily group
Patients who volunteer will be informed of the nature of the study and asked to sign the informed consent form. At least two spermiograms will be performed along with a blood test analyzing the following parameters:FSH,LH,Estradiol,Total testosterone,SHBG,Albumin,Estimation of bioavailable testosterone,Prolactin.
A second baseline visit will be scheduled to evaluate the test results and to check whether these subjects meet all the inclusion criteria for the control group. Those subjects will provide a semen sample which will be stored at -20º C.
Outpatient visit: week twelve: a physical exam will be carried out to identify any adverse reactions. A blood test and a semen sample will also be obtained.
No interventions assigned to this group
Interventions
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Bravelle
Bravelle will be provided to all patients in the treatment group by the principal investigator (PI) or another member of the research team.
From week nine on, the patients will undergo a physical examination on three different occasions to assess the appearance of any adverse reactions during treatment. It will be up to the patient to communicate the appearance of signs or symptoms which could be associated with the use of the drug.
At week 12 the patient will be scheduled for another visit to perform a semen study and to measure new hormone levels. To this end, a blood test will be carried out (FSH, LH, estradiol, total testosterone, SHBG, and albumin to calculate the amount of bioavailable testosterone). A semen sample will also be obtained to carry out a spermiogram according to WHO guidelines; part of this sample will be used for epigenetic analysis.
Eligibility Criteria
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Inclusion Criteria
2. Total sperm concentration (concentration in millions/mL x volume in mL) between 1-10 million (oligozoospermia) in at least 2 spermiograms obtained after a 2-4 day period of sexual abstinence and with a 7-day separation period between tests.
3. Caucasian.
4. Inability of the couple to become pregnant after one year of sexual relations without using any type of contraception.
5. FSH 2-12 IU/mL.
6. Total testosterone \>300 ng/mL and bioavailable testosterone (calculated with the Sexual Hormone Binding Globulin or SHBG albumin) \>145 ng/dL.
1. Between 25-45 years of age.
2. Caucasian.
3. Sperm concentration and motility above the 5th percentile according to the parameters set forth in the 5th edition of the World Health Organization (WHO) guidelines in at least two spermiograms obtained after a 2-4 day period of sexual abstinence and with a 7-day period between tests.
4. Seminal volume \>1 mL.
5. Estradiol \<50 pg/mL
6. FSH \<4.5 IU/L.
7. Total testosterone \>300 ng/dL and bioavailable testosterone \>145 ng/dL.
8. No vasectomy.
9. Has sired a child within the past 5 years.
Exclusion Criteria
2. Sperm motility of 0%.
3. History of cryptorchidism, malignant or benign tumors, known chromosomal abnormalities, testicular tor- sion, testicular trauma, orchitis.
4. Drug use in the past 120 days. thyroid dysfunction
5. Medical history:thyroid dysfunction, blood disease, diabetes.
6. Use of anabolic steroids in the past 2 years or for more than 2 years.
7. Body mass index \>30 kg/m .
8. Intake of over 21 units of alcohol/week in the past 120 days.
25 Years
45 Years
MALE
Yes
Sponsors
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Instituto de Investigacion Sanitaria La Fe
OTHER
Responsible Party
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Locations
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Hospital Universitari i Politècnic La Fe
Valencia, , Spain
Countries
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References
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Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007 Jun;22(6):1506-12. doi: 10.1093/humrep/dem046. Epub 2007 Mar 21.
Dohle GR, Halley DJ, Van Hemel JO, van den Ouwel AM, Pieters MH, Weber RF, Govaerts LC. Genetic risk factors in infertile men with severe oligozoospermia and azoospermia. Hum Reprod. 2002 Jan;17(1):13-6. doi: 10.1093/humrep/17.1.13.
Simoni M, Gromoll J, Dworniczak B, Rolf C, Abshagen K, Kamischke A, Carani C, Meschede D, Behre HM, Horst J, Nieschlag E. Screening for deletions of the Y chromosome involving the DAZ (Deleted in AZoospermia) gene in azoospermia and severe oligozoospermia. Fertil Steril. 1997 Mar;67(3):542-7. doi: 10.1016/s0015-0282(97)80083-0.
Gianotten J, Lombardi MP, Zwinderman AH, Lilford RJ, van der Veen F. Idiopathic impaired spermatogenesis: genetic epidemiology is unlikely to provide a short-cut to better understanding. Hum Reprod Update. 2004 Nov-Dec;10(6):533-9. doi: 10.1093/humupd/dmh045. Epub 2004 Oct 1.
Jenkins TG, Carrell DT. Dynamic alterations in the paternal epigenetic landscape following fertilization. Front Genet. 2012 Jul 31;3:143. doi: 10.3389/fgene.2012.00143. eCollection 2012.
Kelly TL, Li E, Trasler JM. 5-aza-2'-deoxycytidine induces alterations in murine spermatogenesis and pregnancy outcome. J Androl. 2003 Nov-Dec;24(6):822-30. doi: 10.1002/j.1939-4640.2003.tb03133.x.
Houshdaran S, Cortessis VK, Siegmund K, Yang A, Laird PW, Sokol RZ. Widespread epigenetic abnormalities suggest a broad DNA methylation erasure defect in abnormal human sperm. PLoS One. 2007 Dec 12;2(12):e1289. doi: 10.1371/journal.pone.0001289.
Kobayashi H, Sato A, Otsu E, Hiura H, Tomatsu C, Utsunomiya T, Sasaki H, Yaegashi N, Arima T. Aberrant DNA methylation of imprinted loci in sperm from oligospermic patients. Hum Mol Genet. 2007 Nov 1;16(21):2542-51. doi: 10.1093/hmg/ddm187. Epub 2007 Jul 17.
Benchaib M, Braun V, Ressnikof D, Lornage J, Durand P, Niveleau A, Guerin JF. Influence of global sperm DNA methylation on IVF results. Hum Reprod. 2005 Mar;20(3):768-73. doi: 10.1093/humrep/deh684. Epub 2005 Jan 7.
Reyes-Fuentes A, Chavarria ME, Carrera A, Aguilera G, Rosado A, Samojlik E, Iranmanesh A, Veldhuis JD. Alterations in pulsatile luteinizing hormone and follicle-stimulating hormone secretion in idiopathic oligoasthenospermic men: assessment by deconvolution analysis--a clinical research center study. J Clin Endocrinol Metab. 1996 Feb;81(2):524-9. doi: 10.1210/jcem.81.2.8636262.
Fujisawa M, Kanzaki M, Hayashi A, Tanaka H, Okada H, Arakawa S, Kamidono S. Alteration of the hypothalamus-pituitary-testis axis in oligozoospermic men with normal gonadotropin levels. Int J Urol. 1995 Sep;2(4):273-6. doi: 10.1111/j.1442-2042.1995.tb00471.x.
Boissonnas CC, Jouannet P, Jammes H. Epigenetic disorders and male subfertility. Fertil Steril. 2013 Mar 1;99(3):624-31. doi: 10.1016/j.fertnstert.2013.01.124.
Other Identifiers
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FSH_IMEN
Identifier Type: -
Identifier Source: org_study_id
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