Comparative Study Between Single Versus Dual Trigger for Poor Responders in GnRH-antagonist ICSI Cycles

NCT ID: NCT04008966

Last Updated: 2019-07-05

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

PHASE4

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-07-20

Study Completion Date

2019-07-01

Brief Summary

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All participants started with a combination of recombinant FSH 300 U and urinary Gn 150 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response

From day 6 of the cycle, follow up using transvaginal ultrasound was done either daily or on alternate days according to the ovarian response. When the leading follicle reached 12 mm, GnRH antagonist was started using Cetrotide 0.25 subcutaneously daily till the day of triggering. Triggering was done when at least 3 follicles larger than 14 mm and at least one of them reached a mean diameter of 17 mm or more.

At the day of triggering, women were randomized into 2 groups. Group I (single trigger group) that included 80 women who received triggering in the form of 10,000 IU of HCG intramuscular injection. Group II (Dual trigger group) that included 80 women who received triggering in the form of 10,000 IU of HCG intramuscular injection in addition to GnRH agonist triptorelin 0.2 mg subcutaneously.

Ovum pickup was done 34 hours after triggering under the guidance of transvaginal ultrasound.

ISM1 culture medium was used for oocyte collection and embryo culture. Transabdominal ultrasound guided embryo transfer was done 3 days after oocyte retrieval using Labotect semirigid catheter by the same expert operator

Cycle cancellation was done if day 9 folliculometry revealed less than 2 mature follicles, no oocytes were retrieved or if fertilization failed

Luteal phase support was started in all women on the day of oocyte retrieval and continued till the day of serum β-hCG assessment (done 14 days after ET) through administration of 400 mg of natural Progesterone twice daily per vagina . In women with +ve serum β-hCG (\> 5 mIU/ml), transvaginal ultrasound evaluation was done 4 weeks after ET to confirm the presence and number of intrauterine gestational sacs.

Detailed Description

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All participants started with a combination of recombinant FSH 300 U and urinary Gn 150 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response evaluated by transvaginal ultrasound and serum E2. Delayed start

From day 6 of the cycle, follow up using transvaginal ultrasound was done either daily or on alternate days according to the ovarian response. Ultrasound follow up reported number and size of follicles in each ovary and the endometrial thickness and pattern. When the leading follicle reached 12 mm, GnRH antagonist was started using Cetrotide 0.25 subcutaneously daily till the day of triggering. Triggering was done when at least 3 follicles larger than 14 mm and at least one of them reached a mean diameter of 17 mm or more.

At the day of triggering, women were randomized into 2 groups. Group I (single trigger group) that included 80 women who received triggering in the form of 10,000 IU of HCG intramuscular injection. Group II (Dual trigger group) that included 80 women who received triggering in the form of 10,000 IU of HCG intramuscular injection in addition to GnRH agonist triptorelin 0.2 mg subcutaneously.

Ovum pickup was done 34 hours after triggering under the guidance of transvaginal ultrasound.

ISM1 culture medium was used for oocyte collection and embryo culture. Transabdominal ultrasound guided embryo transfer was done 3 days after oocyte retrieval using Labotect semirigid catheter by the same expert operator

Cycle cancellation was done if day 9 folliculometry revealed less than 2 mature follicles, no oocytes were retrieved or if fertilization failed

Luteal phase support was started in all women on the day of oocyte retrieval and continued till the day of serum β-hCG assessment (done 14 days after ET) through administration of 400 mg of natural Progesterone twice daily per vagina . In women with +ve serum β-hCG (\> 5 mIU/ml), transvaginal ultrasound evaluation was done 4 weeks after ET to confirm the presence and number of intrauterine gestational sacs.

Conditions

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Assisted Reproduction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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single trigger

80 women who received triggering in the form of 10,000 IU of HCG intramuscular injection

Group Type ACTIVE_COMPARATOR

combined oral contaraceptive pills

Intervention Type DRUG

1 tablet daily between days 5 and 25 of the cycle before stimulation

recombinant FSH

Intervention Type DRUG

300 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response evaluated by transvaginal ultrasound and serum E2

Urinaru gonadotropin

Intervention Type DRUG

150 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response evaluated by transvaginal ultrasound and serum E2

GnRH antagonist

Intervention Type DRUG

0.25 subcutaneously daily from the day in which the leading follicles reached 12 mm till the day of triggering

Human chorionic gonadotropin

Intervention Type DRUG

10,000 IU intramuscular when at least 3 follicles larger than 14 mm and at least one of them reached a mean diameter of 17 mm or more

Ovum pick up

Intervention Type PROCEDURE

34 hours after triggering under the guidance of transvaginal ultrasound

Embryo transfer

Intervention Type PROCEDURE

Transabdominal ultrasound guided embryo transfer was done 3 days after oocyte retrieval using Labotect semirigid catheter

natural Progesterone

Intervention Type DRUG

400 mg twice daily per vagina

Dual trigger

80 women who received triggering in the form of 10,000 IU of HCG intramuscular injection in addition to GnRH agonist triptorelin 0.2 mg subcutaneously

Group Type ACTIVE_COMPARATOR

combined oral contaraceptive pills

Intervention Type DRUG

1 tablet daily between days 5 and 25 of the cycle before stimulation

recombinant FSH

Intervention Type DRUG

300 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response evaluated by transvaginal ultrasound and serum E2

Urinaru gonadotropin

Intervention Type DRUG

150 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response evaluated by transvaginal ultrasound and serum E2

GnRH antagonist

Intervention Type DRUG

0.25 subcutaneously daily from the day in which the leading follicles reached 12 mm till the day of triggering

Human chorionic gonadotropin

Intervention Type DRUG

10,000 IU intramuscular when at least 3 follicles larger than 14 mm and at least one of them reached a mean diameter of 17 mm or more

GnRH agonist

Intervention Type DRUG

0.2 mg subcutaneously when at least 3 follicles larger than 14 mm and at least one of them reached a mean diameter of 17 mm or more

Ovum pick up

Intervention Type PROCEDURE

34 hours after triggering under the guidance of transvaginal ultrasound

Embryo transfer

Intervention Type PROCEDURE

Transabdominal ultrasound guided embryo transfer was done 3 days after oocyte retrieval using Labotect semirigid catheter

natural Progesterone

Intervention Type DRUG

400 mg twice daily per vagina

Interventions

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combined oral contaraceptive pills

1 tablet daily between days 5 and 25 of the cycle before stimulation

Intervention Type DRUG

recombinant FSH

300 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response evaluated by transvaginal ultrasound and serum E2

Intervention Type DRUG

Urinaru gonadotropin

150 U from the 2nd day of the cycle then the dose was adjusted according to the ovarian response evaluated by transvaginal ultrasound and serum E2

Intervention Type DRUG

GnRH antagonist

0.25 subcutaneously daily from the day in which the leading follicles reached 12 mm till the day of triggering

Intervention Type DRUG

Human chorionic gonadotropin

10,000 IU intramuscular when at least 3 follicles larger than 14 mm and at least one of them reached a mean diameter of 17 mm or more

Intervention Type DRUG

GnRH agonist

0.2 mg subcutaneously when at least 3 follicles larger than 14 mm and at least one of them reached a mean diameter of 17 mm or more

Intervention Type DRUG

Ovum pick up

34 hours after triggering under the guidance of transvaginal ultrasound

Intervention Type PROCEDURE

Embryo transfer

Transabdominal ultrasound guided embryo transfer was done 3 days after oocyte retrieval using Labotect semirigid catheter

Intervention Type PROCEDURE

natural Progesterone

400 mg twice daily per vagina

Intervention Type DRUG

Other Intervention Names

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Gynera Cetrotide triptorelin Prontogest

Eligibility Criteria

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Inclusion Criteria

* women with poor ovarian response candidate for ICSI
* women with spontaneous normal menstrual cycle
* normal uterine cavity

Exclusion Criteria

* women with ovarian cysts
* endometriosis
* hydrosalpinx
* endocrinological disorders as hyperprolactinemia, thyroid or adrenal disorders.
* Couples with azospermic male partner
* those with severe uncontrolled medical or metabolic disorders
Minimum Eligible Age

25 Years

Maximum Eligible Age

42 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Cairo University

OTHER

Sponsor Role lead

Responsible Party

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Ahmed M Maged, MD

professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ahmed maged, MD

Role: PRINCIPAL_INVESTIGATOR

Professor

Locations

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Kasr Alainy medical school

Cairo, , Egypt

Site Status

Countries

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Egypt

References

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Maged AM, Ragab MA, Shohayeb A, Saber W, Ekladious S, Hussein EA, El-Mazny A, Hany A. Comparative study between single versus dual trigger for poor responders in GnRH-antagonist ICSI cycles: A randomized controlled study. Int J Gynaecol Obstet. 2021 Mar;152(3):395-400. doi: 10.1002/ijgo.13405. Epub 2020 Oct 22.

Reference Type DERIVED
PMID: 33011968 (View on PubMed)

Other Identifiers

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58

Identifier Type: -

Identifier Source: org_study_id

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