The Outcomes of ICSI Cycles With and Without Letrozole

NCT ID: NCT04159649

Last Updated: 2019-12-16

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

224 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-12-01

Study Completion Date

2020-12-30

Brief Summary

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A variety of genes working together with ovarian hormones conducts and precisely control the process of endometrial receptivity and implantation.

Leukemia inhibitory factor and αvβ3 integrin are two markers of implantation with at most importance. Reports have emphasized that these important biomarkers have a great role during the process of embryonic implantation.

αvβ3 integrin is one of the adhesion molecules which has a critical role in blastocyst apposition and attachment. Many studies have demonstrated that abnormal expression of αvβ3 integrin is associated with poor reproductive outcomes. Other studies haven't found a strong relation between αvβ3 integrin expression and reproductive outcomes Letrozole is an aromatase inhibitor which has been used in controlled ovarian stimulation especially in women with PCOS . Data suggests that letrozole addition to gonadotropins during ovarian stimulation protocols improve the response of the ovaries to FSH in low responders and increase the number of preovulatory follicles without adversely affect the outcomes.

Letrozole is used as an adjuvant therapy in ovarian stimulation protocols. So this study aims to evaluate whether the use of letrozole in combination with gonadotropins and GnRH antagonist is superior to gonadotropins and antagonist alone in women undergoing ICSI treatment.

Furthermore, both αvβ3 integrin and leukemia inhibitory factor are important markers of endometrial receptivity and implantation. Therefore, this study aims to assess the correlation between mid-luteal gene expression of both αvβ3 integrin and leukemia inhibitory factor and the clinical outcomes of antagonist cycles with or without letrozole.

Detailed Description

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Embryo implantation depends on quality of the embryo, endometrial receptivity and embryo/endometrial interaction. It is estimated that two third of implantation failure is a result of defects in endometrial receptivity. A variety of genes working together with ovarian hormones conducts and precisely control the process of endometrial receptivity and implantation.

Leukemia inhibitory factor and αvβ3 integrin are two markers of implantation with at most importance. Reports have emphasized that these important bio-markers have a great role during the process of embryonic implantation . Both are expressed in the epithelial cells during the mid-secretory phase of the menstrual cycle in healthy fertile women and their absence is associated with infertility and recurrent pregnancy loss .

Leukemia inhibitory factor is a class of cytokines which plays a key role in the process of implantation in both human and animals . Studies suggest that absence of leukemia inhibitory factor in the endometrium has a negative impact on embryo implantation .

αvβ3 integrin is one of the adhesion molecules which has a critical role in blastocyst apposition and attachment. Many studies have demonstrated that abnormal expression of αvβ3 integrin is associated with poor reproductive outcomes . Other studies haven't found a strong relation between αvβ3 integrin expression and reproductive outcomes.

Letrozole is an aromatase inhibitor which has been used in controlled ovarian stimulation especially in women with PCOS . Data suggests that letrozole addition to gonadotropins during ovarian stimulation protocols improve the response of the ovaries to FSH in low responders and increase the number of preovulatory follicles without adversely affect the outcomes.

The study by Miller and his colleagues suggested that letrozole might improve αvβ3 integrin expression with possible increase in pregnancy and implantation rate. They suggested that, this drug may be a useful adjunct therapy during IVF protocols .

Conditions

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EMBRYO IMPLANTATION

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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letrozole, gonadotropins and fixed GnRH antagonist

letrozole (2.5 mg) will be given from the second day of the cycle and for 5 days, gonadotropins will be given from the third day of the cycle and GnRH antagonist will be added from the six day of the cycle for controlled ovarian stimulation in IVF (interventional group). Participant will be exposed to mid luteal endometrial sample in the pretreatment cycle. couples will be asked to use condom in the pretreatment cycle.

Group Type EXPERIMENTAL

Letrozole 2.5Mg Tablet

Intervention Type DRUG

Gonadotropins with or letrozol in fixed Gn RH antagonist IVF protocol

Gonadotropins

Intervention Type DRUG

Gonadotropins without letrozol in fixed Gn RH antagonist IVF protocol

endometrial sample in the pretreatment cycle

Intervention Type PROCEDURE

All participant will be exposed to mid luteal endometrial sample in the pretreatment cycle. couples will be asked to use condom in the pretreatment cycle.

gonadotropins and fixed GnRH antagonist (control group).

gonadotropins will be given from the third day of the cycle and GnRH antagonist will be added from the six day of the cycle for controlled ovarian stimulation in IVF(control group). Participant will be exposed to mid luteal endometrial sample in the pretreatment cycle. couples will be asked to use condom in the pretreatment cycle.

Group Type ACTIVE_COMPARATOR

Gonadotropins

Intervention Type DRUG

Gonadotropins without letrozol in fixed Gn RH antagonist IVF protocol

endometrial sample in the pretreatment cycle

Intervention Type PROCEDURE

All participant will be exposed to mid luteal endometrial sample in the pretreatment cycle. couples will be asked to use condom in the pretreatment cycle.

Interventions

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Letrozole 2.5Mg Tablet

Gonadotropins with or letrozol in fixed Gn RH antagonist IVF protocol

Intervention Type DRUG

Gonadotropins

Gonadotropins without letrozol in fixed Gn RH antagonist IVF protocol

Intervention Type DRUG

endometrial sample in the pretreatment cycle

All participant will be exposed to mid luteal endometrial sample in the pretreatment cycle. couples will be asked to use condom in the pretreatment cycle.

Intervention Type PROCEDURE

Other Intervention Names

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Femara

Eligibility Criteria

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Inclusion Criteria

Women aged from 18 - 40 years old.

* Regular menstrual cycle (25-35).
* Women undergoing ICSI cycle

* Women who will refuse to participate in in the study.
* ICSI cycles with fresh or frozen TESE samples.

Exclusion Criteria

Women younger than 18 or older than 40 years old.

* Women who had unilateral oophorectomy.
* Women who had uterine abnormality or pathology.
Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Zagazig University

OTHER_GOV

Sponsor Role collaborator

Mansoura University

OTHER

Sponsor Role lead

Responsible Party

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Ahmed Gibreel

Assistant professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Eman ElGindy, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Zagazig

Locations

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Mansoura University

Al Mansurah, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Eman ElGindy, MD, PhD

Role: CONTACT

Phone: 01227491143

Email: [email protected]

Facility Contacts

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Ahmed Gibreel

Role: primary

Other Identifiers

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ZU-IRB

Identifier Type: -

Identifier Source: org_study_id