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InfertilityPhase 3ESTHER-1NCT01956110

Evidence-based Stimulation Trial With Human rFSH in Europe and Rest of World 1

A Phase 3 study testing Follitropin Delta (FE 999049) and Follitropin Alfa (GONAL-F) in people with Infertility, run by Ferring Pharmaceuticals at 13 sites in 11 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This trial investigates the effects of FE 999049 compared to GONAL-F. Read more about this study

Who is it for?
Ages 18 to 40 years, women only
Conditions the study is for
Infertility
What is being tested?
Follitropin Delta (FE 999049) and Follitropin Alfa (GONAL-F)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,329 participants
Where
13 sitesin 11 countries
Study dates
Oct 2013to 3 Jan 2017
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 40 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Informed Consent Documents signed prior to screening evaluations
  • In good physical and mental health
  • Pre-menopausal females between the ages of 18 and 40 years
  • Infertile women diagnosed with tubal infertility, unexplained infertility, endometriosis stage I/II or with partners diagnosed with male factor infertility, eligible for in vitro fertilisation (IVF) and/or intracytoplasmic sperm injection (ICSI) using fresh or frozen ejaculated sperm from male partner or sperm donor
  • Infertility for at least one year before randomisation for subjects ≤37 years or for at least 6 months for subjects ≥38 years (not applicable in case of tubal or severe male factor infertility)
  • The trial cycle will be the subject's first controlled ovarian stimulation cycle for IVF/ICSI
Show all 10Show fewer
  • Hysterosalpingography, hysteroscopy, saline infusion sonography, or transvaginal ultrasound documenting a uterus consistent with expected normal function (e.g. no evidence of clinically interfering uterine fibroids defined as submucous or intramural fibroids larger than 3 cm in diameter, no polyps and no congenital structural abnormalities which are associated with a reduced chance of pregnancy) within 1 year prior to randomisation
  • Transvaginal ultrasound documenting presence and adequate visualisation of both ovaries, without evidence of significant abnormality (e.g. no endometrioma greater than 3 cm or enlarged ovaries which would contraindicate the use of gonadotropins) and normal adnexa (e.g. no hydrosalpinx) within 1 year prior to randomisation. Both ovaries must be accessible for oocyte retrieval.
  • Early follicular phase (cycle day 2-4) serum levels of FSH between 1 and 15 IU/L (results obtained within 3 months prior to randomisation)
  • Body mass index (BMI) between 17.5 and 32.0 kg/m2 (both inclusive) at screening

Who cannot join

  • Known endometriosis stage III-IV
  • One or more follicles ≥10 mm observed on the transvaginal ultrasound prior to randomisation on stimulation day 1
  • Known history of recurrent miscarriage (defined as three consecutive losses after ultrasound confirmation of pregnancy (excl. ectopic pregnancy) and before week 24 of pregnancy)
  • Known abnormal karyotype of subject or of her partner/sperm donor, as applicable, depending on source of sperm used for insemination in this trial.
  • Any known clinically significant systemic disease (e.g. insulin-dependent diabetes)
  • Any known endocrine or metabolic abnormalities (pituitary, adrenal, pancreas, liver or kidney) which can compromise participation in the trial with the exception of controlled thyroid function disease
  • Known tumours of the ovary, breast, uterus, adrenal gland, pituitary or hypothalamus which would contraindicate the use of gonadotropins.

Trial locations and contacts

13 sites in 11 countries.

13 sites in 11 countries

Canada3 sites
  • Pacific Centre for Reproductive Medicine

    Burnaby, British Columbia

  • Ottawa Fertility Centre

    Ottawa, Ontario

  • Olive Fertility Centre

    Vancouver, British Columbia

Other trials in Canada

Belgium1 site
  • UZ Brussel (there may be other sites in this country)

    Brussels

Other trials in Belgium

Brazil1 site
  • Fertilitat and PUC-RS (there may be other sites in this country)

    Porto Alegre

Other trials in Brazil

Czechia1 site
  • IVF CUBE SE (there may be other sites in this country)

    Prague

Other trials in Czechia

Denmark1 site
  • Rigshospitalet Fertilitetsklinikken (there may be other sites in this country)

    Copenhagen

Other trials in Denmark

France1 site
  • Department of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre (there may be other sites in this country)

    Lille

Other trials in France

Italy1 site
  • Centro Natalità San Raffaele (there may be other sites in this country)

    Milan

Other trials in Italy

Poland1 site
  • The nOvum Clinic (there may be other sites in this country)

    Warsaw

Other trials in Poland

Russia1 site
  • IVF & Reproductive Genetics Center (there may be other sites in this country)

    Moscow

Other trials in Russia

Spain1 site
  • IVI Sevilla (there may be other sites in this country)

    Seville

Other trials in Spain

United Kingdom1 site
  • Glasgow Centre for Reproductive Medicine Ltd. (there may be other sites in this country)

    Glasgow

Other trials in United Kingdom

About this study

Official title: A Randomised, Controlled, Assessor-blind, Parallel Groups, Multicentre, Multinational Trial Comparing the Efficacy and Safety of FE 999049 With Follitropin Alfa (GONAL-F) in Controlled Ovarian Stimulation in Women Undergoing an Assisted Reproductive Technology Programme

This trial investigates the effects of FE 999049 compared to GONAL-F.

Conditions
Infertility
Being tested
Follitropin Delta (FE 999049), Follitropin Alfa (GONAL-F)
Medical subject headings
Infertility

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Follitropin Delta (FE 999049)Drug

  • Follitropin Alfa (GONAL-F)Drug

Study groups in NCT01956110
Study groupRoleWhat they receive
AExperimentalFollitropin Delta (FE 999049)
Receives: Drug: Follitropin Delta (FE 999049)
BActive comparatorFollitropin Alfa (GONAL-F)
Receives: Drug: Follitropin Alfa (GONAL-F)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Ongoing Pregnancy Rate

    Ongoing pregnancy was defined as at least one intrauterine viable fetus 10-11 weeks after blastocyst transfer.

    Measured: 10-11 weeks after blastocyst transfer

  2. Ongoing Implantation Rate

    Ongoing implantation rate was defined as the number of intrauterine viable fetuses 10-11 weeks after transfer divided by number of blastocysts transferred.

    Measured: 10-11 weeks after blastocyst transfer

Secondary outcomes (21)
  1. Vital Pregnancy Rate

    Vital pregnancy was defined as at least one intrauterine gestational sac with fetal heart beat 5-6 weeks after blastocyst transfer.

    Measured: 5-6 weeks after blastocyst transfer

  2. Implantation Rate

    Implantation rate was defined as the number of gestational sacs 5-6 weeks after transfer divided by number of blastocysts transferred.

    Measured: 5-6 weeks after blastocyst transfer

  3. Proportion of Subjects With Extreme Ovarian Responses, Defined as <4, ≥15 or ≥20 Oocytes Retrieved

    Measured: Day of oocyte retrieval

  4. Proportion of Subjects With Early OHSS (Ovarian Hyperstimulation Syndrome) and/or Preventive Interventions for Early OHSS

    The proportion of subjects with early OHSS, early OHSS of moderate or severe grade, preventive interventions for early OHSS, early OHSS and/or preventive interventions for early OHSS, and early OHSS of moderate or severe grade and/or preventive interventions for early OHSS are presented.

    Measured: ≤9 days after triggering of final follicular maturation

  5. Proportion of Subjects With Cycle Cancellation Due to Poor Ovarian Response or Excessive Ovarian Response

    Proportion of subjects with cycle cancellation due to poor ovarian response, excessive ovarian response, and triggering with gonadotropin-releasing hormone (GnRH) agonist are presented.

    Measured: End-of-stimulation (up to 20 stimulation days)

  6. Number of Oocytes Retrieved

    Measured: Day of oocyte retrieval

  7. Proportion of Subjects With <4, 4-7, 8-14, 15-19 and ≥20 Oocytes Retrieved

    Measured: Day of oocyte retrieval

  8. Percentage of Metaphase II Oocytes (Oocytes Inseminated Using ICSI [Intracytoplasmic Sperm Injection])

    Number of oocytes in metaphase II prior to ICSI insemination is presented.

    Measured: Prior to insemination

  9. Fertilisation Rate

    Fertilisation rate was defined as the number of oocytes with 2 pronuclei divided by the number of oocytes retrieved.

    Measured: Day 1 after insemination

  10. Number and Quality of Embryos on Day 3

    Number of embryos (total and good-quality) on Day 3 are presented. A good-quality embryo was defined as an embryo with ≥6 blastomeres and fragmentation ≤20% on Day 3.

    Measured: On day 3 after oocyte retrieval

  11. Number and Quality of Blastocysts on Day 5

    Number of blastocysts (total and good-quality) on Day 5 are presented. A good-quality blastocyst was defined as a blastocyst of grade 3BB or higher.

    Measured: On day 5 after oocyte retrieval

  12. Total Gonadotropin Dose

    The total gonadotropin dose was recorded.

    Measured: End-of-stimulation (up to 20 stimulation days)

  13. Number of Stimulation Days

    Measured: End-of-stimulation (up to 20 stimulation days)

  14. Proportion of Subjects With Investigator-requested Gonadotropin Dose Adjustments

    Measured: End-of-stimulation (up to 20 stimulation days)

  15. Frequency of Injection Site Reactions (Redness, Pain, Itching, Swelling and Bruising) Assessed by the Subject During the Stimulation Period

    Subjects self-assessed injection site reactions (redness, itching, pain, swelling and bruising) immediately, 30 minutes and 24 hours after each injection. The injection site reactions were assessed as none, mild, moderate and severe. The frequency of injection site reactions (mild, moderate or severe) based on all assessments performed is presented.

    Measured: End-of-stimulation (up to 20 stimulation days)

  16. Abdominal Discomfort Related to Controlled Ovarian Stimulation as Assessed by a Visual Analogue Scale (VAS)

    The subject self-assessed abdominal discomfort related to controlled ovarian stimulation using a VAS going from 0 mm (no abdominal discomfort) to 100 mm (worst imaginable abdominal discomfort).

    Measured: End-of-stimulation and day of blastocyst transfer

  17. Changes in Body Weight

    Change in body weight from baseline to end-of-stimulation and from baseline to day of blastocyst transfer.

    Measured: End-of-stimulation and day of blastocyst transfer

  18. Changes in Maximum Abdominal Circumference

    Change in maximum abdominal circumference from baseline to end-of-stimulation and from baseline to day of blastocyst transfer.

    Measured: End-of-stimulation and day of blastocyst transfer

  19. Proportion of Subjects With Treatment-induced Anti-follicle-stimulating Hormone (FSH) Antibodies

    The proportion of subjects with at least one treatment-induced anti-FSH antibody response at any time point.

    Measured: Stimulation day 1, 7-10 days after last FE 999049 or GONAL-F dose and 21-28 days after last FE 999049 or GONAL-F dose

  20. Proportion of Subjects With Late OHSS

    Late OHSS was defined as OHSS with onset >9 days after triggering of final follicular maturation.The proportion of subjects with late OHSS, and late OHSS of moderate or severe grade are presented.

    Measured: >9 days after triggering of final follicular maturation

  21. Technical Malfunctions of the Administration Pen

    Confirmed technical malfunction of administration pen.

    Measured: End-of-stimulation (up to 20 stimulation days)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Oct 2013 (estimated)
  2. Study startOct 2013
  3. Primary completionMay 2015
  4. Study completion3 Jan 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
1,329 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01956110
Sponsor's protocol ID
000004
Other IDs
2013-001669-17, U1111-1147-6826
Acronym
ESTHER-1
Status last verified
Sep 2018
First submitted
16 Aug 2013
Last updated
13 Jan 2022
Data monitoring committee
No

Publications

  • Arce JC, Larsson P, Garcia-Velasco JA. Establishing the follitropin delta dose that provides a comparable ovarian response to 150 IU/day follitropin alfa. Reprod Biomed Online. 2020 Oct;41(4):616-622. doi: 10.1016/j.rbmo.2020.07.006. Epub 2020 Jul 15.

    PubMed 32819842
  • Havelock J, Aaris Henningsen AK, Mannaerts B, Arce JC; ESTHER-1 and ESTHER-2 Trial Groups. Pregnancy and neonatal outcomes in fresh and frozen cycles using blastocysts derived from ovarian stimulation with follitropin delta. J Assist Reprod Genet. 2021 Oct;38(10):2651-2661. doi: 10.1007/s10815-021-02271-5. Epub 2021 Jul 13.

    PubMed 34254211
  • Ishihara O, Nelson SM, Arce JC. Comparison of ovarian response to follitropin delta in Japanese and White IVF/ICSI patients. Reprod Biomed Online. 2022 Jan;44(1):177-184. doi: 10.1016/j.rbmo.2021.09.014. Epub 2021 Sep 23.

    PubMed 34799275
  • Nelson SM, Larsson P, Mannaerts BMJL, Nyboe Andersen A, Fauser BCJM. Anti-Mullerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta. Clin Endocrinol (Oxf). 2019 May;90(5):719-726. doi: 10.1111/cen.13956. Epub 2019 Mar 18.

    PubMed 30801744
  • Nyboe Andersen A, Nelson SM, Fauser BC, Garcia-Velasco JA, Klein BM, Arce JC; ESTHER-1 study group. Individualized versus conventional ovarian stimulation for in vitro fertilization: a multicenter, randomized, controlled, assessor-blinded, phase 3 noninferiority trial. Fertil Steril. 2017 Feb;107(2):387-396.e4. doi: 10.1016/j.fertnstert.2016.10.033. Epub 2016 Nov 29.

    PubMed 27912901

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Follitropin Delta (FE 999049) and Follitropin Alfa (GONAL-F) in people with Infertility, run by Ferring Pharmaceuticals at 13 sites in 11 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Jan 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in Canada, Belgium, Brazil, Czechia, Denmark and 6 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 25 Sep 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Ongoing Pregnancy Rate (time frame: 10-11 weeks after blastocyst transfer). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01956110, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jan 2022.

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