in Vitro FertilizationNCT02262923
Dopamine D-2 Antagonist Use in Poor Responders in IVF: a Randomized Controlled Trial
A study testing metoclopramide in people with in Vitro Fertilization and Poor Responder, run by Mount Sinai Hospital, Canada at 1 site in Canada.
Trial summary
Metoclopramide is a dopamine D2 receptor antagonist with antiemetic and gastrokinetic properties which has been approved for use in pregnant women. Women with polycystic ovary syndrome (PCOS) have been found to have lower dopaminergic tone and increased ovarian vascularity and vascular endothelial growth factor (VEGF)… Read more about this study
- Who is it for?
- Ages 21 to 43 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- in Vitro Fertilization, Poor Responder
- What is being tested?
- metoclopramide
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- 1 siteCanada
- Study dates
- Mar 2016to Mar 2018
- Phase
- Interventional
- Are there results?
- None posted in the registry
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 21 to 43 years
- Women only
- Healthy volunteers accepted
- Adult
Who may be able to join
- Poor responders undergoing a repeat IVF cycle defined as women who have undergone at least one previous IVF cycle with fewer than 4 oocytes retrieved and at least one of the following:
- Advanced age (≥40 years) or any other risk factor for poor ovarian response
- Abnormal ovarian reserve testing (antral follicle count (AFC) < 5-7 or anti-mullerian hormone (AMH) level < 3.6-7.9 pmol/L)
Who cannot join
- Subjects who have previously been recruited into this study and either had cycle cancellation, underwent retrieval or dropped out of the study.
- Women with contraindications or allergies to metoclopramide.
- Women with elevated prolactin levels or known to have pituitary microadenomas or macroadenoma.
- Women who are taking dopamine agonist medications.
Trial locations and contacts
1 site in 1 country.
About this study
Metoclopramide is a dopamine D2 receptor antagonist with antiemetic and gastrokinetic properties which has been approved for use in pregnant women. Women with polycystic ovary syndrome (PCOS) have been found to have lower dopaminergic tone and increased ovarian vascularity and vascular endothelial growth factor (VEGF) levels compared to controls. During ovarian stimulation, PCOS patients exhibit greater sensitivity to gonadotropins and increased follicular development. Administration of dopamine D2 antagonists may mimic the low dopaminergic tone noted in PCOS patients, increase VEGF levels, angiogenesis, and subsequently improve follicular growth during ovarian stimulation. This strategy could be used to improve IVF outcomes in poor responders.
The investigators hypothesize that, compared to gonadotropin use alone, the use of metoclopramide in combination with gonadotropins in poor responders undergoing IVF will result in an increased number of mature oocytes obtained at oocyte retrieval and improved IVF outcomes.
Read the detailed description
Poor responders constitute a significant and challenging population of women to treat with in vitro fertilization (IVF). This population includes women who respond sub-optimally to conventional ovarian stimulation with poor follicular recruitment. The estimated incidence of poor ovarian response ranges from 9-26%. Patients with PCOS are on the opposite end of the spectrum from poor responders. They are often exquisitely sensitive to ovarian stimulation and are predisposed to over-respond with the development of ovarian hyperstimulation syndrome (OHSS). Understanding the underlying mechanisms that enhance their sensitivity may provide insight into the treatment of poor responders. VEGF is a glycoprotein produced by ovarian granulosa cells that enhances vascular permeability and angiogenesis, and has been implicated in the pathogenesis of OHSS. After ovulation is triggered by LH or hCG, follicular expression of VEGF increases, which is crucial for corpus luteum function and steroidogenesis. However, excessive VEGF production can lead to third-space shifts of fluids, ascites, and other life-threatening features of OHSS. Serum concentrations and granulosa cell expression of VEGF have been shown to be higher in women with PCOS than in controls. Interestingly, compared with controls, patients with PCOS have also been shown to have lower levels of the neurotransmitter dopamine and dopamine D2 receptor levels in the ovary. Administration of dopamine D2 agonists has been shown in animal and human studies to decrease ovarian VEGF production and reduce the risk of OHSS. In this study, the investigators propose a novel approach of administering a dopamine D2 antagonist to poor responders to mimic the low dopaminergic tone of PCOS patients, with the goal of increasing VEGF production and follicular development during ovarian stimulation. Metoclopramide is a dopamine D2 antagonist with antiemetic and prokinetic properties and an established safety profile in pregnancy. The investigators hypothesis is that metoclopramide use prior to, and in conjunction with, conventional gonadotropin stimulation can improve IVF outcomes in poor responders.
- Conditions
- in Vitro Fertilization, Poor Responder
- Being tested
- metoclopramide
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
metoclopramideDrug
| Study group | Role | What they receive |
|---|---|---|
| Control | No intervention | Poor responders will be defined as women who have undergone a previous IVF cycle with fewer than 4 oocytes retrieved and at least one of the following two criteria: (1) advanced age (≥40 years) or any other risk factor for poor ovarian response and (2) abnormal ovarian reserve testing (antral follicle count (AFC) < 5-7 or anti-mullerian hormone (AMH) level < 3.6-7.9 pmol/L). Poor responders who will be undergoing a repeat IVF cycle will be recruited for the study with informed consent. In the control arm, patients will undergo the same ovarian stimulation protocol as the previous IVF cycle in which they experienced a poor response. Starting 3 weeks prior to the first day of stimulation until the time of ovulation trigger (approximately 5 weeks overall), these patients will receive an oral placebo three times daily. |
| Experimental | Experimental | Poor responders will be defined as women who have undergone a previous IVF cycle with fewer than 4 oocytes retrieved and at least one of the following two criteria: (1) advanced age (≥40 years) or any other risk factor for poor ovarian response and (2) abnormal ovarian reserve testing (antral follicle count (AFC) < 5-7 or anti-mullerian hormone (AMH) level < 3.6-7.9 pmol/L). Poor responders who will be undergoing a repeat IVF cycle will be recruited for the study with informed consent.
In the experimental arm, patients will undergo the same ovarian stimulation protocol as the previous IVF cycle in which they experienced a poor response. Starting 3 weeks prior to the first day of stimulation until the time of ovulation trigger (approximately 5 weeks in total), these patients will receive oral metoclopramide 5mg three times daily.. Receives: Drug: metoclopramide |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of oocytes retrieved
Measured: 1 year
Secondary outcomes (9)
Number of mature follicles (≥1.5cm) seen on transvaginal ultrasound at the time of ovulation trigger
Measured: 1 year
Peak serum estradiol levels measured at the time of ovulation trigger shot
Measured: 1 year
Ratio of mature/ immature oocytes obtained at oocyte retrieval
Measured: 1 year
Follicular fluid levels of VEGF, VEGFR-1 and VEGFR-2
Measured: 1 year
Total dose of gonadotropins used and number of days of stimulation
Measured: 1 year
Fertilization rates
Measured: 1 year
Number of embryos on day 3 and 5
Measured: 1 year
Pregnancy and implantation rates
Measured: 1-2 years
Serum prolactin levels on cycle day 3,7 and at the time of ovulation trigger
Measured: 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Oct 2014 (estimated)
- Study startMar 2016
- Primary completionMar 2018
- Study completionMar 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for in Vitro FertilizationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- Mount Sinai Hospital, Canada
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02262923
- Sponsor's protocol ID
- 14-0209-A
- Status last verified
- Mar 2019
- First submitted
- 8 Oct 2014
- Last updated
- 11 Apr 2022
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 11 Apr 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Dopamine D-2 Antagonist Use in Poor Responders in IVF: a Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT02262923
- Acronym / sponsor ID
- 14-0209-A
- Conditions
- in Vitro Fertilization, Poor Responder
- Study type
- Interventional
- Recruitment status
- Withdrawn
- Enrolment
- 0 participants (actual)
- Lead sponsor
- Mount Sinai Hospital, CanadaUniversity, hospital or other
- Study start
- Mar 2016 (actual)
- Primary completion
- Mar 2018 (actual)
- Study completion
- Mar 2018 (actual)
- First posted
- 13 Oct 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Metoclopramide is a dopamine D2 receptor antagonist with antiemetic and gastrokinetic properties which has been approved for use in pregnant women. Women with polycystic ovary syndrome (PCOS) have been found to have lower dopaminergic tone and increased ovarian vascularity and vascular endothelial growth factor (VEGF) levels compared to controls. During ovarian stimulation, PCOS patients exhibit greater sensitivity to gonadotropins and increased follicular development. Administration of dopamine D2 antagonists may mimic the low dopaminergic tone noted in PCOS patients, increase VEGF levels, angiogenesis, and subsequently improve follicular growth during ovarian stimulation. This strategy could be used to improve IVF outcomes in poor responders.
The investigators hypothesize that, compared to gonadotropin use alone, the use of metoclopramide in combination with gonadotropins in poor responders undergoing IVF will result in an increased number of mature oocytes obtained at oocyte retrieval and improved IVF outcomes.
Detailed description
Poor responders constitute a significant and challenging population of women to treat with in vitro fertilization (IVF). This population includes women who respond sub-optimally to conventional ovarian stimulation with poor follicular recruitment. The estimated incidence of poor ovarian response ranges from 9-26%. Patients with PCOS are on the opposite end of the spectrum from poor responders. They are often exquisitely sensitive to ovarian stimulation and are predisposed to over-respond with the development of ovarian hyperstimulation syndrome (OHSS). Understanding the underlying mechanisms that enhance their sensitivity may provide insight into the treatment of poor responders. VEGF is a glycoprotein produced by ovarian granulosa cells that enhances vascular permeability and angiogenesis, and has been implicated in the pathogenesis of OHSS. After ovulation is triggered by LH or hCG, follicular expression of VEGF increases, which is crucial for corpus luteum function and steroidogenesis. However, excessive VEGF production can lead to third-space shifts of fluids, ascites, and other life-threatening features of OHSS. Serum concentrations and granulosa cell expression of VEGF have been shown to be higher in women with PCOS than in controls. Interestingly, compared with controls, patients with PCOS have also been shown to have lower levels of the neurotransmitter dopamine and dopamine D2 receptor levels in the ovary. Administration of dopamine D2 agonists has been shown in animal and human studies to decrease ovarian VEGF production and reduce the risk of OHSS. In this study, the investigators propose a novel approach of administering a dopamine D2 antagonist to poor responders to mimic the low dopaminergic tone of PCOS patients, with the goal of increasing VEGF production and follicular development during ovarian stimulation. Metoclopramide is a dopamine D2 antagonist with antiemetic and prokinetic properties and an established safety profile in pregnancy. The investigators hypothesis is that metoclopramide use prior to, and in conjunction with, conventional gonadotropin stimulation can improve IVF outcomes in poor responders.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Control | No intervention | –Poor responders will be defined as women who have undergone a previous IVF cycle with fewer than 4 oocytes retrieved and at least one of the following two criteria: (1) advanced age (≥40 years) or any other risk factor for poor ovarian response and (2) abnormal ovarian reserve testing (antral follicle count (AFC) < 5-7 or anti-mullerian hormone (AMH) level < 3.6-7.9 pmol/L). Poor responders who will be undergoing a repeat IVF cycle will be recruited for the study with informed consent. In the control arm, patients will undergo the same ovarian stimulation protocol as the previous IVF cycle in which they experienced a poor response. Starting 3 weeks prior to the first day of stimulation until the time of ovulation trigger (approximately 5 weeks overall), these patients will receive an oral placebo three times daily. |
| Experimental | Experimental | Drug: metoclopramidePoor responders will be defined as women who have undergone a previous IVF cycle with fewer than 4 oocytes retrieved and at least one of the following two criteria: (1) advanced age (≥40 years) or any other risk factor for poor ovarian response and (2) abnormal ovarian reserve testing (antral follicle count (AFC) < 5-7 or anti-mullerian hormone (AMH) level < 3.6-7.9 pmol/L). Poor responders who will be undergoing a repeat IVF cycle will be recruited for the study with informed consent. In the experimental arm, patients will undergo the same ovarian stimulation protocol as the previous IVF cycle in which they experienced a poor response. Starting 3 weeks prior to the first day of stimulation until the time of ovulation trigger (approximately 5 weeks in total), these patients will receive oral metoclopramide 5mg three times daily.. |
Who may qualify
- Ages
- 21 to 43 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Poor responders undergoing a repeat IVF cycle defined as women who have undergone at least one previous IVF cycle with fewer than 4 oocytes retrieved and at least one of the following:
Key exclusion criteria (4 listed)
- Subjects who have previously been recruited into this study and either had cycle cancellation, underwent retrieval or dropped out of the study.
- Women with contraindications or allergies to metoclopramide.
- Women with elevated prolactin levels or known to have pituitary microadenomas or macroadenoma.
- Women who are taking dopamine agonist medications.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| metoclopramide | Drug | Experimental |
Primary outcome
Number of oocytes retrieved
Time frame: 1 year
9 secondary outcomes
Number of mature follicles (≥1.5cm) seen on transvaginal ultrasound at the time of ovulation trigger
Time frame: 1 year
Peak serum estradiol levels measured at the time of ovulation trigger shot
Time frame: 1 year
Ratio of mature/ immature oocytes obtained at oocyte retrieval
Time frame: 1 year
Follicular fluid levels of VEGF, VEGFR-1 and VEGFR-2
Time frame: 1 year
Total dose of gonadotropins used and number of days of stimulation
Time frame: 1 year
Fertilization rates
Time frame: 1 year
Number of embryos on day 3 and 5
Time frame: 1 year
Pregnancy and implantation rates
Time frame: 1-2 years
Serum prolactin levels on cycle day 3,7 and at the time of ovulation trigger
Time frame: 1 year
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Apr 2022.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing metoclopramide in people with in Vitro Fertilization and Poor Responder, run by Mount Sinai Hospital, Canada at 1 site in Canada.
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 3 inclusion and 4 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: withdrawn, as of the sponsor's last update on 11 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. 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.
Are results available for this study?
The study was withdrawn before enrolling participants, so there are no results.
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?
Number of oocytes retrieved (time frame: 1 year). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 11 Apr 2022.