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Fertility PreservationPhase 3NCT06227949

FSH and LH Versus FSH Alone for Ovarian Stimulation in Non-hormone Sensitive Onco-fertility Patients

A Phase 3 study testing Luveris in people with Fertility Preservation, run by Ellen Greenblatt.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Fertility preservation has been performed before the initiation of cancer therapy as cancer therapy is known to be toxic for ovarian function. However, recent studies have shown that ovarian function is reduced in cancer patients even before they start cancer therapy. Read more about this study

Who is it for?
Ages 18 to 40 years, women only
Conditions the study is for
Fertility Preservation
What is being tested?
Luveris
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
140 participants
Where
No sites listed yet
Study dates
Feb 2024to Dec 2031
Phase
Phase 3
Are there results?
Not yet: the study is under way

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

  • Between the ages of 18 and 40.
  • Undergoing IVF for fertility preservation (freezing all oocytes or embryos)
  • Diagnosed with a non-hormone sensitive malignancy (malignancy other than breast, uterine and ovarian cancer)
  • GnRH antagonist protocol (standard of care for all fertility preservation patients)

Who cannot join

  • Any contraindication to treatment with gonadotropins (including medical history or risk factors for TE, hypersensitivity to gonadotropins or to any of the excipients).
  • Congenital hypogonadotropic hypogonadism unrelated to the oncological condition.
  • Previous adverse or allergic reaction to luteinizing hormone or any of its drug components.
  • Had prior radiotherapy to the abdomen or pelvis
  • Prior chemotherapy
  • Prior history of deep vein thrombosis, or pulmonary embolism
Show all 12Show fewer
  • Patients with a diagnosis of hormone sensitive cancer including ovarian, uterine, or mammary carcinoma
  • Patients with uncontrolled thyroid or adrenal failure
  • Patients with active, untreated tumors of the hypothalamus and pituitary gland
  • Patients who are lactating
  • Patients with a known diagnosis of primary ovarian failure
  • Previous participant of this study

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

About this study

Official title: FSH and LH Versus FSH Alone for Ovarian Stimulation in Non-hormone Sensitive Onco-fertility Patients: an Exploratory Randomized Controlled Trial

Fertility preservation has been performed before the initiation of cancer therapy as cancer therapy is known to be toxic for ovarian function. However, recent studies have shown that ovarian function is reduced in cancer patients even before they start cancer therapy. Reduced ovarian function has been shown by these patients having fewer mature oocytes (female eggs) and lower peak levels of estradiol (a type of estrogen hormone important for fertility). Other studies have shown that in some types of cancers, cancer patients have lower levels of anti-Müllerian hormone, which is a hormone measured to assess how many eggs patient has remaining in the body. Because of these poorer fertility markers shown in cancer patients prior to therapy, some doctors and researchers believe that alternative medications for stimulating ovaries may prove to be beneficial for stimulating the ovaries during fertility preservation.

Currently, luteinizing hormone injections are approved by Health Canada for patients with hypothalamic dysfunction. Hypothalamic dysfunction is a condition whereby lower levels of fertility hormones are produced because of brain dysfunction. Other reasons luteinizing hormone is used in clinical practice is in patients with poor ovarian reserve and patients who are older.

Read more

Recent research studies have suggested that some oncology patients may be poor responders prior to cancer therapy because of their underlying disease. The exact reasons for this poor response are not known. However, some researchers believe it may be related to the interactions between the brain and fertility organs, similar to patients with hypothalamic dysfunction. Because of this possible similarity to patients with hypothalamic dysfunction, adding luteinizing hormone to follicle-stimulating hormone (the hormone typically used for ovarian stimulation) may be beneficial for fertility preservation. Studies have also shown improved fertility outcomes with the addition of luteinizing hormone in non-cancer patients who were previously known to be poor responders to ovarian stimulation.

The clinical trial team is aiming to conduct a randomized controlled trial to evaluate the safety and efficacy of luteinizing hormone in non-hormone sensitive cancer patients (patients with cancer other than the breast, ovary or uterus).

Read the detailed description

The proposed study is a superiority, randomized controlled trial examining the effect of FSH and rLH (Luveris) versus FSH alone on the number of mature oocytes available for cryopreservation in non-hormone sensitive onco-fertility patients. These patients include those diagnosed with malignancy other than breast, uterine and ovarian cancer.

Given that the care of oncology patients is time sensitive, a random start of the treatment cycle is the usual approach in Mount Sinai Fertility clinic, with no prior priming. The patient has a random serum levels of estrogen, progesterone, LH, FSH and HCG levels. A transvaginal ultrasound is performed as well, and the stage of the cycle is determined. Based on the stage of the cycle, gonadotropin starting time is planned accordingly.

  • Early follicular phase: Gonadotropin stimulation started. A GnRH antagonist will be given once the dominant follicle measures >1.4 cm.
  • Mid to late follicular phase: patients who have a dominant follicle >1.5 cm with an E2 >300 and a progesterone <5 will be triggered usually with HCG (Ovidrel 250 mcg subcutaneous). After three days gonadotropin stimulation is started.
  • Start of luteal phase: start gonadotropin stimulation and once the dominant follicle measure >1.4, a GnRH antagonist will be given.

Patients will be randomly assigned in a 1:1 ratio to either treatment or control group. Treatments in each of the trial arms will be as follows:

  1. Treatment arm: Patients will self-administer a subcutaneous injection of Gonal-F (FSH) in addition to Luveris daily until a pre-set criteria to trigger ovulation is reached.
  2. Control arm: Patients will self-administer a subcutaneous injection of Gonal-F (FSH) daily until a pre-set criteria to trigger ovulation is reached.

Transvaginal ultrasound and bloodwork monitoring is initiated to monitor the ovarian response.

Once the patient meets one of the following two criteria

  1. A serum estradiol (E2) of greater than 2,000 pmol/L
  2. A follicle measuring greater than 14 mm,

A daily, subcutaneous injection of a GnRH antagonist (Cetrotide or Ganirelix 0.25 mg) will be administered by the patient subcutaneously to prevent an endogenous surge in LH. Monitoring of the ovarian response will continue until there are 3 or more follicles visualized by transvaginal ultrasound with a mean diameter of ≥17 mm. Ovulation will be subsequently triggered with a subcutaneous injection of HCG or GnRH agonist depending on the managing IVF physician. Twelve hours after their trigger medication, patients will return to the clinic for standard blood work including LH and progesterone. This is a standard confirmatory blood test to confirm that an endogenous LH surge has occurred. In approximately less than 5% of cases, the GnRH-a trigger fails to elicit an optimal surge, which may require a "rescue" low-dose hCG trigger to be administered 24 hours following the initial trigger. The decision to administer a "rescue" trigger will be at the discretion of the managing IVF physician. Transvaginal, ultrasound-guided oocyte retrieval will be performed approximately 36 hours following the administration of the initial trigger.

Once the oocytes are retrieved, the availability of sperm will determine whether the partner's sperm or donor sperm will be used. If the patient desires to cryopreserve oocytes, mature oocytes will be cryopreserved by vitrification process. If embryo cryopreservation is planned, the retrieved oocytes will be fertilized in the lab using traditional IVF or ICSI. Embryos will be grown to day 5 and all "good quality" blastocysts will be cryopreserved using vitrification. At Mount Sinai Fertility clinic, day 5/6 embryos are considered "good quality" for cryopreservation if they are at least a grade 2BB (or above) on day 5 and/or a 3CC (or above) on day 6, according to the classification system by Gardner and Schoolcraft, 1999. Patients will undergo a freeze-all cycle, with no fresh transfer of embryos.

The primary outcome measure will be the total number of mature (MII) oocytes available for cryopreservation.

Secondary outcome measures will include the following:

  • Total number of oocytes retrieved per cycle
  • Ratio of mature (MII) to immature oocytes
  • Total number of mature oocytes (MII) retrieved per IVF/ICSI cycle
  • Ratio of mature (MII) to immature oocytes per IVF/ICSI cycle
  • Number of two pronuclei (2PN) zygotes
  • Fertilization rate, which will include two outcomes each defined as follows:

Definition 1: number of 2PN zygotes divided by the number of mature oocyte(s) fertilized per IVF/ICSI cycle.

Definition 2: number of 2PN zygotes divided by the number of oocytes incubated with at least 10,000 sperm per IVF cycle.

  • Total number of day 3 embryos
  • Total number of good quality day 5 embryos available for cryopreservation determined by a blinded embryologist using the classification system by Gardner and Schoolcraft, 1999.
  • Incidence of moderate to critical OHSS based on the classification criteria by Mathur et al. 2005
Being tested
Luveris
Keywords
IVF, fertility preservation, oncofertility, rLH, FSH, cryopreservation

What participants receive

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

  • LuverisDrug

    Patients will self-administer a subcutaneous injection of Luveris in addition to Gonal-F (FSH) daily until a pre-set criteria to trigger ovulation is reached.

Study groups in NCT06227949
Study groupRoleWhat they receive
ControlNo interventionsubcutaneous injection of Gonal-F (FSH)
InterventionExperimentalsubcutaneous injection of Luveris in addition to Gonal-F (FSH)
Receives: Drug: Luveris

What is being measured

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

  1. Total number of mature (MII) oocytes available for cryopreservation

    Measured: 12hrs after egg retrieval

Secondary outcomes (9)
  1. Total number of oocytes retrieved per cycle

    Measured: 1hr after egg retrieval

  2. Ratio of mature (MII) to immature oocytes

    Measured: 12 hours after egg retrieval

  3. Total number of mature oocytes (MII) retrieved per IVF/ICSI cycle

    Measured: 12 hours after egg retrieval

  4. Ratio of mature (MII) to immature oocytes per IVF/ICSI cycle

    Measured: 12 hours after egg retrieval

  5. Number of two pronuclei (2PN) zygotes

    Measured: 48 hours after egg retrieval

  6. Fertilization rate, which will include two outcomes each defined as follows:

    • Definition 1: number of 2PN zygotes divided by the number of mature oocyte(s) fertilized per IVF/ICSI cycle.
    • Definition 2: number of 2PN zygotes divided by the number of oocytes incubated with at least 10,000 sperm per IVF cycle.

    Measured: 48 hours after egg retrieval

  7. Total number of day 3 embryos

    Measured: 72-80 hours after egg retrieval

  8. Total number of good quality day 5 embryos available for cryopreservation determined by a blinded embryologist using the classification system by Gardner and Schoolcraft, 1999.

    Measured: 120-132 hours after egg retrieval

  9. Incidence of moderate to critical OHSS based on the classification criteria by Mathur et al. 2005

    Measured: 2 weeks after egg retrieval

Timeline

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

  1. First posted29 Jan 2024
  2. Study startFeb 2024 (estimated)
  3. Primary completionDec 2029 (estimated)
  4. Study completionDec 2031 (estimated)

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
Model description
Patients will be randomly assigned in a 1:1 ratio to either treatment or control group. Treatments in each of the trial arms will be as follows: 1. Treatment arm: Patients will self-administer a subcutaneous injection of Gonal-F (FSH) in addition to Luveris daily until a pre-set criteria to trigger ovulation is reached. 2. Control arm: Patients will self-administer a subcutaneous injection of Gonal-F (FSH) daily until a pre-set criteria to trigger ovulation is reached.
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
140 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06227949
Sponsor's protocol ID
MS200061_0066
Status last verified
Jan 2024
First submitted
21 Dec 2023
Last updated
29 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: All IPD datasets that underlie results in the publication will be shared, including study protocol, statistical analysis plan, and clinical study plan.

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Luveris in people with Fertility Preservation, run by Ellen Greenblatt.

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 4 inclusion and 12 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: opening soon, as of the sponsor's last update on 29 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

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?

This study is still under way. Results are not available in the source record yet.

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

Contact Ellen Greenblatt, MD FRCSC (416 596 5046, ellen.greenblatt@sinaihealth.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total number of mature (MII) oocytes available for cryopreservation (time frame: 12hrs after egg retrieval). 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 29 Jan 2024.

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