MENOPUR® Versus FOLLISTIM®

A Multi-Center, Randomized, Open-Label Evaluation of MENOPUR® Versus FOLLISTIM® in GnRH Antagonist Cycles

To compare the efficacy and safety of highly purified menotropin (Menopur®) with that of follitropin beta (FOLLISTIM®) in patients who are undergoing gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles

Study Overview

• Status: Completed
• Conditions: Infertility
• Intervention / Treatment: Drug: Progesterone in oil; Drug: Menotropin; Drug: Progestrone vaginal insert; Drug: Ganirelix; Drug: follitropin beta

Detailed Description

This multicenter, randomized, open-label exploratory study will be performed in approximately 200 healthy females undergoing in vitro fertilization (IVF). Each study center will follow its study center standard practice for in vitro fertilization (IVF) within the study parameters as noted in this protocol. The study centers will use marketed products purchased from Schraft's Pharmacy for all phases of the study (down-regulation, stimulation, ovulation induction, and luteal support). Subjects will be randomly assigned prior to the start of stimulation to highly purified menotropin (Menopur®) or follitropin beta (Follistim Pen®) for stimulation and progesterone vaginal insert (Endometrin®) or progesterone in oil for luteal support. Subjects will return to the study center for regular scheduled clinic visits as required per in vitro fertilization (IVF) protocol at the site and at specified time periods during the cycle for estradiol (E2), progesterone (P4) and human chorionic gonadotropin (hCG) tests, and first serum pregnancy test. All subjects will be required to complete a final study visit at completion of luteal support or negative serum pregnancy test following embryo transfer.

• Study Type: Interventional
• Enrollment (Actual): 173
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • California
    • Pasadena, California, United States, 91105
      • Huntington Reproductive Center
    • San Diego, California, United States, 92130
      • San Diego Fertility Center
  • Colorado
    • Littleton, Colorado, United States, 80129
      • Conceptions Reproductive Associates of Colorado
  • Florida
    • Clearwater, Florida, United States, 33759
      • Women's Medical Research Group, LLC
  • Illinois
    • Naperville, Illinois, United States, 60540
      • The Advanced IVF Institute; Charles E. Miller, MD & Associates
  • Louisiana
    • Baton Rouge, Louisiana, United States, 70815
      • A Woman's Center for Reproductive Medicine
  • Texas
    • Bedford, Texas, United States, 76022
      • Center for Assisted Reproduction

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 42 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Pre-menopausal females between the ages of 18 and 42 years
2. Body mass index (BMI) of 18-34
3. Early follicular phase (day 2-4) Follicle stimulating hormone (FSH) <15 IU/L and Estradiol (E2) within normal limits
4. Documented history of infertility (e.g., unable to conceive for at least one year, or for 6 months for women >38 years of age, or bilateral tubal occlusion or absence, or male factor but excluding severe male factor requiring invasive or surgical sperm retrieval. Donor sperm may be used.)
5. Transvaginal ultrasound at screening consistent with findings adequate for assisted reproductive technology (ART) with respect to uterus and adnexa
6. Signed informed consent

Exclusion Criteria:

1. Gestational or surrogate carrier, donor oocyte
2. Presence of any clinically relevant systemic disease (e.g., insulin-dependent diabetes mellitus, uterine cancer)
3. Surgical or medical condition which, in the judgment of the Investigator or Sponsor, may interfere with absorption, distribution, metabolism, or excretion of the drugs to be used
4. Previous In vitro fertilization (IVF) or Assisted reproductive technology (ART) failure due to a poor response to gonadotropins. Poor response is defined as development of 2 mature follicles or history of >2 previous failed in vitro fertilization (IVF) cycles.
5. History of recurrent pregnancy loss (>2).
6. Presence of abnormal uterine bleeding of undetermined origin
7. Current or recent substance abuse, including alcohol or smoking >10 cigarettes per day
8. Refusal or inability to comply with the requirements of the Protocol for any reason, including scheduled clinic visits and laboratory tests
9. Participation in any experimental drug study within 30 days prior to Screening
10. Severe male factor requiring invasive or surgical sperm retrieval (e.g., microsurgical epididymal sperm aspiration [MESA], testicular sperm extraction [TESE])

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Menopur/Endometrin; Highly purified menotropin (Menopur®) 225 IU from day 1-6 of menstrual cycle. May be adjusted up to 450 IU daily for more days until human chorionic gonadotropin (hCG) criteria are met. Progestrone vaginal insert (Endometrin®) starts on the day following oocyte retrieval and continues for a total duration of 10 weeks or until a negative pregnancy test is obtained.	Drug: Menotropin; 225 IU (up to 450 IU) by subcutaneous injection once per day for up to about 15 days until human chorionic gonadotropin (hCG) criteria are met.; Other Names: Menopur®; hMG; highly purified menotropins; Drug: Progestrone vaginal insert; 100 mg progesterone vaginal insert 2 or 3 times daily (BID or TID) (start on the day after oocyte retrieval) until 10 weeks gestation or confirmation of negative pregnancy test.; Other Names: progesterone; Endometrin®; Drug: Ganirelix; Ganirelix acetate 250 µg as a daily subcutaneous injection starting on day 6 and continuing until hCG criteria were met.; Other Names: ganirelix acetate; GnRH antagonist
Experimental: Menopur/Progesterone in Oil; Highly purified menotropin (Menopur®) 225 IU from day 1-6 of menstrual cycle. May be adjusted up to 450 IU daily for more days until human chorionic gonadotropin (hCG) criteria are met. Progesterone in Oil injections start on the day following oocyte retrieval and continue for a total duration of 10 weeks or until a negative pregnancy test is obtained.	Drug: Progesterone in oil; 50 mg by intramuscular injection once per day, starting on the day after oocyte retrieval until 10 weeks gestation or confirmation of negative pregnancy test.; Drug: Menotropin; 225 IU (up to 450 IU) by subcutaneous injection once per day for up to about 15 days until human chorionic gonadotropin (hCG) criteria are met.; Other Names: Menopur®; hMG; highly purified menotropins; Drug: Ganirelix; Ganirelix acetate 250 µg as a daily subcutaneous injection starting on day 6 and continuing until hCG criteria were met.; Other Names: ganirelix acetate; GnRH antagonist
Active Comparator: Follistim/Endometrin; Follitropin beta (Follistim®) 225 IU from day 1-6 of menstrual cycle. May be adjusted up to 450 IU daily for more days until human chorionic gonadotropin (hCG) criteria are met. Progestrone vaginal insert (Endometrin®) starts on the day following oocyte retrieval and continues for a total duration of 10 weeks or until a negative pregnancy test is obtained.	Drug: Progestrone vaginal insert; 100 mg progesterone vaginal insert 2 or 3 times daily (BID or TID) (start on the day after oocyte retrieval) until 10 weeks gestation or confirmation of negative pregnancy test.; Other Names: progesterone; Endometrin®; Drug: Ganirelix; Ganirelix acetate 250 µg as a daily subcutaneous injection starting on day 6 and continuing until hCG criteria were met.; Other Names: ganirelix acetate; GnRH antagonist; Drug: follitropin beta; 225 IU (up to 450 IU) by subcutaneous injection once per day for up to about 15 days until human chorionic gonadotropin (hCG) criteria are met.; Other Names: Follistim®; Follistim Pen®
Active Comparator: Follistim/Progesterone in Oil; Follitropin beta (Follistim®) 225 IU from day 1-6 of menstrual cycle. May be adjusted up to 450 IU daily for more days until human chorionic gonadotropin (hCG) criteria are met. Progesterone in Oil injections start on the day following oocyte retrieval and continue for a total duration of 10 weeks or until a negative pregnancy test is obtained.	Drug: Progesterone in oil; 50 mg by intramuscular injection once per day, starting on the day after oocyte retrieval until 10 weeks gestation or confirmation of negative pregnancy test.; Drug: Ganirelix; Ganirelix acetate 250 µg as a daily subcutaneous injection starting on day 6 and continuing until hCG criteria were met.; Other Names: ganirelix acetate; GnRH antagonist; Drug: follitropin beta; 225 IU (up to 450 IU) by subcutaneous injection once per day for up to about 15 days until human chorionic gonadotropin (hCG) criteria are met.; Other Names: Follistim®; Follistim Pen®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With Ongoing Pregnancy at Week 8	The ongoing pregnancy was defined as a positive fetal heart movement (motion) at approximately six weeks of gestation and confirmed in a follow-up pregnancy ultrasound.	Week 8 (Week 6 of gestation)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Follicles Observed at Day 15	The mean number of follicles observed in both ovaries at the last transvaginal ultrasound in the stimulation phase.	Day 15
Number of Oocytes Retrieved at Day 18	The mean number of oocytes retrieved within 34-36 hours of human chorionic gonadotropin (hCG) administration.	Approximately Day 18
Proportion of Oocytes Fertilized of the Total Number of Oocytes Retrieved	The proportion of the number of oocytes inseminated (fertilized) of the total number of oocytes retrieved.	Approximately Day 19
Number of Embryos Transferred at Three Stages of Development	The number of embryos, morula and blastocytes transferred to the study participant on either day 3 or day 5 following fertilization.	Approximately Day 24
Number of Embryos Frozen at Day 24	The number of embryos that were not transferred but instead were frozen for future use.	Approximately Day 24
Participants With Cycle Cancellation Following One In Vitro Fertilization (IVF) Treatment Cycle	A count of participants whose discontinuation was clearly documented on the study completion/termination form as 1) due to cycle cancelled or 2) cycle cancellation for risk of ovarian hyperstimulation syndrome (OHSS).	Day 1 to Day 24
Participants With Biochemical Pregnancy at Day 38	Biochemical pregnancy is a positive β-hCG pregnancy test 12-14 days post embryo transfer.	approximately day 38 (Day 14 post embryo transfer)
Participants With Clinical Pregnancy at Week 7	Clinical pregnancy is the confirmation of the presence of intrauterine gestational sacs on pregnancy ultrasound examination.	approximately week 7
Participants With Adverse Events (AEs), Including Ovarian Hyperstimulation Syndrome (OHSS)	Number of participants with adverse events (AEs) that started after first treatment. Severity used a three point scale: mild=awareness of signs/symptoms, but no disruption of usual activity moderate=event sufficient to affect usual activity (disturbing) severe=event causes inability to work or perform usual activities (unacceptable) Relatedness to study treatment used a four point scale: unrelated, unlikely, possible, probable. Seriousness refers to death, hospitalization, a life-threatening experience, persistent or significant disability/incapacity, or congenital anomaly.	Day 1 - week 12
Number of Live Births		Approximately 10 months

Collaborators and Investigators

• Sponsor: Ferring Pharmaceuticals

Study record dates

Study Major Dates

• Study Start: December 1, 2008
• Primary Completion (Actual): November 1, 2009
• Study Completion (Actual): January 1, 2010

Study Registration Dates

• First Submitted: December 3, 2008
• First Submitted That Met QC Criteria: December 3, 2008
• First Posted (Estimate): December 4, 2008

Study Record Updates

• Last Update Posted (Estimate): November 2, 2011
• Last Update Submitted That Met QC Criteria: October 31, 2011
• Last Verified: October 1, 2011

More Information

Terms related to this study

• Keywords: Healthy, pre-menopausal women, age 18-42 with a history of infertility and requiring IVF
• Additional Relevant MeSH Terms: Infertility; Physiological Effects of Drugs; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Hormone Antagonists; Reproductive Control Agents; Fertility Agents, Female; Fertility Agents; Progestins; Follicle Stimulating Hormone; Menotropins; Progesterone; Ganirelix
• Other Study ID Numbers: 2008-04