Menopur® Versus Follistim® in Polycystic Ovarian Syndrome (PCOS)

A Multi-Center, Randomized, Open-Label Evaluation of MENOPUR® Versus FOLLISTIM® in Polycystic Ovarian Syndrome (PCOS) Patients

This multicenter, randomized, open-label exploratory study will be performed in approximately 200 polycystic ovary syndrome (PCOS) but otherwise healthy females undergoing in vitro fertilization (IVF). Each study center will follow its 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 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 times during the cycle (Stimulation Day 6, Day of human chorionic gonadotropin (hCG), and first serum pregnancy test) for estradiol (E2), progesterone (P4) and human chorionic gonadotropin (hCG) labs. 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 Overview

• Status: Completed
• Conditions: Infertility; Polycystic Ovarian Syndrome
• Intervention / Treatment: Drug: Menotropin; Drug: Progesterone vaginal insert; Drug: leuprolide acetate; Drug: Progesterone in oil; Drug: Follitropin beta

• Study Type: Interventional
• Enrollment (Actual): 110
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Littleton, Colorado, United States, 80129
      • Conceptions Reproductive Associates of Colorado
  • Florida
    • Clearwater, Florida, United States, 33759
      • Women's Medical Research Group LLC, Florida
  • Illinois
    • Chicago, Illinois, United States, 60610
      • Fertility Center of Illinois
  • New York
    • New York, New York, United States, 10021
      • Weill Cornell Medical College
  • Rhode Island
    • Providence, Rhode Island, United States, 02905
      • Women & Infants' Hospital of RI
  • Texas
    • Bedford, Texas, United States, 76022
      • Center for Assisted Reproduction

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 38 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. Diagnosed with polycystic ovary syndrome (PCOS), using criteria adopted as the 2003 Rotterdam PCOS Consensus (2 out of 3, excluding other etiologies [congenital adrenal hyperplasia, androgen-secreting tumors, Cushing's syndrome])

   • Oligo- or anovulation
   • Clinical and/or biochemical signs of hyperandrogenism
   • Polycystic ovaries
3. Body mass index (BMI) of 18-39
4. Early follicular phase (Day 3) follicle stimulating hormone (FSH) < 15 IU/L and estradiol (E2) within normal limits
5. 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.)
6. Transvaginal ultrasound at screening consistent with findings adequate for assisted reproductive technology (ART) with respect to uterus and adnexa
7. Signed informed consent

Exclusion Criteria:

1. Gestational or surrogate carrier, donor oocyte
2. Presence of any clinically relevant systemic disease (e.g., uncontrolled thyroid or adrenal dysfunction, an organic intracranial lesion such as a pituitary tumor, 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. Two or more previous failed in vitro fertilization (IVF) cycles or in vitro fertilization (IVF)/assisted reproductive technology (ART) failure due to a poor response to gonadotropins, defined as development of 2 mature follicles
5. History of recurrent pregnancy loss, defined as more than two clinical losses
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])
11. Prior hypersensitivity to any of the protocol drugs

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: Menotropin/Progesterone vaginal insert; 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 vaginal insert (Endometrin®) 100 mg 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.; Other Names: Menopur®; Drug: Progesterone vaginal insert; 100 mg inserted vaginally 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: Endometrin®; Drug: leuprolide acetate; Daily administration of 0.5mg of leuprolide acetate (depot formulations were not permitted) began on Day 21 following onset of menses, and then decreased to 0.25 mg when gonadotropin therapy was initiated.; Other Names: Lupron
Experimental: Menotropin/Progesterone in oil; 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 50 mg 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: Menotropin; 225 IU (up to 450 IU) by subcutaneous injection once per day for up to about 15 days.; Other Names: Menopur®; Drug: leuprolide acetate; Daily administration of 0.5mg of leuprolide acetate (depot formulations were not permitted) began on Day 21 following onset of menses, and then decreased to 0.25 mg when gonadotropin therapy was initiated.; Other Names: Lupron; 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.
Active Comparator: Follitropin beta/Progesterone vaginal insert; Follitropin beta (Follistim Pen®) 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 vaginal insert (Endometrin®) 50 mg 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 vaginal insert; 100 mg inserted vaginally 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: Endometrin®; Drug: leuprolide acetate; Daily administration of 0.5mg of leuprolide acetate (depot formulations were not permitted) began on Day 21 following onset of menses, and then decreased to 0.25 mg when gonadotropin therapy was initiated.; Other Names: Lupron; Drug: Follitropin beta; 225 IU (up to 450 IU) by subcutaneous injection once per day for up to about 15 days.; Other Names: Follistim Pen®
Active Comparator: Follitropin beta/Progesterone in oil; Follitropin beta (Follistim Pen®) 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 50 mg 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: leuprolide acetate; Daily administration of 0.5mg of leuprolide acetate (depot formulations were not permitted) began on Day 21 following onset of menses, and then decreased to 0.25 mg when gonadotropin therapy was initiated.; Other Names: Lupron; 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: Follitropin beta; 225 IU (up to 450 IU) by subcutaneous injection once per day for up to about 15 days.; Other Names: Follistim Pen®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participants With Cycle Cancellation Due to Risk of Ovarian Hyperstimulation Syndrome (OHSS) Between Weeks 1 - 3	A count of participants whose discontinuation was clearly documented on the study completion/termination form as cycle cancellation for risk of ovarian hyperstimulation syndrome (OHSS).	weeks 1-3

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.	approximately day 15
Number of Oocytes Retrieved at Day 18	The mean number of oocytes retrieved approximately 36 hours after hCG (Novarel®) administration and fertilized (by insemination or intra cytoplasmic sperm injection (ICSI)) according to site-specific procedures.	approximately day 18
Percentage of Oocytes Fertilized of the Total Number of Oocytes Retrieved	The fertilization rate for each participant was the percentage of the number of oocytes inseminated of the total number of oocytes retrieved.	approximately day 19
Number of Embryos Transferred at Three Stages of Development Before Implantation	The number of embryos, morulas and blastocysts transferred to the study participant on either day 3 or day 5 following fertilization. Embryos represent the earliest development stage and contain 2-8 cells. Morulas, the next stage, continued cellular cleavage results in a 16-30 cell solid sphere. Morula further develop into blastocyst, which contains 70-100 cells in a hollow spherical shape.	approximately day 24
Number of Embryos Frozen	The number of embryos that were not transferred but instead were frozen for future use.	approximately day 24
Percentage of Participants With Biochemical Pregnancy at Approximately 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)
Percentage of Participants With Clinical Pregnancy at Week 7	Clinical pregnancy is the confirmation of the presence of intrauterine gestational sacs on pregnancy ultrasound examination.	approximately Day 52
Percentage of Participants With Ongoing Pregnancy at Week 9	Clinical pregnancy is the confirmation of the presence of intrauterine gestational sacs on pregnancy ultrasound examination.	approximately Day 65
Estradiol Levels at Day 6	Estradiol monitoring during fertility therapy assesses follicular growth and is useful in monitoring the treatment. Blood tests sent to a central laboratory to obtain estradiol levels.	Day 6
Human Chorionic Gonadotropin (hCG) Levels at Day 6	Blood tests were sent to a central laboratory to obtain hCG levels.	Day 6
Progesterone Levels at Human Chorionic Gonadotropin (hCG) Administration	Blood tests were sent to a central laboratory to obtain progesterone levels.	approximately day 16
Number of Live Births Resulting From the In Vitro Fertilization Process	Number of live births resulting from the IVF process	Approximately 10 months
Participants With Treatment Emergent Adverse Events	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.	Week 1 to week12

Collaborators and Investigators

• Sponsor: Ferring Pharmaceuticals

Publications and helpful links

General Publications

• Beltsos AN, Sanchez MD, Doody KJ, Bush MR, Domar AD, Collins MG. Patients' administration preferences: progesterone vaginal insert (Endometrin(R)) compared to intramuscular progesterone for Luteal phase support. Reprod Health. 2014 Nov 11;11:78. doi: 10.1186/1742-4755-11-78.

Study record dates

Study Major Dates

• Study Start: January 1, 2009
• Primary Completion (Actual): July 1, 2010
• Study Completion (Actual): September 1, 2010

Study Registration Dates

• First Submitted: December 9, 2008
• First Submitted That Met QC Criteria: December 9, 2008
• First Posted (Estimate): December 10, 2008

Study Record Updates

• Last Update Posted (Estimate): January 27, 2012
• Last Update Submitted That Met QC Criteria: January 26, 2012
• Last Verified: January 1, 2012

More Information

Terms related to this study

• Keywords: IVF; PCOS; infertility; in vitro fertilization; polycystic ovarian syndrome; pre-menopausal women
• Additional Relevant MeSH Terms: Pathologic Processes; Neoplasms; Endocrine System Diseases; Disease; Ovarian Cysts; Cysts; Ovarian Diseases; Adnexal Diseases; Gonadal Disorders; Polycystic Ovary Syndrome; Syndrome; Infertility; Physiological Effects of Drugs; Antineoplastic Agents; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Antineoplastic Agents, Hormonal; Reproductive Control Agents; Fertility Agents, Female; Fertility Agents; Progestins; Follicle Stimulating Hormone; Leuprolide; Menotropins; Progesterone
• Other Study ID Numbers: 2008-05