PERgoveriS In Stratified Treatment for Assisted Reproductive Technique (PERSIST)

A Phase IIIB, Multicentre, Multinational, Randomized, Open-label Trial to Compare the Efficacy and Safety of Ovarian Stimulation With GONAL-f® Day 1 to Day 5 Followed by Pergoveris® Starting Day 6 to Pergoveris® Starting Day 1 in Women Between 36 and 40 Years of Age Undergoing Assisted Reproductive Technique (ART)

This is a multicenter, multi-national, randomized, open-label comparative trial. After screening, the subjects will start down-regulation treatment on Day 21-22 of the cycle. Down-regulation treatment will start within 2 months following the screening visit. The routine long luteal phase protocol for gonadotropin-releasing hormone (GnRH) agonist treatment will be followed. Once down-regulation has been confirmed, a pregnancy test will be performed just before randomization and start of recombinant human follicle-stimulating hormone (r-hFSH) treatment to rule out any pre-existing pregnancy. If the result is negative, the subject will be randomly assigned to one of the two treatment arms of the trial:

• GONAL-f®: (Liquid Pen; 300 international unit [IU] of per day) stimulation Day 1-5 followed by Pergoveris® (vial/powder, 300 IU per day) from stimulation Day 6 and until required recombinant human chorionic hormone (r-hCG) criterion is met. The dose can be adjusted from stimulation Day 6 (increased or decreased) based upon the subject's ovarian response and according to the center's standard practice.
• Pergoveris®: (vial/powder, 300 IU per day) from stimulation Day 1 and until required r-hCG criterion is met. The dose can be adjusted from stimulation Day 6 (increased or decreased) based upon the subject's ovarian response and according to the center's standard practice.

Randomization across the two treatment arms will be kept balanced in a 1:1 ratio. Follicular development will be monitored according to the center's standard practice by ultrasound (US) and/or estradiol (E2) levels, until the protocol r-hCG requirement is met (i.e., at least one follicle greater than or equal to [>=] 18 millimeter [mm] and two follicles >=16 mm). After this, a single injection of r-hCG will be administered in order to induce final oocyte maturation.

At a time of 34-38 hours after r-hCG administration, oocytes will be recovered vaginally under US monitoring. Oocytes will then be fertilized in vitro and embryos replaced 2-5 days after oocyte recovery. Ovum pick up (OPU), in vitro fertilization (IVF), embryo transfer (ET) and luteal support will be performed as per center's standard practice.

A post-treatment safety visit will be performed for all subjects who received r-hCG (pregnant and non- pregnant) on Day 15-20 post-hCG. For subjects who have withdrawn from treatment (i.e. after starting Pergoveris® or Gonal-f® but before hCG is given) this visit will take place 20-30 days after their first Pergoveris® or Gonal-f® treatment injection (excluding pregnancy testing).

Study Overview

• Status: Completed
• Conditions: Assisted Reproductive Techniques; Reproductive Technology, Assisted
• Intervention / Treatment: Drug: Gonal-f®; Drug: Pergoveris®; Drug: Pergoveris®; Drug: Recombinant human chorionic gonadotropin (r-hCG)

• Study Type: Interventional
• Enrollment (Actual): 202
• Phase: Phase 3

Contacts and Locations

Study Locations

• Denmark
  • Dronninglund, Denmark
    • Research Site
  • Fredericia, Denmark
    • Research Site
• Finland
  • Helsinki, Finland
    • Research Site
• France
  • Bondy CEDEX, France
    • Research Site
  • Bruges, France
    • Research Site
  • Clamart CEDEX, France
    • Research Site
  • Tenon, France
    • Research Site
  • Villeurbanne, France
    • Research Site
• Germany
  • Berlin, Germany
    • Research Site
  • Halle, Germany
    • Research Site
• Greece
  • Athen, Greece
    • Research Site
  • Crete
    • Heraklion, Crete, Greece
      • Research Site
  • Thessaloniki
    • Pylaia, Thessaloniki, Greece
      • Research Site
• Italy
  • Bologna, Italy
    • Research Site
  • Firenze, Italy
    • Research Site
  • Torino, Italy
    • Research Site
• Netherlands
  • Zwolle, Netherlands
    • Research Site
• Poland
  • Warszawa, Poland
    • Research Site
• Russian Federation
  • Moscow, Russian Federation
    • Research Site
  • Samara, Russian Federation
    • Research Site
• Slovakia
  • Bratislava, Slovakia
    • Research Site
• United Kingdom
  • London, United Kingdom
    • Research Site
  • Swansea, United Kingdom
    • Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 32 years to 36 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Be a female subject justifying an in vitro fertilization and embryo transfer (IVF/ET) treatment
• Be between her 36th and 40th birthday (both included) at the time of the randomization visit
• Have early follicular phase (Day 2-4) serum level of basal follicle stimulating hormone (FSH less than or equal to (=<)12 IU/L) measured in the center's local laboratory during the screening period (that is within 2 months prior to down-regulation start)
• A body mass index (BMI) less than (<) 30 kilogram per square meter (kg/m^2)
• Have a regular spontaneous ovulatory menstrual cycle between 21 and 35 days in length
• Be willing and able to comply with the protocol for the duration of the trial
• Have given written informed consent, prior to any trial-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to her future medical care
• Have a male partner with semen analysis within the past 6 months prior to randomization considered adequate to proceed with regular insemination or intracytoplasmic sperm injection (ICSI) according to the center's standard practice. If these criteria are not met, the subject can only be entered if donor sperm will be used
• Other protocol specified inclusion criteria could also apply.

Exclusion Criteria:

• Had >= 2 previous ART cycles with a poor response to gonadotrophin stimulation defined as =< 6 mature follicles and/or =<4 oocytes collected in any previous IVF cycle or previous cycles with a hyper response defined as >= 25 oocytes retrieved
• Any medical condition, which in the judgment of the investigator may interfere with the absorption, distribution, metabolism or excretion of the drug. In case of doubt, the subject in question should be discussed with Merck Serono's medical responsible
• Had previous severe ovarian Hyperstimulation Syndrome (OHSS)
• Polycystic ovary syndrome (PCOS; Rotterdam criteria) to reduce the risk of the occurrence of OHSS
• Any contraindication to being pregnant and/or carrying a pregnancy to term
• History of 3 or more miscarriages (early or late miscarriages) due to any cause
• A clinically significant systemic disease
• Known infection with Human Immunodeficiency Virus (HIV), Hepatitis B or C virus in the trial subject or her male partner
• Known allergy or hypersensitivity to human gonadotrophin preparations
• Entered previously into this trial or simultaneous participation in another clinical trial.
• Pregnancy and lactation period
• Participation in another clinical trial within the past 30 days
• Other protocol specified inclusion criteria could also apply.

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

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Pergoveris®	Drug: Pergoveris®; Pergoveris® (follitropin alfa and lutropin alfa) 300 IU will be administered subcutaneously starting from S6 until recombinant human chorionic gonadotropin (r-hCG) administration day (at least 1 follicles >= 18 mm). The dose of Pergoveris® was adjusted based upon the participant's ovarian response and according to the site's standard practice.; Drug: Pergoveris®; Pergoveris® (follitropin alfa and lutropin alfa) 300 IU will be administered subcutaneously once daily from S1 until r-hCG administration day (at least 1 follicles >= 18 mm). The dose of Pergoveris® was adjusted starting from S6 based upon the participant's ovarian response and according to the site's standard practice.; Drug: Recombinant human chorionic gonadotropin (r-hCG); 250 microgram of r-hCG will be administered once subcutaneously on r-hCG day (at least 1 follicles >= 18 mm).; Other Names: Ovidrel®; Ovitrelle®
Active Comparator: Gonal-f® Plus Pergoveris®	Drug: Gonal-f®; Gonal-f® (follitropin alfa) 300 International Unit (IU) will be administered subcutaneously once daily from stimulation day 1 (S1) to stimulation day 5 (S5).; Other Names: Follitropin alfa; Drug: Pergoveris®; Pergoveris® (follitropin alfa and lutropin alfa) 300 IU will be administered subcutaneously starting from S6 until recombinant human chorionic gonadotropin (r-hCG) administration day (at least 1 follicles >= 18 mm). The dose of Pergoveris® was adjusted based upon the participant's ovarian response and according to the site's standard practice.; Drug: Pergoveris®; Pergoveris® (follitropin alfa and lutropin alfa) 300 IU will be administered subcutaneously once daily from S1 until r-hCG administration day (at least 1 follicles >= 18 mm). The dose of Pergoveris® was adjusted starting from S6 based upon the participant's ovarian response and according to the site's standard practice.; Drug: Recombinant human chorionic gonadotropin (r-hCG); 250 microgram of r-hCG will be administered once subcutaneously on r-hCG day (at least 1 follicles >= 18 mm).; Other Names: Ovidrel®; Ovitrelle®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Number of Oocytes Retrieved	The total number of oocytes retrieved per reporting group on the day of ovum pick-up (OPU) (34-38 hours post r-hCG day) was calculated. Oocyte retrieval is a technique used in in-vitro fertilization (IVF) in order to remove oocytes from the ovary of the female participant, enabling fertilization outside the body.	OPU day (34-38 hours post r-hCG day [end of stimulation cycle {approximately 11 days}])

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Dose and Mean Daily Dose of Follicle Stimulating Hormone (FSH)		Day 1 up to r-hCG day (end of stimulation cycle [approximately 11 days])
Total Number of Stimulation Treatment Days		Day 1 up to r-hCG day (end of stimulation cycle [approximately 11 days])
Implantation Rate	Implantation rate per reporting group was measured as the number of fetal sacs observed, divided by the number of embryos transferred multiplied by 100.	Days 35-42 post r-hCG day (end of stimulation cycle [approximately 11 days])
Number of Fetal Sacs With Activity	Number of fetal sacs with activity was evaluated by ultrasound scan	Days 35-42 post r-hCG day [end of stimulation cycle {approximately 11 days}])
Number of Fetal Hearts With Activity	Number of fetal hearts with activity was evaluated by ultrasound scan	Days 35-42 post r-hCG day [end of stimulation cycle {approximately 11 days}])
Clinical Pregnancy Rate	Clinical pregnancy was defined as pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. It includes ectopic pregnancy. Clinical pregnancy rate was reported as total clinical pregnancy rate, clinical pregnancy rate per cycle started and per embryo transfer [ET]).	Days 35-42 post r-hCG day (end of stimulation cycle [approximately 11 days])
Number of Participants With Cancelled Cycles Due to Excessive or Insufficient Ovarian Response to Treatment	An excessive ovarian response: greater than or equal to 25 oocytes which could put the participant at risk of OHSS; An insufficient ovarian response: defined as 3 or less follicles of greater than or equal to 12 millimeter developing following at least 7 days of treatment.	S1 until Day 15-20 post r-hCG day (end of stimulation cycle [approximately 11 days])
Biochemical Pregnancies Rate	Biochemical pregnancy was defined as the pregnancy diagnosed only by the detection of human chorionic gonadotropin (hCG) in serum or urine and that does not develop into a clinical pregnancy. Participants with beta- hCG concentration greater than 10 international units per liter (IU/L) were considered as biochemical pregnant.	Days 15-20 post r-hCG day (end of stimulation cycle [approximately 11 days])
Number of Participants With Multiple Pregnancies	Multiple pregnancy was defined as the existence of more than one fetal sac with fetal heart activity.	Days 35-42 post r-hCG day (end of stimulation cycle [approximately 11 days])
Number of Participants With Early and Late Ovarian Hyper Stimulation Syndrome (OHSS)	Ovarian Hyper Stimulation Syndrome (OHSS) is a syndrome which can manifest with enlarged ovaries, advanced ascites with increased vascular permeability, pleural fluid accumulation, hemoconcentration, and increased blood clotting. Early OHSS was defined as the onset of OHSS occurring within 9 days after oocyte retrieval and late OHSS was defined as the onset of OHSS occurring on or after day 10 from oocyte retrieval.	Days 15-20 post r-hCG day (end of stimulation cycle [approximately 11 days])
Number of Participants With Treatment-emergent Adverse Events	An adverse event (AE) was defined as any untoward medical occurrence in the form of signs, symptoms, abnormal laboratory findings, or diseases that emerges or worsens relative to baseline during a clinical study with an Investigational Medicinal Product (IMP), regardless of causal relationship and even if no IMP has been administered.	Day 1 up to days 15-20 post r-hCG day (end of stimulation cycle [approximately 11 days])
Systolic and Diastolic Arterial Blood Pressure Assessments		Days 15-20 post r-hCG day (end of stimulation cycle [approximately 11 days])
Heart Rate Assessments		Days 15-20 post r-hCG day (end of stimulation cycle [approximately 11 days])

Collaborators and Investigators

• Sponsor: Merck KGaA, Darmstadt, Germany
• Collaborators: Merck Serono GmbH, Germany; Merck B.V., Netherlands; Merck A.E., Greece; Merck OY, Finland; Merck Serono S.A.S, France; Merck Serono S.P.A., Italy; Merck Serono S.A., Geneva; Merck A/S, Denmark; Merck SP. Z.O.O., Poland; Merck Services U.K. Ltd, UK; LLC Merck, Russia; Merck spol. s r.o., Slovakia; Merck Pharma, K.S., Slovakia
• Investigators: Study Director: Salvatore Longobardi, MD, Merck Serono S.P.A., Italy

Publications and helpful links

General Publications

• H Behre, C Howles, S Longobardi. Luteinizing hormone supplementation from Day 1 versus 6 of ovarian stimulation in women aged 36-40 years: results from an open-label, randomized, multicentre, multinational trial. Human Reproduction. 2013;28(suppl 1)
• Behre HM, Howles CM, Longobardi S; PERSIST Study Investigators. Randomized trial comparing luteinizing hormone supplementation timing strategies in older women undergoing ovarian stimulation. Reprod Biomed Online. 2015 Sep;31(3):339-46. doi: 10.1016/j.rbmo.2015.06.002. Epub 2015 Jun 15.

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start (Actual): May 31, 2011
• Primary Completion (Actual): October 31, 2012
• Study Completion (Actual): October 31, 2012

Study Registration Dates

• First Submitted: February 15, 2011
• First Submitted That Met QC Criteria: February 15, 2011
• First Posted (Estimate): February 16, 2011

Study Record Updates

• Last Update Posted (Actual): May 28, 2021
• Last Update Submitted That Met QC Criteria: May 4, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Keywords: Ovarian Stimulation; Ovulation Induction; Assisted Reproductive Technics; Assisted Reproductive Technique; Reproductive Technique, Assisted; Reproductive Technology, Assisted
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Reproductive Control Agents; Follicle Stimulating Hormone; Chorionic Gonadotropin
• Other Study ID Numbers: EMR 200061-504; 2010-023534-23 (EudraCT Number)