Oral Versus Vaginal Progesterone in the Luteal Support in Cryo-warmed Embryo Transfer Cycles

Overview

In IVF/ICSI cycles, the progesterone levels induced by ovarian stimulation are low, therefore the luteal phase is supported by progesterone. The use of progestogens in IVF is associated with an improvement in the live birth rate Standard protocol for luteal phase support has not yet been established. Currently vaginal progesterone is widely used, since the classic oral progesterone seems to result in a low bioavailability and a lower pregnancy rate. However, vaginal administration of progesterone is associated with vaginal irritation, discharge and bleeding. For all these reasons, there is a need for an effective, well tolerated, and safe treatment that can improve patient satisfaction and compliance.

Many studies have observed similar pregnancy rate results with dydrogesterone and micronized vaginal progesterone. A new RCT including a total of 1143 patients by Tournaye, showed that dydrogesterone treatment had a similar safety profile to micronized vaginal progesterone (MVP) for luteal support as part of ART treatment. The crude pregnancy rates at 12 weeks were 37.6% and 33.1% in the dydrogesterone and MVP treatment groups respectively.

Regarding the administration route of progesterone, intramuscular and transvaginal routes are the two conventional progesterone administration techniques. However, very few studies have compared the advantages of oral dydrogestrone with vaginal progesterone for luteal support in ART cycles.

The objective of the investigator's study is to demonstrate the superiority of oral dydrogesterone (Duphaston) 10 over MVP (Utrogestan) used for luteal supplementation in cryo-warmed embryo transfer cycles. Upon consent, 224 patients women will be randomly allocated into either one of the study groups using a simple randomization method by computer-generated random numbers. Group I will receive the oral dydrogesterone, while group II will receive the vaginal microprogesterone.

Full Title of Study: “Oral Dydrogesterone Versus Vaginal Progesterone in the Luteal Phase Support in Cryo-warmed Embryo Transfer Cycles: Randomized Controlled Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: August 1, 2020

Interventions

  • Drug: Progesterone
    • Patients will be randomly assigned during the treatment follow up, at the time of addition of progesterone to the regimen, following computerized random number generator in procedure, to one of the study groups. Patients will be aware of the allocated arm since the treatment drugs have different route of administration. Group I will receive the oral dydrogesterone, while group II will receive the vaginal microprogesterone.

Arms, Groups and Cohorts

  • Experimental: Oral Dydrogesterone
    • Oral dydrogesterone (Duphaston 10 mg) will be given orally four times daily : will be continued till the pregnancy test, and till at least 12 weeks of gestation in case of a positive pregnancy test.
  • Experimental: Vaginal microprogesterone
    • Vaginal progesterone (Utrogestan 200 mg) will be given vaginally four times daily: will be continued till the pregnancy test, and till at least 12 weeks of gestation in case of a positive pregnancy test

Clinical Trial Outcome Measures

Primary Measures

  • Live births per embryo transferred
    • Time Frame: until date of delivery
    • Number of live births per number of embryos transferred

Secondary Measures

  • Ongoing or Clinical pregnancy rate per started treatment cycle (CPR)
    • Time Frame: 20 weeks from Last Menstrual Period (LMP)
    • The presence of a viable fetus at 20 weeks gestation or fetal heart beat on transvaginal ultrasound after 6-7 weeks of gestation
  • Implantation rate (IR)
    • Time Frame: 7 weeks from LMP
    • Number of intrauterine gestational sacs observed on transvaginal ultrasound divided by the number of transferred embryos
  • Miscarriage rates
    • Time Frame: From a positive pregnancy test till 12 weeks gestation
    • Pregnancy loss prior to 12 weeks of gestation
  • Multiple gestation rate
    • Time Frame: 6-7 weeks of gestation
    • More than one intra-uterine gestation sac at 6 weeks of gestation

Participating in This Clinical Trial

Inclusion Criteria

  • Normal uterine cavity
  • Normal Hormonal investigation: TSH,PRL,FBS
  • Frozen embryo transfer cycles: at least 2 embryos
  • Primary or secondary infertility: tubal occlusion, male factor, unexplained, endometriosis, ovarian factors…
  • Body mass index (BMI) ≥18 to ≤30 kg/m2

Exclusion Criteria

  • Preexisting untreated medical condition (thyroid disease, diabetes mellitus, hypertension, pulmonary conditions, cardiac condition…)
  • History of three or more consecutively failed In Vitro Fertilization (IVF) cycles after embryo transfer
  • History of three or more miscarriages
  • Previous allergy reactions to progesterone products

Gender Eligibility: Female

Minimum Age: 18 Years

Maximum Age: 38 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • American University of Beirut Medical Center
  • Provider of Information About this Clinical Study
    • Principal Investigator: Johnny Awwad, Professor of Obstetrics and Gynecology – American University of Beirut Medical Center
  • Overall Contact(s)
    • Johnny Awwad, M.D, 009613500, jawwad@aub.edu.lb

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.