Human Growth Hormone Pre-treatment for 6 Weeks Prior to Ovulation Induction for IVF

NCT02179255 | Unknown Phase 1

• 1 other identifier: 04082014-02
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Synthetic human growth hormone (HGH) has been available for more than a decade for specific indication in children and adults. Past Randomized Control Trials (RCT)s of HGH (under off-label use) for improving ovarian function have shown that a combination of traditional gonadotropin ovulation induction protocols, with addition of HGH is effective in increasing pregnancy rates, but not increasing egg production after IVF in women with documented diminished ovarian reserve (DOR). The investigators hypothesize that by initiating HGH at least 6 weeks prior to IVF start, the investigators will be able to increase production of oocytes and further improve pregnancy chances. This hypothesis is based on prior observations of effects of growth hormone on small antral follicles and the fact that prior studies utilized HGH principally only during ovulation induction itself. The investigators plan to recruit 30 women (15 in each group) to an open label randomized controlled trial of HGH for augmentation of ovarian response among women with documented DOR and poor prior response to ovulation induction. Eligible participants will be women \< 45 years with documented history of prior retrieval of 2 or fewer oocytes while on maximal ovulation induction despite prior supplementation with dehydroepiandrosterone (DHEA). Women will be treated with 1.9 mg (5.7 units) of HGH per day, beginning about 6 weeks before start of their treatment cycle. Cost of treatment with HGH will be a cost to the participating patient. HGH will cost the patient approximately $800 per week of treatment. Patients who are randomized to the non-HGH treated group, and do not conceive, will in the following cycle be offered HGH supplementation outside of this clinical trial. This subsequent cycle will not be part of the study dataset and patients will also be responsible for the cost of HGH. Even with only 7 patients in each group, this trial will have a 99% power (error 0.05%) to detect a mean increase to 4 oocytes in the treated group. The investigators plan to recruit 15 patients in each group to allow for possible dropouts.

Conditions

Female Infertility Due to Diminished Ovarian Reserve

Keywords

DOR; Premature Ovarian Failure (POF); Ovarian Failure; Human Growth Hormone

Outcome Measures

Primary Outcomes (1)

• Oocytes retrieved for IVF

  8 weeks after starting intervention

Secondary Outcomes (1)

• Clinical Pregnancy Rates

  12 weeks after starting intervention

Study Arms (2)

Human Growth Hormone

EXPERIMENTAL

1.9 mg (5.7 units) daily injection of Recombinant Human Growth Hormone (HGH) for at least 6 weeks (42 days) plus FSH 450 to 600 units per day administered subcutaneous (SQ) daily dose adjusted based on the patients response starting on day 2 of the 28 day menstrual cycle and continued until Ovulation trigger

Drug: Human Growth Hormone; Drug: Follicle Stimulating Hormone

Follicle Stimulating Hormone

ACTIVE COMPARATOR

FSH 450 to 600 units per day administered SQ daily dose adjusted based on the patients response starting on day 2 of the 28 day menstrual cycle and continued until Ovulation trigger

Drug: Follicle Stimulating Hormone

Interventions

Human Growth Hormone DRUG

1.9 mg (5.7 units) daily injection of Recombinant Human Growth Hormone (HGH) for at least 6 weeks (42 days) continuing into the approximately 14 days of ovulation induction phase of the trial.

Also known as: Human Growth Hormone (HGH), Somatotropin, Omnitrope, Norditropin, Humatrope, Saizen, Genotropin, Serostim, Nutropin, Tev-tropin, Zorbtive

Human Growth Hormone

Follicle Stimulating Hormone DRUG

FSH 450 to 600 units per day administered SQ daily dose adjusted based on the patients response starting on day 2 of the 28 day menstrual cycle and continued until Ovulation trigger

Also known as: Bravelle, Follistim, Gonal-F, Menopure

Follicle Stimulating Hormone; Human Growth Hormone

Eligibility Criteria

• Age: 18 Years - 44 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• The study will be limited to women with Poor Response to prior treatment with evidence of diminished ovarian reserve with 2 or fewer oocytes in a previous ovulation induction cycles with maximal gonadotrophin stimulation. All women in this study will be \<45 years old.

You may not qualify if:

• Cardiac disease, evidence of glucose intolerance

Sponsors & Collaborators

• Center for Human Reproduction: lead

Study Sites (1)

Center for Human Reproduction

New York, New York, 10021, United States

Location

Related Publications (17)

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  PMID: 11361571 BACKGROUND

• FDA approves growth hormone for short children. Child Health Alert. 2003 Sep;21:4. No abstract available.

  PMID: 14552287 BACKGROUND

• Bergh C, Hillensjo T, Wikland M, Nilsson L, Borg G, Hamberger L. Adjuvant growth hormone treatment during in vitro fertilization: a randomized, placebo-controlled study. Fertil Steril. 1994 Jul;62(1):113-20.

  PMID: 7516295 BACKGROUND

• Dor J, Seidman DS, Amudai E, Bider D, Levran D, Mashiach S. Adjuvant growth hormone therapy in poor responders to in-vitro fertilization: a prospective randomized placebo-controlled double-blind study. Hum Reprod. 1995 Jan;10(1):40-3. doi: 10.1093/humrep/10.1.40.

  PMID: 7745068 BACKGROUND

• Suikkari A, MacLachlan V, Koistinen R, Seppala M, Healy D. Double-blind placebo controlled study: human biosynthetic growth hormone for assisted reproductive technology. Fertil Steril. 1996 Apr;65(4):800-5. doi: 10.1016/s0015-0282(16)58217-x.

  PMID: 8654642 BACKGROUND

• Bergh C, Carlstrom K, Selleskog U, Hillensjo T. Effect of growth hormone on follicular fluid androgen levels in patients treated with gonadotropins before in vitro fertilization. Eur J Endocrinol. 1996 Feb;134(2):190-6. doi: 10.1530/eje.0.1340190.

  PMID: 8630518 BACKGROUND

• Casson PR, Lindsay MS, Pisarska MD, Carson SA, Buster JE. Dehydroepiandrosterone supplementation augments ovarian stimulation in poor responders: a case series. Hum Reprod. 2000 Oct;15(10):2129-32. doi: 10.1093/humrep/15.10.2129.

  PMID: 11006185 BACKGROUND

• Casson PR, Santoro N, Elkind-Hirsch K, Carson SA, Hornsby PJ, Abraham G, Buster JE. Postmenopausal dehydroepiandrosterone administration increases free insulin-like growth factor-I and decreases high-density lipoprotein: a six-month trial. Fertil Steril. 1998 Jul;70(1):107-10. doi: 10.1016/s0015-0282(98)00121-6.

  PMID: 9660430 BACKGROUND

• Hazout A, Junca Am, Menezo Y, Demouzon J, Cohen-Bacrie P. Effect of growth hormone on oocyte competence in patients with multiple IVF failures. Reprod Biomed Online. 2009 May;18(5):664-70. doi: 10.1016/s1472-6483(10)60011-9.

  PMID: 19549445 BACKGROUND

• Kucuk T, Kozinoglu H, Kaba A. Growth hormone co-treatment within a GnRH agonist long protocol in patients with poor ovarian response: a prospective, randomized, clinical trial. J Assist Reprod Genet. 2008 Apr;25(4):123-7. doi: 10.1007/s10815-008-9212-7.

  PMID: 18392675 BACKGROUND

• Owen EJ, Shoham Z, Mason BA, Ostergaard H, Jacobs HS. Cotreatment with growth hormone, after pituitary suppression, for ovarian stimulation in in vitro fertilization: a randomized, double-blind, placebo-control trial. Fertil Steril. 1991 Dec;56(6):1104-10. doi: 10.1016/s0015-0282(16)54724-4.

  PMID: 1743329 BACKGROUND

• Tesarik J, Hazout A, Mendoza C. Improvement of delivery and live birth rates after ICSI in women aged >40 years by ovarian co-stimulation with growth hormone. Hum Reprod. 2005 Sep;20(9):2536-41. doi: 10.1093/humrep/dei066. Epub 2005 Apr 28.

  PMID: 15860489 BACKGROUND

• Yoshimura Y, Ando M, Nagamatsu S, Iwashita M, Adachi T, Sueoka K, Miyazaki T, Kuji N, Tanaka M. Effects of insulin-like growth factor-I on follicle growth, oocyte maturation, and ovarian steroidogenesis and plasminogen activator activity in the rabbit. Biol Reprod. 1996 Jul;55(1):152-60. doi: 10.1095/biolreprod55.1.152.

  PMID: 8793070 BACKGROUND

• Demeestere I, Gervy C, Centner J, Devreker F, Englert Y, Delbaere A. Effect of insulin-like growth factor-I during preantral follicular culture on steroidogenesis, in vitro oocyte maturation, and embryo development in mice. Biol Reprod. 2004 Jun;70(6):1664-9. doi: 10.1095/biolreprod.103.023317. Epub 2004 Feb 11.

  PMID: 14960488 BACKGROUND

• Yoshimura Y, Aoki N, Sueoka K, Miyazaki T, Kuji N, Tanaka M, Kobayashi T. Interactions between insulin-like growth factor-I (IGF-I) and the renin-angiotensin system in follicular growth and ovulation. J Clin Invest. 1996 Jul 15;98(2):308-16. doi: 10.1172/JCI118794.

  PMID: 8755639 BACKGROUND

• Zhuang GL, Wong SX, Zhou CQ. [The effect of co-administration of low dosage growth hormone and gonadotropin for ovarian hyperstimulation in vitro fertilization and embryo transfer]. Zhonghua Fu Chan Ke Za Zhi. 1994 Aug;29(8):471-4, 510. Chinese.

  PMID: 7835118 BACKGROUND

• Sood A, Mohiyiddeen G, Ahmad G, Fitzgerald C, Watson A, Mohiyiddeen L. Growth hormone for in vitro fertilisation (IVF). Cochrane Database Syst Rev. 2021 Nov 22;11(11):CD000099. doi: 10.1002/14651858.CD000099.pub4.

  PMID: 34808697 DERIVED

MeSH Terms

Conditions

Primary Ovarian Insufficiency

Interventions

Human Growth Hormone; Growth Hormone; Follicle Stimulating Hormone; Urofollitropin; follitropin beta; follitropin alfa

Condition Hierarchy (Ancestors)

Ovarian Diseases; Adnexal Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases; Gonadal Disorders; Endocrine System Diseases

Intervention Hierarchy (Ancestors)

Pituitary Hormones, Anterior; Pituitary Hormones; Peptide Hormones; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Peptides; Amino Acids, Peptides, and Proteins; Gonadotropins, Pituitary; Gonadotropins; Menotropins

Study Officials

• David H Barad, MD

  Center for Human Reproduction

  PRINCIPAL INVESTIGATOR

• Norbert Gleicher

  Center for Human Reproduction

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 15, 2014
• First Posted: July 1, 2014
• Study Start: August 1, 2014
• Primary Completion: June 1, 2021
• Study Completion: June 1, 2022
• Last Updated: February 18, 2020

Record last verified: 2020-02

Locations

US (1)