INTEnsity of ovariaN Stimulation and Embryo Quality

NCT04983173 | Completed Phase 4

• 2 other identifiers: FSD-IEQ-2021-032021-000941-42
• Study Type: interventional
• Target: 110
• Locations: 1 country
• Sites: 1

Brief Summary

The management of suboptimal ovarian responders remains a challenging task in IVF. These patients are frequently managed with an intense stimulation protocol of ovarian stimulation in order obtain the maximum number of embryos and, therefore, maximize the cumulative live birth rate. However, the concept of "the more the better" has been recently defied by the one of "mild stimulation". Defenders of this protocol state that with mild stimulation only the best quality oocytes are allowed to grow and, therefore, higher quality embryos will be obtained. However, the impact of the intensity of ovarian stimulation on embryo quality is far from consensual. Moreover, its effect on early embryo development has never been evaluated. Therefore, the investigators set out to perform this randomized controlled trial comparing the number of GQB and the morphokinetic parameters of early embryo development in infertile patients undergoing two different intensities of ovarian stimulation, a milder approach (CC plus 150 IU daily dose of rFSH) and a more intense approach (300 IU daily dose of rFSH).

Conditions

Infertility

Outcome Measures

Primary Outcomes (1)

• Number of good quality blastocysts

  Until 5, 6 or 7 days after oocyte pick-up

Secondary Outcomes (31)

• Change in Progesterone values

  days 1, 6, 8, 10 and the day of ovulation triggering

• Change in Estradiol values

  days 1, 6, 8, 10 and the day of ovulation triggering

• Change in FSH Values

  days 1, 6, 8, 10 and the day of ovulation triggering

• Change in LH values

  days 1, 6, 8, 10 and the day of ovulation triggering

• Length of ovarian stimulation

  7 -20 days from initiation of ovarian stimulation

Other Outcomes (3)

• Ovarian hyperstimulation syndrome (OHSS) (percent)

  Until 15 days after the end of ovarian stimulation

• Miscarriages

  before completion of 12 weeks of gestation

• Incidence of adverse events and serious adverse events

  Until 15 days after the end of ovarian stimulation

Study Arms (2)

Experimental: Clomiphene Citrate (CC) + rFSH

EXPERIMENTAL

Ovarian Stimulation with CC+rFSH

Drug: Ovarian Stimulation with CC+rFSH

rFSH

ACTIVE COMPARATOR

Ovarian Stimulation with rFSH

Drug: Ovarian Stimulation with rFSH

Interventions

Ovarian Stimulation with CC+rFSH DRUG

: CC 50 mg/day (Omifin®) + rFSH 150 IU (Ovaleap®) GnRH antagonist: ganirelix 0.25 mg (Orgalutran®) Recombinant human chorionic gonadotropin (rhCG) 250 μg (Ovitrelle®) micronized progesterone 200 mg 3id (Utrogestan®)

Experimental: Clomiphene Citrate (CC) + rFSH

Ovarian Stimulation with rFSH DRUG

rFSH 300 IU rFSH (Ovaleap®) GnRH antagonist: ganirelix 0.25 mg (Orgalutran®) Recombinant human chorionic gonadotropin (rhCG) 250 μg (Ovitrelle®) micronized progesterone 200 mg 3id (Utrogestan®)

rFSH

Eligibility Criteria

• Age: 35 Years - 40 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Able and willing to sign the Patient Consent Form and adhere to study visitation schedule
• Antral follicle count (AFC) ≥ 5 and ≤ 10
• Anti-Mullerian hormone (AMH) ≤1.5 ng/ml (AMH result of up to one year will be valid)
• Age ≥ 35 years and ≤40 years
• BMI ≥18.5 and \<25 kg/m2

You may not qualify if:

• AFC \>10
• History of untreated autoimmune, endocrine or metabolic disorders
• Contraindication for hormonal treatment
• Preimplantation genetic diagnosis cycles
• Severe male factor (sperm concentration \<5 M/mL)
• Recent history of severe disease requiring regular treatment (clinically significant concurrent medical condition that could compromise subject safety or interfered with the trial assessment and patients with any contraindication of being pregnant).

Sponsors & Collaborators

• Fundación Santiago Dexeus Font: lead

Study Sites (1)

Salud de la Mujer Dexeus

Barcelona, 08028, Spain

Location

Related Publications (29)

• Nargund G, Fauser BC, Macklon NS, Ombelet W, Nygren K, Frydman R; Rotterdam ISMAAR Consensus Group on Terminology for Ovarian Stimulation for IVF. The ISMAAR proposal on terminology for ovarian stimulation for IVF. Hum Reprod. 2007 Nov;22(11):2801-4. doi: 10.1093/humrep/dem285. Epub 2007 Sep 12.

  PMID: 17855409 BACKGROUND

• Dickey RP, Holtkamp DE. Development, pharmacology and clinical experience with clomiphene citrate. Hum Reprod Update. 1996 Nov-Dec;2(6):483-506. doi: 10.1093/humupd/2.6.483.

  PMID: 9111183 BACKGROUND

• Bechtejew TN, Nadai MN, Nastri CO, Martins WP. Clomiphene citrate and letrozole to reduce follicle-stimulating hormone consumption during ovarian stimulation: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017 Sep;50(3):315-323. doi: 10.1002/uog.17442. Epub 2017 Aug 10.

  PMID: 28236310 BACKGROUND

• Kamath MS, Maheshwari A, Bhattacharya S, Lor KY, Gibreel A. Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation. Cochrane Database Syst Rev. 2017 Nov 2;11(11):CD008528. doi: 10.1002/14651858.CD008528.pub3.

  PMID: 29096046 BACKGROUND

• ESHRE Reproductive endocrinology guidelines group. Ovarian Stimulation for IVF / ICSI - Guideline of the European Society of Human Reproduction and Embryology. Belgium: ESHRE; 2019

  BACKGROUND

• Zhang JJ, Merhi Z, Yang M, Bodri D, Chavez-Badiola A, Repping S, van Wely M. Minimal stimulation IVF vs conventional IVF: a randomized controlled trial. Am J Obstet Gynecol. 2016 Jan;214(1):96.e1-8. doi: 10.1016/j.ajog.2015.08.009. Epub 2015 Aug 8.

  PMID: 26259908 BACKGROUND

• Verberg MF, Eijkemans MJ, Heijnen EM, Broekmans FJ, de Klerk C, Fauser BC, Macklon NS. Why do couples drop-out from IVF treatment? A prospective cohort study. Hum Reprod. 2008 Sep;23(9):2050-5. doi: 10.1093/humrep/den219. Epub 2008 Jun 10.

  PMID: 18544578 BACKGROUND

• Heijnen EM, Eijkemans MJ, De Klerk C, Polinder S, Beckers NG, Klinkert ER, Broekmans FJ, Passchier J, Te Velde ER, Macklon NS, Fauser BC. A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial. Lancet. 2007 Mar 3;369(9563):743-749. doi: 10.1016/S0140-6736(07)60360-2.

  PMID: 17336650 BACKGROUND

• Aleyamma TK, Kamath MS, Muthukumar K, Mangalaraj AM, George K. Affordable ART: a different perspective. Hum Reprod. 2011 Dec;26(12):3312-8. doi: 10.1093/humrep/der323. Epub 2011 Oct 10.

  PMID: 21987524 BACKGROUND

• Paulson RJ, Fauser BCJM, Vuong LTN, Doody K. Can we modify assisted reproductive technology practice to broaden reproductive care access? Fertil Steril. 2016 May;105(5):1138-1143. doi: 10.1016/j.fertnstert.2016.03.013. Epub 2016 Apr 4.

  PMID: 27054309 BACKGROUND

• Polyzos NP, Popovic-Todorovic B. SAY NO to mild ovarian stimulation for all poor responders: it is time to realize that not all poor responders are the same. Hum Reprod. 2020 Sep 1;35(9):1964-1971. doi: 10.1093/humrep/deaa183.

  PMID: 32830232 BACKGROUND

• van Tilborg TC, Torrance HL, Oudshoorn SC, Eijkemans MJC, Koks CAM, Verhoeve HR, Nap AW, Scheffer GJ, Manger AP, Schoot BC, Sluijmer AV, Verhoeff A, Groen H, Laven JSE, Mol BWJ, Broekmans FJM; OPTIMIST study group. Individualized versus standard FSH dosing in women starting IVF/ICSI: an RCT. Part 1: The predicted poor responder. Hum Reprod. 2017 Dec 1;32(12):2496-2505. doi: 10.1093/humrep/dex318.

  PMID: 29121326 BACKGROUND

• Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, Fauser BC, Broekmans FJ. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009 Jan-Feb;15(1):5-12. doi: 10.1093/humupd/dmn053.

  PMID: 19091754 BACKGROUND

• Matsaseng T, Kruger T, Steyn W. Mild ovarian stimulation for in vitro fertilization: are we ready to change? A meta-analysis. Gynecol Obstet Invest. 2013;76(4):233-40. doi: 10.1159/000355980. Epub 2013 Nov 2.

  PMID: 24192422 BACKGROUND

• Sterrenburg MD, Veltman-Verhulst SM, Eijkemans MJ, Hughes EG, Macklon NS, Broekmans FJ, Fauser BC. Clinical outcomes in relation to the daily dose of recombinant follicle-stimulating hormone for ovarian stimulation in in vitro fertilization in presumed normal responders younger than 39 years: a meta-analysis. Hum Reprod Update. 2011 Mar-Apr;17(2):184-96. doi: 10.1093/humupd/dmq041. Epub 2010 Sep 15.

  PMID: 20843965 BACKGROUND

• Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, Macklon NS, Fauser BC. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007 Apr;22(4):980-8. doi: 10.1093/humrep/del484. Epub 2007 Jan 4.

  PMID: 17204525 BACKGROUND

• La Marca A, Minasi MG, Sighinolfi G, Greco P, Argento C, Grisendi V, Fiorentino F, Greco E. Female age, serum antimullerian hormone level, and number of oocytes affect the rate and number of euploid blastocysts in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2017 Nov;108(5):777-783.e2. doi: 10.1016/j.fertnstert.2017.08.029. Epub 2017 Oct 4.

  PMID: 28987789 BACKGROUND

• Wu Q, Li H, Zhu Y, Jiang W, Lu J, Wei D, Yan J, Chen ZJ. Dosage of exogenous gonadotropins is not associated with blastocyst aneuploidy or live-birth rates in PGS cycles in Chinese women. Hum Reprod. 2018 Oct 1;33(10):1875-1882. doi: 10.1093/humrep/dey270.

  PMID: 30137360 BACKGROUND

• Venetis CA, Tilia L, Panlilio E, Kan A. Is more better? A higher oocyte yield is independently associated with more day-3 euploid embryos after ICSI. Hum Reprod. 2019 Jan 1;34(1):79-83. doi: 10.1093/humrep/dey342.

  PMID: 30476100 BACKGROUND

• Irani M, Canon C, Robles A, Maddy B, Gunnala V, Qin X, Zhang C, Xu K, Rosenwaks Z. No effect of ovarian stimulation and oocyte yield on euploidy and live birth rates: an analysis of 12 298 trophectoderm biopsies. Hum Reprod. 2020 May 1;35(5):1082-1089. doi: 10.1093/humrep/deaa028.

  PMID: 32348476 BACKGROUND

• Ghosh Dastidar S, Maity S, Ghosh Dastidar B. Reappraisal of IVF stimulation in good prognosis patients - a prospective randomized study to compare mild versus standard long protocol. Fertil Steril [Internet]. 2010;94(4):S28. Available from: http://dx.doi.org/10.1016/j.fertnstert.2010.07.108

  BACKGROUND

• Golan A, Weissman A. Symposium: Update on prediction and management of OHSS. A modern classification of OHSS. Reprod Biomed Online. 2009 Jul;19(1):28-32. doi: 10.1016/s1472-6483(10)60042-9.

  PMID: 19573287 BACKGROUND

• Hohmann FP, Macklon NS, Fauser BC. A randomized comparison of two ovarian stimulation protocols with gonadotropin-releasing hormone (GnRH) antagonist cotreatment for in vitro fertilization commencing recombinant follicle-stimulating hormone on cycle day 2 or 5 with the standard long GnRH agonist protocol. J Clin Endocrinol Metab. 2003 Jan;88(1):166-73. doi: 10.1210/jc.2002-020788.

  PMID: 12519847 BACKGROUND

• Datta AK, Maheshwari A, Felix N, Campbell S, Nargund G. Mild versus conventional ovarian stimulation for IVF in poor, normal and hyper-responders: a systematic review and meta-analysis. Hum Reprod Update. 2021 Feb 19;27(2):229-253. doi: 10.1093/humupd/dmaa035.

  PMID: 33146690 BACKGROUND

• Vermey BG, Chua SJ, Zafarmand MH, Wang R, Longobardi S, Cottell E, Beckers F, Mol BW, Venetis CA, D'Hooghe T. Is there an association between oocyte number and embryo quality? A systematic review and meta-analysis. Reprod Biomed Online. 2019 Nov;39(5):751-763. doi: 10.1016/j.rbmo.2019.06.013. Epub 2019 Jul 3.

  PMID: 31540848 BACKGROUND

• Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011 Jun;26(6):1270-83. doi: 10.1093/humrep/der037. Epub 2011 Apr 18.

  PMID: 21502182 BACKGROUND

• ESHRE Special Interest Group of Embryology and Alpha Scientists in Reproductive Medicine. Electronic address: coticchio.biogenesi@grupposandonato.it. The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators. Reprod Biomed Online. 2017 Nov;35(5):494-510. doi: 10.1016/j.rbmo.2017.06.015. Epub 2017 Aug 4.

  PMID: 28784335 BACKGROUND

• Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, Rienzi L, Sunde A, Schmidt L, Cooke ID, Simpson JL, van der Poel S. The International Glossary on Infertility and Fertility Care, 2017. Fertil Steril. 2017 Sep;108(3):393-406. doi: 10.1016/j.fertnstert.2017.06.005. Epub 2017 Jul 29.

  PMID: 28760517 BACKGROUND

• Montoya-Botero P, Martinez F, Rodriguez-Purata J, Rodriguez I, Coroleu B, Polyzos NP. Erratum. The effect of type of oral contraceptive pill and duration of use on fresh and cumulative live birth rates in IVF/ICSI cycles. Hum Reprod. 2021 Mar 18;36(4):1159-1161. doi: 10.1093/humrep/deaa358. No abstract available.

  PMID: 33515004 BACKGROUND

Related Links

• Department of Obstetrics, Gynaecology and Reproduction Hospital Universitari Quiron Dexeus

MeSH Terms

Conditions

Infertility

Interventions

Ovulation Induction

Condition Hierarchy (Ancestors)

Genital Diseases; Urogenital Diseases

Intervention Hierarchy (Ancestors)

Reproductive Techniques, Assisted; Reproductive Techniques; Therapeutics; Investigative Techniques

Study Officials

• Nikolaos P Polyzos, MD PhD

  Hospital Universitari Dexeus

  STUDY CHAIR

• Ana Neves, MD

  Hospital Universitari Dexeus

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 5, 2021
• First Posted: July 30, 2021
• Study Start: November 23, 2021
• Primary Completion: March 11, 2026
• Study Completion: March 11, 2026
• Last Updated: April 14, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

ES (1)