Polycystic Ovary Syndrome, Infertility
Conditions
Keywords
PCOS, Polycystic ovary syndrome, Infertility, Anovulation, Clomiphene citrate, Clomid, Progestin, Provera, Progesterone, Endometrial shedding
Brief summary
Progestin-induced endometrial shedding (PIES) followed by clomiphene citrate is fertility treatment of choice in anovulatory women with polycystic ovary syndrome (PCOS). However, some preliminary data suggest that skipping PIES could result in a higher live birth rate. The investigators are performing the first randomized controlled trial to find out if skipping the use of progestin during fertility treatment of anovulatory PCOS women is associated with improved pregnancy and live birth rates compared to the traditional approach of using progestin prior to use of clomiphene citrate.
Detailed description
This is a prospective randomized trial of clomiphene citrate (CC) preceded by progestin-induced endometrial shedding (PIES) vs CC without PIES in the treatment of infertility in patients with PCOS, for up to 5 treatment cycles. Participants will be randomized to receive either progestin followed by CC starting on day 3 of the induced menses, or CC without induced menses. Study participants will be monitored at regular 2 to 4 wks intervals for response to medication using ultrasound and hormonal parameters. The maximum dose of CC will not exceed 750 mg/cycle. Treatment will not exceed 5 ovulatory cycles. Participants who are resistant to 150 mg of CC will exit the study. 170 anovulatory PCOS women actively seeking pregnancy, aged 18 through 40 years will be enrolled and randomized in a 1:1 treatment ratio into the two study arms. Anovulation will be the only infertility factor in all patients.
Interventions
DRUGProgestin
DRUGClomiphene Citrate
Sponsors
University of Illinois at Chicago
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
Inclusion * Women aged 18 - 40, desiring pregnancy * Established diagnosis of PCOS confirmed by the Rotterdam criteria * Oligo or anovulatory, with menstrual cycles \> 35 days apart or less than 9 menstrual cycles per year * Normal vaginal ultrasound with endometrial stripe \< 12 mm * Normal thyroid stimulating hormone (TSH) within past one year * Normal prolactin (PRL) within past one year * For women with previous successful Clomid treatment, a washout period of at least 2 months is required Exclusion * Regular menstrual cycles occurring less than 35 days apart * Evidence of other infertility factors such as endometriosis, tubal factor or male infertility * Prior unsuccessful Clomiphene citrate ovulation cycles * Abnormal vaginal ultrasound findings such as endometrial polyps, submucous myomas, synechiae * Uterine anomaly such as unicornuate or bicornuate uterus * Presence of hydrosalpinx * Evidence of active endocrinopathy, such as thyroid disorder or hyperprolactinemia * Partner with abnormal semen analysis (count \< 15 million sperm /ml)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Live Birth | Within 36 weeks of a positive pregnancy test | Delivery of a viable infant after 24 weeks of pregnancy |
Countries
United States
Participant flow
Pre-assignment details
The study was terminated and data cannot be retrieved as the software where data has been stored has been upgraded. We have exhausted efforts to retrieve the data from this software and no study data are available.
Participants by arm
| Arm | Count |
|---|---|
| Group A (No PIES) Subjects randomized to this group will receive clomiphene citrate (CC) without using progestin throughout their treatment course.
* CC 50 mg oral for 5 days (Days 3-7)
* If no ovulation, CC 100 mg for 5 days (Days 12-16)
* If no ovulation, CC 150 mg for 5 days (Day 21-25)
* Exit study if no response to 150 mg CC, or if no pregnancy after 5 ovulatory cycles
Clomiphene Citrate | 0 |
| Group B (PIES Group) Women randomized to this group will receive progestin to induce endometrial shedding before starting any doses of clomiphene citrate (CC)
* Progestin 10 mg oral for 10 days to induce endometrial shedding (PIES)
* CC 50 mg oral for 5 days (Day 3-7)
* If no ovulation, progestin 10 mg for 10 days to induce endometrial shedding (starting on CD28) and CC 100 mg x 5 days, starting on day 3 of induced menses
* If no ovulation, progestin 10 mg for 10 days to induce endometrial shedding, and CC 150 mg for 5 days
* Exit study if no response to 150 mg CC, or if no pregnancy after 5 ovulatory cycles
Progestin
Clomiphene Citrate | 0 |
| Total | 0 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Live Birth
Delivery of a viable infant after 24 weeks of pregnancy
Time frame: Within 36 weeks of a positive pregnancy test
Population: The study was terminated and data cannot be retrieved as the software where data has been stored has been upgraded. We have exhausted efforts to retrieve the data from this software and no study data are available.