Idiopathic Hypogonadotropic Hypogonadism, Luteal Phase Deficiency, Luteal Phase Support
Conditions
Keywords
Luteal phase deficiency, Idiopathic hypogonadotropic hypogonadism
Brief summary
Luteal phase deficiency (LPD) accounts for most failures of assistant artificial reproduction (ART) and early pregnancy loss for patients with idiopathic hypogonadotropic hypogonadism (IHH). Luteal phase support (LPS) is one of the indispensable interventions in ART treatments for IHH patients, which includes progestin, estrogen, human chorionic gonadotropin (hCG), and GnRH agonists (GnRHa). We aim to verify additional hCG injection 48 hours following routine hCG trigger and ovulation for LPS on the basis of supplementation of estrogen and dydrogesterone could improve clinical pregnancy rate, cumulative pregnancy rate, live birth rate and the prevalence of early pregnancy loss and ovarian hyperstimulation syndrome (OHSS) by an open labeled, prospective, and randomized clinical trial (RCT) in IHH patients in a single center.
Detailed description
Idiopathic hypogonadotropic hypogonadism (IHH) is a congenital disease caused by a variety of gene variants leading to dysfunction in the secretion of hypothalamic gonadotropin-releasing hormones (GnRHs), with a prevalence of 1:125 000 in females. Girls with IHH often suffer from lack of puberty onset, amenorrhea and infertility, complicated with psychological problems such as depression and anxiety, due to delayed diagnosis and inappropriate treatment. Luteal phase deficiency (LPD) accounts for most failures of assistant artificial reproduction (ART) and early pregnancy loss for IHH patients. We have reported a severe LPD during the early trimester in a case with secondary HH following craniopharyngioma resection and speculated similar LPD happen in IHH patients complicated with low clinical pregnancy rate and live birth rate. Therefore, luteal phase support (LPS) is one of the indispensable interventions in ART treatments for IHH patients, which includes progestin, estrogen, human chorionic gonadotropin (hCG), and GnRH agonists (GnRHa). We aim to verify additional hCG injection 48 hours following routine hCG trigger and ovulation for LPS on the basis of supplementation of estrogen and dydrogesterone could improve clinical pregnancy rate, cumulative pregnancy rate, live birth rate and the prevalence of early pregnancy loss and ovarian hyperstimulation syndrome (OHSS) by an open labeled, prospective, and randomized clinical trial (RCT) in IHH patients in a single center of the Obstetrics and Gynecology Hospital Affiliated to Fudan University. The onset of patients' mental and psychological diseases such as depression and anxiety rely on their reproductive needs and pregnancy outcomes, which will also be investigated in the current study. Moreover, the effect of clinical interventions to improve pregnancy outcomes and emotional disorders would be discussed.
Interventions
DRUGAdditional hCG injection
An additional hCG injection of 2000-5000IU would be given 48 hours following routine hCG trigger and ovulation for LPS on the basis of supplementation of estrogen and dydrogesterone.
DRUGestrogen and dydrogesterone
estrogen and dydrogesterone
Sponsors
Fudan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
In the current study, none of patients, investigators and designers is marked.
Intervention model description
We have two cohorts in the current study and patients are randomly assigned to either cohort of additional hCG injection or not.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Clinical diagnosis of IHH (primary amenorrhea (with or without a history of hormone supplementation therapy); basic LH levels \<5IU/L, FSH\<5IU/L or normal; no organic lesions in the hypothalamus and pituitary MRI). * Women of childbearing age who desire to get pregnant
Exclusion criteria
* Premature ovarian insufficiency or premature ovarian failure * Primary amenorrhea due to hypothalamic/pituitary lesions * Secondary amenorrhea
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical pregnancy rate | 7 weeks | Defined as the presence of a gestational sac under ultrasonography |
| Cumulative pregnancy rate | 12 weeks | Defined as a pregnancy with a detectable heart rate at 12 weeks of gestation or beyond. |
| Live birth rate | 42 weeks or beyond | Defined as the number of deliveries that resulted in a live born neonate, expressed per 100 pregnancies. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of IHH patients ending in early pregnancy loss | 12 weeks | Early pregnancy loss is defined as the loss of a pregnancy prior to 12 weeks gestation |
| Number of IHH patients with ovarian hyperstimulation syndrome | 12 weeks or beyond | Ovarian hyperstimulation syndrome is defined as an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Serum progesterone levels on Day 1, 7, and 14 after ovulation | 7 weeks | Serum progesterone levels is a symbol of luteal function |
Countries
China
Contacts
Primary ContactHexia Xia, M.D.
Backup ContactWei Zhang, Ph.D.,M.D.
Outcome results
None listed