IVF/ICSI Protocols in Poor Responders With Growth Hormone

Study Overview
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Brief Summary
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in this study, we are trying to monitor the effect of the addition of growth hormone on the different down regulation protocols ( long, short, antagonist and microflare). The outcome will be primarily assessed by the clinical pregnancy rates.

Detailed Description
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Poor responders undergoing IVF/ICSI cycles have emerged as a major problem. the need to find a proper stimulation protocol is a must. in this study we are trying to detect the best stimulation protocol ,in addition to growth hormone ,that can give the highest pregnancy rates in these patients.

Official Title
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Which is the Best IVF/ICSI Protocol to be Used in Poor Responders Receiving Growth Hormone as an Adjuvant Treatment ? A Prospective Randomized Study

Conditions
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Female Infertility Due to Diminished Ovarian Reserve

Intervention / Treatment
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* Drug: Growth hormone (Norditropin, Novo nordisk)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ESHRE consensus 2011,At least two of the following three features must be present: Advanced maternal age (≥40 years) or any other risk factor for POR; A previous POR (≤3 oocytes with a conventional stimulation protocol); An abnormal ovarian reserve test (i.e. AFC < 5-7 follicles or AMH < 0.5 -1.1 ng/ml). Exclusion Criteria: female patients with causes of infertility other than poor ovarian reserve females suffering from congenital or acquired uterine anomalies females with focal uterine lesions females who had previous ovarian surgeries females with history of previous exposure to radiotherapy , or chemotherapy females refusing to get enrolled in the study

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: The Long protocol<br>Patients in the group A received a long protocol of pituitary down-regulation with triptorelin (Decapeptyl; Ferring, Switzerland) which started on day 21 of preceding cycle at a dose of 0.1 mg/day. On the second day of menstruation HMG was started and this was associated with reduction of triptorelin to 0.05 mg/day. This reduced daily dose was administered until the day hCG was given. Growth hormone co-treatment was administrated on day 6 of HMG stimulation daily in a dose of 2.5 mg S.C. till the day of hCG administration. | Drug: Growth hormone (Norditropin, Novo nordisk)<br> <br> |
| Experimental: The Short protocol<br>The short agonist protocol was started on cycle day 1 with triptorelin (Decapeptyl Ferring Pharmaceuticals, Germany) 0.05 mg/day S.C. Human menopausal gonadotropin IM daily (HMG 75 IU, Merional, IBSA) were also administered starting from days 2 to 3 of cycle. The dose was adjusted for each patient according to the diameter of the follicles detected in their follow up ultrasound. Growth hormone (Norditropin, Novo nordisk) was administrated on day 6 of HMG stimulation daily in a dose of 2.5 mg S.C. till the day of hCG administration. | Drug: Growth hormone (Norditropin, Novo nordisk)<br> <br> |
| Experimental: The Antagonist protocol<br>Gonadotrophins IM daily (HMG 75 IU, Merional, IBSA)was administrated from day 2 of the cycle. Growth hormone (Norditropin, Novo nordisk) was administrated on day 6 of HMG stimulation daily in a dose of 2.5 mg S.C. till the day of hCG administration. The GnRH antagonist (Cetrotide) was given when the leading follicle was from 12 to 14 mm, at a daily dose of 0.25 mg SC. | Drug: Growth hormone (Norditropin, Novo nordisk)<br> <br> |
| Experimental: The Microflare protocol<br>the patients in this group were given oral contraceptive pills (OCPs) for 28 days, this was followed by 2 days free. Triptorelin (Decapeptyl Ferring Pharmaceuticals, Germany) 0.05 mg/day S.C. was then started daily followed by human menopausal gonadotropin IM daily (HMG 75 IU, Merional, IBSA) 3 days later. Growth hormone (Norditropin, Novo nordisk) was administrated on day 6 of HMG stimulation daily in a dose of 2.5 mg S.C. till the day of hCG administration. | Drug: Growth hormone (Norditropin, Novo nordisk)<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numbers of oocytes retrieved and number of fertilized oocytes | Number of oocytes retrieved on the day of vaginal egg collection guided by trans vaginal ultrasound scan , 35 hours after hCG administration. | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Poor Ovarian Response, Poor Responders, IVF/ICSI, Growth Hormone