Corifollitropin Alfa and Embryo Morphokinetics

Study Overview
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Brief Summary
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The study evaluates the influence of corifollitropin alfa (Elonva) on embryo morphokinetics and fertility treatment outcome in comparison to a control group stimulated with Follitropin beta (Puregon).

Detailed Description
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Morphokinetic parameters of embryo development have been intensively investigated. However, little attention has been paid to the influence of ovarian stimulation on morphokinetic parameters. Gryshenko et al. found a significant difference in the fourth cell division time (t5) of embryos obtained after controlled ovarian hyperstimulation in long GnRH agonists and GnRH antagonist protocols. Furthermore, higher gonadotropin doses were found to slow down the development of the embryos. Hence, the aim of this study is to investigate the influence of corifollitropin alfa (Elonva) on embryo morphokinetics and fertility treatment outcome in comparison to a control group stimulated with Follitropin beta (Puregon). The investigators hypothesize that there are differences in morphokinetic behavior of embryos within the different stimulation protocols. A total of 742 embryos from 215 different patients suffering from infertility undergoing ovarian stimulation with Elonva and a total of 5148 embryos from 1136 patients undergoing ovarian stimulation with Puregon will be retrospectively analyzed. To exclude environmental factors the evaluation will distinguish between embryos cultured under 21% oxygen and embryos with reduced oxygen conditions (5% oxygen) in the embryoscope. Groups will be age and BMI matched. All women included in the study underwent GnRH (Gonadotropin-releasing hormone) antagonist protocol controlled ovarian hyperstimulation. Patients received recombinant human follicle-stimulating hormone (Elonva; MSD Sharp &Dohme GMBH, Puregon; MSD Sharp & Dohme GMBH). ELONVA was administered for 7 days with subsequent administration of Puregon (MSD Sharp & Dohme GMBH) in case of further need of stimulation. Puregon was administered for 8-10 days with dosage adaption according to age, weight, serum anti-mullerian hormone (sAMH) concentration, and hormonal status. Trans-vaginal sonography was performed after 5 days of stimulation, followed by every second day until the day of oocyte retrieval. Ultrasonographical measurement was performed using a RIC 5-9-D 4D intravaginal probe of a GE Voluson E8 BT09 ultrasound machine (both from GE Healthcare Austria GmbH). GnRH antagonist (Cetrotide, Merck KGaA) was injected to avoid premature ovulation. Triggering was initiated 35 h before oocyte retrieval, administered with 5000-10,000 IU human chorionic gonadotropin (hCG) subcutaneously (Pregnyl, N.V. Organon), with dosage adaption according to body weight of the patient. Follicles larger than 10 mm in diameter were aspirated under sedation (Propofol, Fresenius Kabi Austria GmbH; Rapifen, Janssen-Cilag Pharma GmbH) and transvaginal ultrasound guidance (GE Healthcare Austria GmbH). Follicular fluid (FF) were examined for oocytes under constant conditions of 37 °C in an IVF workstation L24E with heating stage (K-SYSTEMS Kivex Biotec A/S). Intracytoplasmic sperm injection (ICSI) was performed on all metaphase II (MII) oocytes 4-5h after oocyte retrieval according to our standard operating procedure in both groups of patients. After oocyte retrieval and fertilization, oocytes were cultivated in universal culture medium (Gynemed Medizinprodukte GmbH & Co. KG, Germany). After 14-16 h, fertilization check was performed. All normal fertilized embryos with two pronuclei (PN) were then cultured using Embryoslide dishes in Embryoscope® time-lapse incubator (both Vitrolife AB, Sweden). With the built-in camera and microscope, images of the developing embryo were taken every 15 min in seven different layers. Definition of morphokinetic parameters was performed according to the criteria proposed by Ciray et al. and was analyzed with software developed for time-lapse image analysis (Embryoviewer® software; Vitrolife AB, Sweden).

Official Title
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Influence of Corifollitropin Alfa (Elonva) on Embryo Morphokinetics and Fertility Treatment Outcome

Conditions
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Infertility

Intervention / Treatment
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* Drug: ELONVA
* Drug: PUREGON


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: 18-42 BMI: 19-29.9 Primary or secondary infertility Ovarian stimulation with Elonva/Puregon Embryos cultured in embryoscope Exclusion Criteria: unexpected low response genetic testing

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 42 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ELONVA<br>Patients stimulated with Elonva | Drug: ELONVA<br>* Elonva is a solution for injection that contains the active substance corifollitropin alfa. It is available as a pre-filled syringe (100 and 150 micrograms).Elonva is used in women who are undergoing fertility treatment to stimulate the development of more than one mature egg at a time in the ovaries.<br>|
| PUREGON<br>Patients stimulated with Puregon | Drug: PUREGON<br>* Puregon contains the active substance follitropin beta. fertilisation). Puregon is administered to stimulate the ovaries to produce more than one egg at a time<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of pronuclei disappearance | Time of pronuclei disappearance in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 16-18 hours after fertilization | 
| Two discrete cells | The first observation of two discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 26-28 hours after fertilization | 
| Three discrete cells | The first observation of three discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 28-44 hours after fertilization | 
| Four discrete cells | The first observation of four discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 44-45 hours after fertilization | 
| Five discrete cells | The first observation of five discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 44-68 hours after fertilization | 
| Six discrete cells | The first observation of six discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 44-68 hours after fertilization | 
| Seven discrete cells | The first observation of seven discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 44-68 hours after fertilization | 
| Eight discrete cells | The first observation of eight discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 68-69 hours after fertilization | 
| Nine discrete cells | The first observation of nine discrete cells in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 69-92 hours after fertilization | 
| Morula stage | End of the compaction process; when observable compaction is complete in embryos of patients stimulated with ELONVA versus embryos of patients stimulated with PUREGON | 92 hours after fertilization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of oocytes retrieved | The influence of ELONVA versus PUREGON on the number of oocytes retrieved will be assessed. | Number of oocytes retrieved will be evaluated after one treatment cycle (each cycle is between 28 and 35 days) | 
| Stage of oocyte development | The influence of ELONVA versus PUREGON on the maturity stage of oocytes (germinal vesicle, metaphase I (MI) or MII phase) retrieved will be assessed. | Stage of oocytes retrieved will be evaluated after one treatment cycle (each cycle is between 28 and 35 days) | 
| Fertilized oocytes | The influence of ELONVA versus PUREGON on the number of fertilized oocytes will be assessed. | Number of fertilized oocytes will be evaluated after one treatment cycle (each cycle is between 28 and 35 days) | 
| Embryo grading | The influence of ELONVA versus PUREGON on embryo grading (Istanbul consensus criteria) will be assessed. The grading consists of assessment of cell number, fragmentation, multinucleation, cell size, cytoplasmic granularity, membrane appearance, and the presence of vacuoles). | The quality of embryos will be evaluated after one treatment cycle (each cycle is between 28 and 35 days) | 
| Biochemical pregnancy (measurement of beta hCG) | The influence of Elonva versus Puregon on the number of biochemical pregnancies will be assessed. | Biochemical pregnancies will be evaluated after successful implantation (1 week after embryo transfer) | 
| Life birth | The influence of Elonva versus Puregon on the number of life births will be assessed. | Life births will be evaluated after successful pregnancy (9 moths after embryo transfer) | 
| Weight (kilograms) | The influence of Elonva versus Puregon on the weight of the newborn will be assessed. | Weight of the newborn will be evaluated after birth (9 moths after embryo transfer) | 
| Height (centimeters) | The influence of Elonva versus Puregon on the height of the newborn will be assessed. | Height of the newborn will be evaluated after birth (9 moths after embryo transfer) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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follicle-stimulating hormone, embryo morphokinetics, reproductive medicine