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Trial registered on ANZCTR
Registration number
ACTRN12617001016325
Ethics application status
Approved
Date submitted
9/07/2017
Date registered
14/07/2017
Date last updated
24/10/2019
Date data sharing statement initially provided
27/02/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Pregnancy outcomes when adding a progesterone pessary dose amongst women who are receiving frozen embryo transfer with hormone replacement therapy, compared with placebo.
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Scientific title
Prospective randomised trial of change of progesterone dosage in HRT FETs with low serum progesterone concentrations after 2 days of progesterone pessary treatment
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Secondary ID [1]
292392
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Infertility
303957
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Condition category
Condition code
Reproductive Health and Childbirth
303312
303312
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0
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Fertility including in vitro fertilisation
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Participants will be randomised to receive either an extra progesterone 400mg pessary or a placebo pessary for 12 weeks. For patients on a twice daily dose this study pessary will be used at midday. Those on a thrice daily dose will use the extra study pessary in the late evening. This aims to leave unchanged the timing of initial active pessaries for patients where a placebo pessary is added, so that there is no change to the background dosing. We do not intend to monitor compliance of participants with the allocated intervention. Participation will be viewed on an ‘intention to treat’ analysis.
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Intervention code [1]
298565
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Treatment: Drugs
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Comparator / control treatment
Treatment arm: progesterone pessary 400mg dose daily for 12 weeks
Control arm: placebo pessary daily for 12 weeks
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Live birth rate
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Assessment method [1]
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Timepoint [1]
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At time of birth
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Secondary outcome [1]
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Clinical pregnancy levels at 16 days of treatment. This will be measured by serum hCG level.
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Assessment method [1]
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Timepoint [1]
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Day 16 of treatment
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Secondary outcome [2]
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Serum progesterone levels at Day 2 and Day 16 of treatment
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Assessment method [2]
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Timepoint [2]
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Day 2 and Day 16 of treatment
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Eligibility
Key inclusion criteria
1. Is a female receiving single embryo FET with HRT at Monash IVF
2. Is between the age of 18 and 45 years
3. Has provided informed consent
4. Speaks sufficient English to provide informed consent
5. Has been prescribed an initial progesterone pessary dose of 400mg bd or tds and is obtaining these pessaries from Slade pharmacy
6. Low serum progesterone levels at Day 2 of progesterone treatment (<50nmol/L)
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Minimum age
18
Years
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Maximum age
45
Years
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Sex
Females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
• Already completed an HRT FET cycle in this study
• Planned double embryo transfer.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
2 sets of sealed envelopes will be held by trial coordinator. The envelopes will be opened consecutively as each new patientis enrolled in the study (ie provides consent and then has Day 2 progesterone <50 nmol/L). Trial coordinator will then communicate the assignment (green vs orange) to the patient and pharmacy.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Consecutive randomisation (as above).
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Sample size – this has been calculated based on Monash IVF data (live birth rate if P4<50 nmol/L of 11.3% vs 26.4% if >50nmonl/L). For power of 80 and alpha of 0.05, requires 152 patients in each group.
For comparison of proportions Chi square testing will be used. Continuous variables will be compared using Mann Whitney U testing. Repeated measures ANOVA or linear mixed modelling will be used for comparison of repeated measures.
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Recruitment
Recruitment status
Withdrawn
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Reason for early stopping/withdrawal
Participant recruitment difficulties
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Date of first participant enrolment
Anticipated
1/01/2019
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
304
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Monash IVF - Clayton - Clayton
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Recruitment hospital [2]
8505
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Epworth Richmond - Richmond
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Recruitment hospital [3]
8506
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Western Day Surgery - St Albans
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Recruitment postcode(s) [1]
16597
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3168 - Clayton
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Recruitment postcode(s) [2]
16598
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3121 - Richmond
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Recruitment postcode(s) [3]
16599
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3021 - St Albans
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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Monash IVF Pty Ltd
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Address [1]
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Epworth Hospital Richmond, Level 7, 89 Bridge Road, Richmond VIC 3121
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Country [1]
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Australia
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Primary sponsor type
Commercial sector/Industry
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Name
Monash IVF Pty Ltd
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Address
Epworth Hospital Richmond, Level 7, 89 Bridge Road, Richmond VIC 3121
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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N/A
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Address [1]
295951
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N/A
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Country [1]
295951
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
298152
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Monash Health
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Ethics committee address [1]
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246 Clayton Road Clayton VIC 3168
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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23/03/2017
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Approval date [1]
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22/02/2019
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Ethics approval number [1]
298152
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Summary
Brief summary
FETs using HRT stimulation occur with no corpus luteum. This means endometrial growth, maturation and maintenance is entirely dependent on the effect of HRT for at least the first 2-5 weeks post-transfer. By 10 weeks post-transfer the placenta is producing adequate hormone to support the endometrium. Although intramuscular progesterone treatment is popular in North America, in Australia and Europe vaginal preparations are preferred. Natural and HRT FET cycles have been compared and show equivalent live birth rates on meta-analysis. The local experience at Monash IVF is different, with a significantly lower live birth rate for HRT compared to natural FETs (14.5% vs 22.4% - OR 0.59 (0.55-0.62)) for all comers. This difference is maintained when 20 potential confounding factors are allowed for using logistic regression (patient age; number of embryos transferred, embryo maturity etc) with an adjusted odds ratio of 0.55 (0.48-0.64). A recent publication from Yovich (2015) showed a significantly higher live birth rate in women undergoing HRT FETs, where the mid-luteal phase serum progesterone was >50 nmol/L. Review of the Monash IVF dataset investigating serum progesterone concentrations after 14-18 days of treatment in HRT FETs confirmed a significantly higher live birth rate (26.4% vs 11.3%). A shortcoming of measuring progesterone both at mid-luteal and Day 14-18, is that the opportunity to change management and improve outcome has potentially already passed. A further retrospective review of Monash IVF HRT FET cycles investigating progesterone dosage, Day 14-18 serum progesterone and live birth rates, suggested that dose frequency may be as important of actual dosage. This study aims to investigate “at risk” women with low serum progesterone (<50 nmol/L), but measure this after 2 days of treatment and then assess the effect of adding an extra dose of progesterone each day upon the live birth rate.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Martin Healey
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Address
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Monash IVF Pty Ltd, 7/89 Bridge Rd, Richmond VIC 3121
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Country
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Australia
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Phone
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+6139429 9188
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Samantha Ter
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Address
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Monash IVF Pty Ltd, 7/89 Bridge Rd, Richmond VIC 3121
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Country
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Australia
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Phone
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+61394208245
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Surabhi Basnayake
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Address
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Monash Health
246 Clayton Road
Clayton
VIC 3168
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Country
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Australia
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Phone
76156
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+61395946666
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Fax
76156
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Email
76156
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Privacy
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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