Pre-IVF Treatment With a GnRH Antagonist in Women With endometriosis_temp

Recruitment Status
RECRUITING
(See Contacts and Locations)Verified June 2025 by Yale University
Sponsor
Yale University
Information Provided by (Responsible Party)
Heping Zhang
Clinicaltrials.gov Identifier
NCT06375811
Other Study ID Numbers:
2000027121_a
First Submitted
April 15, 2024
First Posted
April 18, 2024
Last Update Posted
July 23, 2025
Last Verified
June 2025

ClinicalTrials.gov processed this data on July 2025. Link to the current ClinicalTrials.gov record .

History of Changes

Study Details

Study Description

Infertility is a common complication of endometriosis; while IVF successfully treats endometriosis-associated infertility, pregnancy rates are diminished compared to other etiologies of infertility. The study's long- term objectives are to better identify and treat endometriosis related infertility. The investigators' central hypothesis is that in infertile woman with endometriosis undergoing in vitro fertilization-embryo transfer (IVF-ET), live birth rates will improve in those pretreated with GnRH antagonist compared to those not pretreated with GnRH antagonist. The use of gonadotropin releasing hormone (GnRH) agonist prior to IVF has been suggested to improve success, however studies have been small and rarely reported live birth rates. Further, use of this approach is limited by the long treatment time required. Recent approval of an oral GnRH antagonist for endometriosis provides a novel option for women with endometriosis who are undergoing IVF. This agent avoids parenteral administration and the prolonged delay in initiation of action as was seen with GnRH agonists. There have been no studies on the efficacy of GnRH antagonists for the treatment of endometriosis-related infertility. The investigators propose a clinical trial of oral GnRH antagonist pre-treatment for women with endometriosis who are undergoing IVF, with a primary outcome of live birth rate. Participants will include those who agree to be randomized and those who do not want to be randomized. Those who agree to be randomized will be randomly assigned to either the elagolix group or placebo group. Those who do not want to be randomized can choose either the active treatment elagolix and follow the same procedures as those agreeing to be randomized or continue their ongoing or planned IVF and follow standard of care (SOC) (SOC IVF) if they do not want to delay the IVF procedure.

Condition or DiseaseIntervention/Treatment
InfertilityEndometriosis
Drug: Elagolix 200 MGOther: Placebo or SOC IVF

Study Design

Study TypeInterventional
Actual Enrollment297 participants
Design AllocationRandomized
Interventional ModelParallel Assignment
MaskingTriple
Primary PurposeTreatment
Official TitlePre-IVF Treatment With a GnRH Antagonist in Women With Endometriosis - A Prospective Clinical Trial
Study Start DateMarch 15, 2024
Actual Primary Completion Date1mo 2w from now
Actual Study Completion Date4mos 2w from now

Groups and Cohorts

Group/CohortIntervention/Treatment
Pre-IVF Treatment with 60 day course of oral GnRH antagonist
For those who agree to be randomized, subjects will be randomized to elagolix 200mg BID. The medication will be taken orally and subjects will be counseled to take the medication at the same time each day. This arm will also include participants who do not want to be randomized while choose elagolix.
Drug: Elagolix 200 MG
Elagolix tablet
Pre-IVF Treatment with 60 day course of Placebo or SOC IVF
For those who agree to be randomized, subjects will be randomized to placebo, BID. The medication will be taken orally and subjects will be counseled to take the medication at the same time each day. This arm will also include participants who want to continue their ongoing or planned IVF and follow standard of care (SOC) (SOC IVF) if the participants do not want to delay the IVF procedure.
Other: Placebo or SOC IVF
Sugar pill manufactured to mimic Elagolix 200mg

Outcome Measures

Primary Outcome Measures
  1. Live birth rate
    Live birth rate per participant is defined as live birth at ≥24 weeks of gestation.
Secondary Outcome Measures
  1. Fertilization rate
    Fertilization rate per participant is defined as the rate of \[two pronuclei (2PN)\]/\[total number of oocytes injected or inseminated\]
  2. Number of embryos transferred
    Number of embryos transferred per participant
  3. Implantation rate
    Implantation rate per participant is defined as the rate of (number of gestation sacs visible by Ultrasound) / (Number of Embryo Transfer),
  4. Biochemical pregnancy rate
    Biochemical pregnancy rate per participant is defined as positive pregnancy test following embryo transfer
  5. Clinical pregnancy rate
    Clinical pregnancy rate per participant is defined as ultrasound evidence of intrauterine gestational sac with fetal cardiac activity
  6. Miscarriage rate
    Miscarriage rate among those who achieved pregnancy. Miscarriage is defined as pregnancy loss prior to viability scan and including those confirmed on ultrasound scan up to ≤23+6 weeks of gestation gestation.
  7. Overall pregnancy complication rate
    Overall pregnancy complication rate among those who achieved pregnancy. Overall pregnancy complication including any of the following: preterm delivery, preeclampsia, incidence of abnormal placentation (placenta previa, accreta, increta, percreta, abruption), bleeding in pregnancy (antepartum or postpartum)
  8. Gestation age at delivery
    Gestation age (weeks) at delivery per infant delivered
  9. Infant birth weight
    Infant birth weight (gram) per infant delivered.

Eligibility Criteria

Ages Eligible for Study(Adult)
Sexes Eligible for StudyFemale
Accepts Healthy VolunteersNo
Inclusion Criteria
1. Women who plan to undergo IVF for treatment of infertility. 2. Age ≥18 and \<40 years at time of egg retrieval or signing informed consent. 3. Documentation of diagnosis of endometriosis by surgical visualization of endometriosis (laparoscopy or laparotomy) or diagnosis by pathology within the last 10 years before the initial trial entry visit or documentation of ovarian endometrioma \>2 cm or two or more smaller endometriomas that total \>2 cm in diameter. If entry is based on the presence of an endometrioma, transvaginal ultrasound evaluation must document the same unambiguous endometrioma on two separate occasions in more than one menstrual cycle. Images will be printed or transmitted electronically and read centrally by investigators at Yale to assure uniform diagnostic criteria (classic ground glass appearance) are applied. 4. Body mass index (BMI) of 18-40 kg/m2 (both inclusive) at screening. 5. AMH \> 0.5ng/ml, within 12 months of a fresh IVF cycle start. For frozen embryo transfers (FET) , AMH level eligibility criteria may not be met as long as the patient has at least one good quality blastocyst stored for the FET. 6. No known uterine cavity abnormalities at time of screening. Uterine cavity assessment by sonohysterogram or hysteroscopy within 12 months of embryo transfer indicating absence of focal intracavitary pathology and hence establishing adequate cavity at the time of embryo transfer. Ultrasound or MRI features suggestive of adenomyosis will be acceptable for inclusion. Type 3 fibroids are allowed up to 4cm size. 7. Presence of at least one ovary with no clinically significant abnormalities other than endometrioma. For eligible women with evidence of a hemorrhagic ovarian cyst, a repeat US will be needed in a subsequent menstrual cycle to ensure persistent cyst for patient to be deemed eligible. 8. Negative urine or cervical swab for gonorrhea and chlamydia within 12 months of screening. 9. Willing and able to comply with trial procedures, including reporting of obstetrical outcomes after delivery.
Exclusion Criteria
1. Use of depot GnRH agonists within 6 months of study start. Use of subcutaneous antagonists or nasal agonist within 2 months of study start unless part of regular IVF or previous IUI cycle°. 2. Use of depot medroxyprogesterone acetate (MPA) (injectable) or birth control implants (e.g., Implanon® or Nexplanon®) within 6 months of study start°. 3. Continuous use of oral progestins (MPA, NETA) within 1 month of study start°. 4. Use of aromatase inhibitors, danazol or hormonal contraceptives (Including combined oral contraceptive pill, progestin-only pill, transdermal patch or contraceptive ring, or double barrier contraception) within 1 month of study start. 5. Pregnancy greater than 8 weeks in length within the last 6 months. 6. Number of previous IVF/ICSI attempts ≥3 unsuccessful (negative pregnancy test). 7. Presence of hydrosalpinx measuring \>2cm on ultrasound, untreated endometrial polyps or intrauterine adhesions. 8. Abnormal cytology on a cervical screening based on the American College of Obstetricians and Gynecologists (ACOG) guidelines and patient age. (CIN1 or HPV allowed to participate in the study, CIN2 excluded unless treated and cleared, CIN3 excluded). 9. History of malignancy within 5 years of the start of screening, except for treated basal cell carcinoma and squamous cell carcinoma of the skin. 10. Any thoughts of suicide in the last 12 months per self-report, or documented in the electronic medical record (EMR). 11. Hypersensitivity to the study drugs. 12. Planned surgical treatment of endometriosis or planned surgery in the abdominal-pelvic area within the duration of the trial. 13. Untreated abnormal prolactin or TSH 14. Any conditions that preclude pregnancy. 15. Patients with a known history of a low-trauma fracture or other risk factors for osteoporosis or bone loss. 16. Patients with cirrhosis or abnormal LFTs per self report or documented in the electronic medical record (EMR).
Exclusion criteria number 1,2, and 3 are not required to be met by individuals in the standard of care arm of the study. The study team will collect the information regarding whether the subject has used these drugs in the aforementioned time frame using the concomitant medication log and the individual will be allowed to participate in the study under the standard of care arm only.

Contacts and Locations

Sponsors and CollaboratorsYale University
Locations
University of Colorado Department of Obstetrics & Gynecology | Aurora Colorado, United States, 80045Yale School of Medicine Dept.of Ob/Gyn & Reproductive Sciences | New Haven Connecticut, United States, 06520Northwestern University Department of Obstetrics and Gynecology | Chicago Illinois, United States, 60611Johns Hopkins, Division of Reproductive Science and Women's Health Research | Baltimore Maryland, United States, 21205Duke Fertility | Morrisville North Carolina, United States, 27560
Investigators
Principal Investigator: Hugh Taylor, MD, Yale UniversityStudy Director: Heping Zhang, PhD, Yale UniversityStudy Director: Nanette Santoro, MD, University of Colorado, DenverStudy Director: Emily Jungheim, MD, Northwestern UniversityStudy Director: Steven Young, MD, PhD, Duke UniversityStudy Director: Jim Segars, MD, Johns Hopkins University