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Abbara A, Clarke S, Islam R, Prague JK, Comninos AN, Narayanaswamy S, Papadopoulou D, Roberts R, Izzi-Engbeaya C, Ratnasabapathy R, Nesbitt A, Vimalesvaran S, Salim R, Lavery SA, Bloom SR, Huson L, Trew GH, Dhillo WS. A second dose of kisspeptin-54 improves oocyte maturation in women at high risk of ovarian hyperstimulation syndrome: a Phase 2 randomized controlled trial. Hum Reprod 2017; 32:1915-1924. [PMID: 28854728 PMCID: PMC5850304 DOI: 10.1093/humrep/dex253] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/15/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Can increasing the duration of LH-exposure with a second dose of kisspeptin-54 improve oocyte maturation in women at high risk of ovarian hyperstimulation syndrome (OHSS)? SUMMARY ANSWER A second dose of kisspeptin-54 at 10 h following the first improves oocyte yield in women at high risk of OHSS. WHAT IS KNOWN ALREADY Kisspeptin acts at the hypothalamus to stimulate the release of an endogenous pool of GnRH from the hypothalamus. We have previously reported that a single dose of kisspeptin-54 results in an LH-surge of ~12-14 h duration, which safely triggers oocyte maturation in women at high risk of OHSS. STUDY DESIGN, SIZE, DURATION Phase-2 randomized placebo-controlled trial of 62 women at high risk of OHSS recruited between August 2015 and May 2016. Following controlled ovarian stimulation, all patients (n = 62) received a subcutaneous injection of kisspeptin-54 (9.6 nmol/kg) 36 h prior to oocyte retrieval. Patients were randomized 1:1 to receive either a second dose of kisspeptin-54 (D; Double, n = 31), or saline (S; Single, n = 31) 10 h thereafter. Patients, embryologists, and IVF clinicians remained blinded to the dosing allocation. PARTICIPANTS/MATERIALS, SETTING, METHODS Study participants: Sixty-two women aged 18-34 years at high risk of OHSS (antral follicle count ≥23 or anti-Mullerian hormone level ≥40 pmol/L). Setting: Single centre study carried out at Hammersmith Hospital IVF unit, London, UK. Primary outcome: Proportion of patients achieving an oocyte yield (percentage of mature oocytes retrieved from follicles ≥14 mm on morning of first kisspeptin-54 trigger administration) of at least 60%. Secondary outcomes: Reproductive hormone levels, implantation rate and OHSS occurrence. MAIN RESULTS AND THE ROLE OF CHANCE A second dose of kisspeptin-54 at 10 h following the first induced further LH-secretion at 4 h after administration. A higher proportion of patients achieved an oocyte yield ≥60% following a second dose of kisspeptin-54 (Single: 14/31, 45%, Double: 21/31, 71%; absolute difference +26%, CI 2-50%, P = 0.042). Patients receiving two doses of kisspeptin-54 had a variable LH-response following the second kisspeptin dose, which appeared to be dependent on the LH-response following the first kisspeptin injection. Patients who had a lower LH-rise following the first dose of kisspeptin had a more substantial 'rescue' LH-response following the second dose of kisspeptin. The variable LH-response following the second dose of kisspeptin resulted in a greater proportion of patients achieving an oocyte yield ≥60%, but without also increasing the frequency of ovarian over-response and moderate OHSS (Single: 1/31, 3.2%, Double: 0/31, 0%). LIMITATIONS, REASONS FOR CAUTION Further studies are warranted to directly compare kisspeptin-54 to more established triggers of oocyte maturation. WIDER IMPLICATIONS OF THE FINDINGS Triggering final oocyte maturation with kisspeptin is a novel therapeutic option to enable the use of fresh embryo transfer even in the woman at high risk of OHSS. STUDY FUNDING/COMPETING INTEREST(S) The study was designed, conducted, analysed and reported entirely by the authors. The Medical Research Council (MRC), Wellcome Trust & National Institute of Health Research (NIHR) provided research funding to carry out the studies. There are no competing interests to declare. TRIAL REGISTRATION NUMBER Clinicaltrial.gov identifier NCT01667406. TRIAL REGISTRATION DATE 8 August 2012. DATE OF FIRST PATIENT'S ENROLMENT 10 August 2015.
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Affiliation(s)
- Ali Abbara
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Sophie Clarke
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Rumana Islam
- IVF Unit, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Julia K Prague
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Alexander N Comninos
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Shakunthala Narayanaswamy
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Deborah Papadopoulou
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Rachel Roberts
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Chioma Izzi-Engbeaya
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Risheka Ratnasabapathy
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Alexander Nesbitt
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Sunitha Vimalesvaran
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Rehan Salim
- IVF Unit, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Stuart A Lavery
- IVF Unit, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Stephen R Bloom
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Les Huson
- Division of Experimental Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Geoffrey H Trew
- IVF Unit, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Waljit S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
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Abbara A, Jayasena CN, Christopoulos G, Narayanaswamy S, Izzi-Engbeaya C, Nijher GMK, Comninos AN, Peters D, Buckley A, Ratnasabapathy R, Prague JK, Salim R, Lavery SA, Bloom SR, Szigeti M, Ashby DA, Trew GH, Dhillo WS. Efficacy of Kisspeptin-54 to Trigger Oocyte Maturation in Women at High Risk of Ovarian Hyperstimulation Syndrome (OHSS) During In Vitro Fertilization (IVF) Therapy. J Clin Endocrinol Metab 2015; 100:3322-31. [PMID: 26192876 PMCID: PMC4570165 DOI: 10.1210/jc.2015-2332] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In vitro fertilization (IVF) treatment is an effective therapy for infertility, but can result in the potentially life-threatening complication, ovarian hyperstimulation syndrome (OHSS). OBJECTIVE This study aimed to investigate whether kisspeptin-54 can be used to effectively and safely trigger oocyte maturation in women undergoing IVF treatment at high risk of developing OHSS. SETTING AND DESIGN This was a phase 2, multi-dose, open-label, randomized clinical trial of 60 women at high risk of developing OHSS carried out during 2013-2014 at Hammersmith Hospital IVF unit, London, United Kingdom. INTERVENTION Following a standard recombinant FSH/GnRH antagonist protocol, patients were randomly assigned to receive a single injection of kisspeptin-54 to trigger oocyte maturation using an adaptive design for dose allocation (3.2 nmol/kg, n = 5; 6.4 nmol/kg, n = 20; 9.6 nmol/kg, n = 15; 12.8 nmol/kg, n = 20). Oocytes were retrieved 36 h after kisspeptin-54 administration, assessed for maturation, and fertilized by intracytoplasmic sperm injection with subsequent transfer of one or two embryos. Women were routinely screened for the development of OHSS. MAIN OUTCOME MEASURE Oocyte maturation was measured by oocyte yield (percentage of mature oocytes retrieved from follicles ≥ 14 mm on ultrasound). Secondary outcomes include rates of OHSS and pregnancy. RESULTS Oocyte maturation occurred in 95% of women. Highest oocyte yield (121%) was observed following 12.8 nmol/kg kisspeptin-54, which was +69% (confidence interval, -16-153%) greater than following 3.2 nmol/kg. At all doses of kisspeptin-54, biochemical pregnancy, clinical pregnancy, and live birth rates per transfer (n = 51) were 63, 53, and 45%, respectively. Highest pregnancy rates were observed following 9.6 nmol/kg kisspeptin-54 (85, 77, and 62%, respectively). No woman developed moderate, severe, or critical OHSS. CONCLUSION Kisspeptin-54 is a promising approach to effectively and safely trigger oocyte maturation in women undergoing IVF treatment at high risk of developing OHSS.
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Affiliation(s)
- Ali Abbara
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Channa N Jayasena
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Georgios Christopoulos
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Shakunthala Narayanaswamy
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Chioma Izzi-Engbeaya
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Gurjinder M K Nijher
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Alexander N Comninos
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Deborah Peters
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Adam Buckley
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Risheka Ratnasabapathy
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Julia K Prague
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Rehan Salim
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Stuart A Lavery
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Stephen R Bloom
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Matyas Szigeti
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Deborah A Ashby
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Geoffrey H Trew
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
| | - Waljit S Dhillo
- Department of Investigative Medicine (A.A., C.N.J., S.N., C.I.-E., G.M.K.N., A.N.C., D.P., A.B., R.R., J.K.P., S.R.B., W.S.D.), Imperial College London, Hammersmith Hospital, London, W12 0NN, United Kingdom; IVF Unit (G.C., R.S., S.A.L., G.H.T.), Hammersmith Hospital, London, W12 0HS, United Kingdom; and Imperial Clinical Trials Unit (M.S., D.A.A.), Imperial College London, St Mary's Hospital, Norfolk Pl, London, W2 1PG, United Kingdom
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