An Exploratory Study to Investigate the Effect of FE 999302 When Given Together With Follitropin Delta During Controlled Ovarian Stimulation

• Follitropin delta (Drug), also known as REKOVELLE: The effect on parameters influencing pregnancy rates in women undergoing controlled ovarian stimulation with a fixed dose of follitropin.
• FE999302 (Drug): To investigate the effect of FE 999302 on parameters influencing pregnancy rates in women undergoing controlled ovarian stimulation with a fixed dose of follitropin delta in a gonadotropin-releasing hormone (GnRH) antagonist protocol
• FE999302 Placebo (Drug): To investigate the effect of FE 999302 on parameters influencing pregnancy rates in women undergoing controlled ovarian stimulation with a fixed dose of follitropin delta in a gonadotropin-releasing hormone (GnRH) antagonist protocol

Primary outcomes

• Number of good-quality blastocysts [Day 5 after oocyte retrieval.]: The number of good-quality blastocysts

Secondary outcomes

• Number and size of follicles [On stimulation day 6 and up to 20 days]: Number of follicles by size category
• Serum hormone concentrations [On stimulation day 6, and up to 20 days]: Serum hormone concentrations of progesterone, 17-OH-progesterone, androstenedione, testosterone, estradiol, inhibin B, and luteinising hormone (LH) on stimulation day 6 and at end of stimulation.
• Serum hormone concentrations [Up to 22 days]: Serum hormone concentrations of progesterone, 17-OH-progesterone, androstenedione, testosterone, and estradiol at oocyte retrieval
• Number of Stimulation days [Up to 20 days]: Number of stimulation days
• Number of oocytes [Up to 22 days]: Number of oocytes retrieved
• Number of metaphase II oocytes [Up to 22 days]: Number of metaphase II (MII) oocytes
• Number of fertilised oocytes [Up to 22 days]: Number of fertilised (2 pronuclei \[2PN\]) oocytes
• Number of blastocysts [Up to 27 days]: Number of blastocysts
• Number of cryopreserved blastocysts [Up to 28 days]: Number of cryopreserved blastocysts
• Endometrial thickness [Up to 20 days, and up to 27 days]: Endometrial thickness
• Positive βhCG [13 to 15 days after fresh transfer]: Positive βhCG (positive serum βhCG test )
• Clinical pregnancy [5-6 weeks after fresh transfer]: Clinical pregnancy (at least one gestational sac)
• Vital pregnancy [5-6 weeks after fresh transfer]: Vital pregnancy (at least one intrauterine gestational sac with fetal heart beat)
• Ongoing pregnancy [10-11 weeks after fresh transfer]: Ongoing pregnancy (at least one intrauterine viable fetus)

Sex: Female, ages: 18 Years to 40 Years, accepts healthy volunteers

Inclusion Criteria:

1. Subject informed consent form signed before any trial-related activities.
2. In good physical and mental health as judged by the investigator.
3. Serum anti-Müllerian hormone (AMH) levels of 15.0-35.0 pmol/L at screening (measured at central laboratory).
4. Pre-menopausal women between the ages of 18 and 40 years. The subjects must be at least 18 years (including the 18th birthday) and no more than 40 years (up to the day before the 41st birthday) when they sign the informed consent(s).
5. Infertile women diagnosed with tubal infertility, unexplained infertility, endometriosis stage I/II or with partners diagnosed with male factor infertility, eligible for in vitro fertilisation (IVF) and/or intracytoplasmic sperm injection (ICSI) using fresh or frozen ejaculated sperm from male partner or sperm donor.
6. Infertility for at least 1 year before screening for subjects <35 years or for at least 6 months for subjects ≥35 years (not applicable in case of tubal or severe male factor infertility).
7. No more than two controlled ovarian stimulation cycles initiated, regardless of outcome (taking exclusion criteria 2 and 3 into account) and the subject must be suitable for treatment with 10 or 15 µg/day follitropin delta (corresponding to 150 or 225 IU).
8. Regular menstrual cycles of 24-35 days (both inclusive), presumed to be ovulatory.
9. Early follicular phase (cycle day 2-5) serum levels of follicle-stimulating hormone (FSH) between 1 and 15 IU/L (measured at central laboratory).
10. Body mass index (BMI) between 18.0 and 30.0 kg/m2 (both inclusive) at screening.

Exclusion Criteria:

1. Known polycystic ovary syndrome (PCOS) or known endometriosis stage III-IV (American Society for Reproductive Medicine, 2012).
2. Poor response in a previous controlled ovarian stimulation cycle using a gonadotropin starting dose of 150 IU/day or higher. Poor response is defined as <4 oocytes retrieved, or cycle cancellation before oocyte retrieval due to inadequate follicular development.
3. Excessive ovarian response in a previous controlled ovarian stimulation cycle for IVF/ICSI using a daily FSH/ human menopausal gonadotropin (hMG) dose of ≤225 IU, defined as ≥25 oocytes retrieved or cycle cancellation before oocyte retrieval due to excessive ovarian response, including risk of ovarian hyperstimulation syndrome (OHSS).
4. One or more follicles ≥10 mm (including cysts) observed on the transvaginal ultrasound before randomisation on stimulation day 1 (puncture of cysts is allowed before randomisation).
5. Known history of recurrent miscarriage (defined as three consecutive losses after ultrasound confirmation of pregnancy \[excluding ectopic pregnancy\] and before week 24 of pregnancy).
6. Any known clinically significant systemic disease (e.g. insulin-dependent diabetes).
7. Any known endocrine or metabolic abnormalities (pituitary, adrenal, pancreas, liver, or kidney) with the exception of controlled thyroid function disease.
8. Known tumours of the ovary, breast, uterus, adrenal gland, pituitary, or hypothalamus which would contraindicate the use of gonadotropins.
9. Any abnormal finding of clinical chemistry and haematology at screening or vital signs at randomisation, which is judged clinically relevant by the investigator and/or requires intervention.
10. Currently breast-feeding.
11. Undiagnosed vaginal bleeding.
12. Findings at the gynaecological examination at screening which preclude gonadotropin stimulation or are associated with a reduced chance of pregnancy, e.g. congenital uterine abnormalities or retained intrauterine device.
13. Pregnancy (negative urinary pregnancy tests must be documented at screening and before randomisation) or contraindication to pregnancy.
14. Use of fertility modifiers during the last menstrual cycle before start of stimulation in the trial, including dehydroepiandrosterone (DHEA) and metformin or cycle programming with oral contraceptives, progestogen, or estrogen preparations

• Global Clinical Compliance, Study director, Ferring Pharmaceuticals

NIH grants: 2023