Principal Investigator: Lori Gawron
Keywords: Family Planning , Women's Health , Contraception , Hormonal IUD Department: Obstetrics And Gynecology (Dept)
IRB Number: 00136600
Specialty: OB/Gyn, General
Sub Specialties: Contraception and Family Planning
Recruitment Status: Not yet recruiting

Contact Information

Jasmin Alcantara-Montes
jasmin.alcantara@hsc.utah.edu
801-213-2774

Brief Summary

Objectives

The primary objective of the study is to assess the contraceptive efficacy (prevention of pregnancy) of LevoCept.

The secondary objectives of the study are to assess the following for LevoCept:

  • Safety and tolerability
  • Return to fertility after LevoCept removal, only for subjects requesting LevoCept removal to become pregnant
  • Release rate of LNG from the IUS and resulting pharmacokinetics of LNG (PK substudy)

Endpoints

Primary Endpoint

The primary endpoint is the contraceptive efficacy through 3 years of use, as assessed by the Pearl Index. The Pearl Index will be calculated for Years 1, 2, and 3 as well as cumulatively through Year 3.

Secondary Endpoints

Secondary endpoints include: Contraceptive Efficacy

  • Pearl Index at Years 4 and 5 as well as cumulatively through Years 4 and 5
  • Pregnancy percentage by life table analysis (Kaplan Meier) at Years 1, 2, 3, 4, and 5
    Study drug placement
  • Ease of LevoCept placement
  • Placement success

Safety

  • Serious adverse events (SAEs)
  • Adverse events (AEs)
  • Pelvic infection (pelvic inflammatory disease (PID) or endometritis)
  • Occurrence and severity of dyspareunia
  • Insertions requiring cervical dilation
  • Ectopic pregnancies
  • Uterine perforations
  • Dysmenorrhea
  • Abdominal pain
  • Hypersensitivity/allergic reactions
  • Expulsion rates at Years 1, 2, 3, 4, and 5  

Tolerability

  • Bleeding and spotting patterns
  • Insertion pain assessed immediately after insertion
  • Continuation rates at Years 1, 2, 3, 4, and 5
  • Reasons for discontinuation  

Return to fertility

  • Pregnancy rate in subjects who request LevoCept removal specifically to become pregnant. Subjects who desire pregnancy after having LevoCept removed will be followed for either 1 year after the removal date, or until they decide to no longer try to conceive or they become pregnant, whichever comes first.

Pharmacokinetics

●       Release rate of LNG from the IUS

Inclusion Criteria

Subjects must meet all of the following criteria to participate in this study:

1.     Post-menarcheal, pre-menopausal females up to 45 years of age at the time of informed consent and in good general health;

2.     History of regular menstrual cycles defined as occurring every 21-35 days when not using hormones or prior to recent pregnancy or spontaneous or induced abortion;

3.     Sexually active with a male partner who has not had a vasectomy nor other known fertility problems;

4.     Reasonably expect to have coitus at least once monthly during the study period;

5.     In a mutually monogamous relationship of at least 3 months duration at time of consent;

6.     Seeking to avoid pregnancy for the duration of the study;

7.     Willing to use the study drug as the sole form of contraception;

8.     Willing to accept a risk of pregnancy;

9.     Subjects must be in compliance with cervical cancer screening guidelines per the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines without evidence of disease. Subjects who are age 21 to 24 y/o, at time of informed consent, must have a normal Papanicolaou test (Pap), atypical squamous cells of undetermined significance (ASC-US), or low-grade squamous intraepithelial lesion (LSIL). Subjects who are 25 or older at the time of informed consent must have a normal Pap test or an ASC-US result with a negative high-risk human papilloma virus (HPV) test result within the appropriate screen timeframe per ASCCP guidelines, and prior to the study IUD insertion. Alternatively, the subject must have had a colposcopy performed within the appropriate screen timeframe, and prior to the study IUD insertion that showed no evidence of dysplasia requiring treatment per ASCCP guidelines, or treatment was performed and follow-up at least 6 months after the treatment showed no evidence of disease by clinical evaluation;

10.  Able and willing to comply with all study tests, procedures, assessment tools (including e-diary) and follow-up;

11.  Able and willing to provide and document informed consent and Authorization for Release of PHI. 

12.  Plan to reside within a reasonable travel distance of a research site for the duration of the study.

13.  Subject agrees not to intentionally self-remove LevoCept.

Exclusion Criteria

A subject will be excluded from participating in the study if any of the following conditions apply:

1.     Known or suspected pregnancy; or at risk for pregnancy from unprotected intercourse earlier in current cycle;

2.     Has had any procedure for or causing sterility (e.g. tubal ligation procedure);

3.     Subject who anticipates separation from her partner for more than a 6-month period during use of LevoCept;

4.     A previously inserted IUD/IUS that has not been removed by the time the study IUS is placed;

5.     History of previous IUD/IUS complications, such as perforation, expulsion, or pregnancy with IUD/IUS in place;

6.     Pain with current IUD/IUS;

7.     Injection of hormonal contraceptive (e.g., Depo-Provera) within the last 10 months and has not had 2 normal menstrual cycles since the last injection;

8.     Subject is <4 weeks post-pregnancy (postpartum, spontaneous or induced abortion)

9.     Planned use of any non-contraceptive estrogen, progesterone or testosterone any time during the 60 months of study participation;

10.  Exclusively breastfeeding before return of menses; lactating women will be excluded unless they have had 2 normal menstrual periods prior to enrollment;

11.  Unexplained abnormal uterine bleeding (suspicious for a serious condition), including bleeding 4 weeks post-septic abortion or puerperal sepsis;

12.  Severely heavy or painful menstrual bleeding;

13.  Suspected or known cervical, uterine or ovarian cancer, or unresolved clinically significant abnormal Pap test requiring evaluation or treatment;

14.  Any history of gestational trophoblastic disease with or without detectable elevated ß- human chorionic gonadotropin (ß-hCG) levels, or related malignant disease;

15.  Any congenital or acquired uterine anomaly that may complicate study drug placement, such as:

●       Submucosal uterine leiomyoma

●       Asherman’s syndromes

●       Pedunculated polyps

●       Bicornuate uterus

●       Didelphus or uterine septa

16.  Any distortions of the uterine cavity (e.g. fibroids), that, in the opinion of the investigator, are likely to cause issues during insertion, retention or removal of the IUS;

17.  Known anatomical abnormalities of the cervix such as severe cervical stenosis, prior trachelectomy or extensive conization that, in the opinion of the investigator would prevent cervical dilation and study drug placement;

18.  Untreated or unresolved acute cervicitis or vaginitis;

19.  Known or suspected breast cancer or other progestin-sensitive cancer now or in the past;

20.  Known acute liver disease or liver tumor;

21.  Subjects who have an established immunodeficiency;

22.  Known or suspected human immunodeficiency virus (HIV) infection or clinical AIDS;

23.  At high risk for sexually transmitted infections (e.g. multiple sexual partners);

24.  Known intolerance or allergy to any components of LevoCept, including intolerance or allergy to levonorgestrel, nickel, titanium, or silicone;

25.  Currently participating or planning future participation in a research study of an investigational drug or device during the course of this investigational study. Subject must have waited at least 30 days from exiting their last study prior to informed consent in this study;

26.  Subject has previously been enrolled in a VeraCept or LevoCept study (including the current study);

27.  Known or suspected alcohol or drug abuse within 12 months prior to the screening visit;

28.  Any general health, mental health or behavioral condition that, in the opinion of the investigator, could represent an increased risk for the subject or would render the subject less likely to provide the needed study information;

29.  Study staff or a member of the immediate family of study staff.