O emprego de hormônio luteinizante recombinante associado ao hormônio folículo-estimulante recombinante nos protocolos de estimulação ovariana com antagonista do GnRH

The purpose of this investigation was to verify the efficacy of recombinant LH supplementation for controlled ovarian stimulation in GnRH-antagonist protocol for assisted reproductive technologies cycles. Search strategies included on-line surveys of databases from 1990 to 2006. In this review and meta-analysis, the observed advantages for the LH supplementation protocol were a higher serum estradiol levels on the day of hCG administration and a higher number of mature oocytes. However, there were no differences observed in the total amount of r-FSH administered, days of stimulation, number of oocyte retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of r-LH with r-FSH may prevent any decrease in estradiol after antagonist administration and a significant higher number of mature oocytes was obtained. Nevertheless, additional randomized controlled trials are needed confirm these observations.

GnRH agonist versus GnRH antagonist in poor ovarian responders: A meta-analysis

The aim of this meta-analysis was to compare the efficacy of gonadotrophin antagonist (GnRH-ant) versus GnRH agonist (GnRHa) as coadjuvant therapy for ovarian stimulation in poor ovarian responders in IVF/intracytoplasmic sperm injection cycles. Search strategies included on-line surveys of databases such as MEDLINE, EMBASE and others. A fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Six trials fulfilled the inclusion criteria (randomized controlled trials). There was no difference between GnRH-ant and GnRHa (long and flare-up protocols) with respect to cycle cancellation rate, number of mature oocytes and clinical pregnancy rate per cycle initiated, per oocyte retrieval and per embryo transfer. When the mete-analysis was applied to the two trials that had used GnRH-ant versus long protocols of GnRHa, a significantly higher number of retrieved oocytes was observed in the GnRH-ant protocols [P = 0.018; WMD: 1.12 (0.18, 2.05)]. However, when the meta-analysis was applied to the four trials that had used GnRH-ant versus flare-up protocols, a significantly higher number of retrieved oocytes (P = 0.032; WMD: -0.51, 95% CI -0.99, -0.04) was observed in the GnRHa protocols. Nevertheless, additional randomized controlled trials with better planning are needed to confirm these results.

Laser-assisted hatching of cryopreserved-thawed embryos by thinning one quarter of the zona

Laser-assisted hatching is little documented in the literature regarding its efficacy in cryopreserved-thawed (CT) embryo transfer cycles. The aim of the present study was to evaluate in a randomized manner the efficacy of thinning one quarter of the zona pellucida of CT embryos to a depth of 50-80% of the original thickness, via laser treatment (the qLZT-AH procedure), in improving implantation and pregnancy rates. Two populations were studied: population I, patients who had all their supernumerary embryos cryopreserved, regardless of their morphology, and population II, patients at risk of ovarian hyperstimulation syndrome who had all their embryos cryopreserved. Artificial and natural protocols were used for the embryo transfers. A total of 350 laser-thinned CT embryos were compared with 352 intact zona embryos. No difference in implantation or pregnancy rate was found after using qLZT-AH in either population. These findings suggest that qLZT-AH should not be routinely performed in cryopreserved embryo programmes.

Recombinant LH supplementation to recombinant FSH during induced ovarian stimulation in the GnRH-antagonist protocol: A meta-analysis

This study aims to compare the efficacy of recombinant LH (rLH) supplementation for ovarian stimulation in gonadotrophin-releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration (P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (rFSH) administered, days of stimulation, number of oocytes retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of rLH with rFSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further. © 2007 Published by Reproductive Healthcare Ltd.

The effect of type of vaginal insert and dose of pLH on embryo production, following fixed-time AI in a progestin-based superstimulatory protocol in Nelore cattle

The objective was to analyze and report field data focusing on the effect of type of progesterone-releasing vaginal insert and dose of pLH on embryo production, following a superstimulatory protocol involving fixed-time artificial insemination (FTAI) in Nelore cattle (Bos taurus indicus). Donor heifers and cows (n = 68; 136 superstimulations over 2 years) received an intravaginal, progesterone-releasing insert (CIDR® or DIB®, with 1.9 or 1.0 g progesterone, respectively) and 3-4 mg of estradiol benzoate (EB) i.m. at random stages of the estrous cycle. Five days later (designated Day 0), cattle were superstimulated with a total of 120-200 mg of pFSH (Folltropin-V®), given twice daily in decreasing doses from Days 0 to 3. All cattle received two luteolytic doses of PGF2α at 08:00 and 20:00 h on Day 2 and progesterone inserts were removed at 20:00 h on Day 3 (36 h after the first PGF2α injection). Ovulation was induced with pLH (Lutropin-V®, 12.5 or 25 mg, i.m.) at 08:00 h on Day 4 with FTAI 12, 24 and in several cases, 36 h later. Embryos were recovered on Days 11 or 12, graded and transferred to synchronous recipients. Overall, the mean (±S.E.M.) number of total ova/embryos (13.3 ± 0.8) and viable embryos (9.4 ± 0.6) and pregnancy rate (43.5%; 528/1213) did not differ among groups, but embryo viability rate (overall, 70.8%) was higher in donors with a DIB (72.3%) than a CIDR (68.3%, P = 0.007). In conclusion, the administration of pLH 12 h after progesterone removal in a progestin-based superstimulatory protocol facilitated fixed-time AI in Nelore donors, with embryo production, embryo viability and pregnancy rates after embryo transfer, comparable to published results where estrus detection and AI was done. Results suggested a possible alternative, which would eliminate the need for estrus detection in donors. © 2006 Elsevier Inc. All rights reserved.

Eficiência do protocolo Ovsynch em ovelhas da raça Santa Inês

Twenty six Santa Inês ewes were asigned to three treatments to evaluate the efficiency of the Ovsynch protocol. In the treatment 1 - control (n=8), the estrus was synchronized with sponges containing 60 mg MAP for 14 days. On D14, 300 IU eCG were administered. In treatment 2 (n=9) the Ovsynch protocol was used: 25 μg of GnRH (D0), 37.5 μg of PGF2α (D7) and 25 μg of GnRH (D9). In treatment 3 (n=9) the modified Ovsynch protocol was used: the administration of PGF2α and second GnRH as two days early. Estrus detection was accomplished using teaser. All ewes were mated twice with 12 hours of interval. Pregnancy rate (PR) was evaluated by ultrasonography 30 days after the end of mating. Estrus response was of 88.46% on average, and without differences among treatments (p>0.05). The interval for onset of estrus was greater (p<0.05) in T1, when compared with T2 and T3 (41.31±7.2, 13.37±8.42 and 6.75±5.2 h, respectively). The time of receptivity was greater (p<0.05) in females of T1 and T3 (40.5±6.49 h and 53.68±10.27 h, respectively), compared to females of T2 (34.56±7.2 h). The duration of the induced estrus did not differ significant among treatments (p>0.05). Pregnancy rate was significantly greater (p<0.05) in ewes synchronized with Ovsynch protocol (37.5%, 62.5% and 25% for treatment 1, 2 and 3, respectively). The results show superior efficiency of the Ovsynch protocol, under the experimental conditions.

A síndrome do hiperestímulo ovariano não influencia os resultados clínicos após ciclos de descongelamento de embriões provenientes de ciclos de ICSI

Objective: The objective of this study was evaluate if the embryos cryopreservation from OHSS patients Intracytoplasmic Sperm Injection (ICSI) cycles could be influence the clinical outcomes when compared to patients who receive oocytes from donors but the endometrium was not prepared and the embryos were cryopreserved. Methods: Fifty eight couples submitted to ICSI cycles in which 26 with OHSS clinical manifestation (OHSS group) and 32 couples who have received oocytes from donors (control group). The embryos were frozen on day+2 or +3of development. All patients included in this study had embryos crypreserved before the transfer, and in the thawing cycle, only the endometrium preparation was performed. The embryo survival, implantation, pregnancy and miscarriage rates were evaluated in the embryo thawing cycle. Results: There was no difference among the groups in relation to fertilization rate (OHSS: 71.89% ± 15.45, Control: 79.75% ± 21.68, p= 0.234), survival embryos rate (OHSS: 68.85 ± 21.10, Control: 59.53 ± 36.79, p= 0.233), high quality embryos rate (OHSS: 25.20 ± 23.90, Control: 27.40 ± 30.30, p= 0.760), implantation rate (OHSS: 17.9 ± 26.9, Control: 12.5 ± 23.7, p= 0.435), pregnancy rate (OHSS: 38.50, Control: 28.60, p= 0.441) and miscarriage rate (OHSS: 40.00, Control: 25.00, p= 0.332). Conclusion: Our findings suggest that clinical outcomes in freeze and thawing cycles were not affected by the presence of ovarian hyperstimulation syndrome clinical manifestation after controlled ovarian stimulation.

Fatores preditivos do sucesso da inseminação intrauterina: A morfologia espermática de acordo com o novo manual de laboratório da Organização Mundial de Saúde

Objective: The aim of our study was to assess the likelihood of IUI success as a function of the previously described predictive factors, including sperm morphology according to the new reference values defined by WHO. Material and Methods: This retrospective study enrolled 300 couples which underwent IUI. Regression analyses were used to correlate maternal age, number of preovulatory follicles on the day of hCG administration, number of inseminated motile sperm, and normal sperm morphology with clinical pregnancy. Results are expressed as odds ratio (OR) with 95% of confidence intervals (CI). Results: Women older than 35 years showed a lower pregnancy rate (6.5% vs 18.2%, p=0.017). Logistic regression models confirmed the lower chance of pregnancy occurrence for older women (OR: 0.39; CI: 0.16-0.96; p=0.040). The presence of two or more preovulatory follicles on the day of hCG administration resulted in higher pregnancy rate when compared to cases in which only one preovulatory follicle was present (18.6% vs 8.2%, p=0.011). The regression model showed a more than two fold increase on probability of pregnancy when two or more preovulatory follicles were detected (OR: 2.58; CI: 1.22-5.46, p=0.013). The number of inseminated motile sperm positively influenced pregnancy occurrence (OR: 1.47; CI: 0.88-3.14, p=0.027). Similar pregnancy rates were observed when semen samples were classified as having normal or abnormal morphology (10.6% vs 10.2%, p=0.936). Conclusion: Our results demonstrate that sperm morphological normalcy, according to the new reference value, has no predictive value on IUI outcomes. © Todos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.

Relevância do assited hatching com laser em um programa de ovo-doação utilizando banco de óvulos criopreservados: Um estudo prospectivo randomizado

Objective: This prospective randomized trial evaluated if there is an improvement in clinical outcomes when assisted hatching is performed in embryos derived from vitrified oocytes in an ovum donation program. Methods: Sixty oocyte recipients undergoing donation program using egg-cryobanking were randomly allocated to the assisted hatched (AH, n=30) or control group (n=30). Pregnancy and implantation rates were compared between the groups. Vitrification and warming procedure were carried out according to the Cryotopmethod. Immediately before embryo transfer, embryos undergoing laser-assisted hatching had the zona pellucida thinned using a 1.48 μm wavelength diode laser. Results: A total of 288 vitrified MII oocytes were warmed for the 60 recipients (4.8 oocytes per recipient). Out of 288 vitrified oocytes, 273 (94.8%) survived. All surviving oocytes were sperm injected and 228 displayed 2 pronucleus 16-18h after injection (83.5%). There were 172 good quality embryos transferred. Twenty four patients achieved clinical pregnancy (total pregnancy rate of 40%). The clinical pregnancy rate did not differ between AH and control groups (44.4% and 33.3%, respectively, p=0.1967), however AH resulted in a significant higher implantation rate (31.6% and 18.4%, p=0.0206). These findings were confirmed by the regression models either for pregnancy (OR = 1.14; IC 95% = 0.80-.72; p= 0.766), as for the implantation rate (RC:19.45, P=0.041). Conclusions: Our evidences demonstrated the effectiveness of the AH in embryos derived from warmed oocytes and suggest that oocyte cryopreservation is a valuable tool to provide successful outcomes in an egg donor program. © Todos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.

How FTAI and FTET impact reproductive efficiency of Brazilian dairy herds

Background: Throughout dairy cows evolution, milk production was always the key point to select the superior animal. Currently, several evidences has shown that high milk production have intensively contributed to the decline of dairy cattle fertility. Beyond milk production, dairy cows have their reproductive performance impaired by another factors, heat stress and repeat-breeding. Methods like fixed time artificial insemination and embryo transfer were developed to minimize the effects of these factors, and improve dairy herds profitability. This review aims to show some key-point experiments conducted to improve the efficiency of the self-appointed protocols for artificial insemination and embryo transfer in Brazil, overcoming several reproductive problems. Our goal is to develop cheap and easy self-appointed programs that facilitate animal handling and maximize their reproductive outcomes all over the year. Review: Failure in estrus detection is the mainly limiting factor for the use of artificial insemination in high-production dairy herd. An excellent alternative to overcome the need of estrus detection is fixed time artificial insemination. Many protocols with and without the use of estradiol have been developed to that end. Among the protocols for fixed time artificial insemination without estradiol, DoubleOvsynch has been extensively used recently in American dairy herds. In Brazil, similar pregnancy rate was obtained compared to progesterone-estradiol based protocols for fixed time artificial insemination. Particularities of progesterone-estradiol based protocols as (1) new progesterone device or devices previously used for eight days; (2) different doses of eCG; and (3) the use of estradiol cypionate for fixed time artificial insemination have been studied in Brazil. The use of self-appointed artificial insemination also enabled the reduction of the interval calving-conception compared to cows inseminated following the standing estrus. Regarding the low fertility of repeat breeders and the effect of heat stress at early pregnancy, other methods like embryo transfer became important tools to enhance reproductive efficiency of Brazilian dairy herds. Protocols were also developed to allow fixed time embryo transfer, eliminating the need of estrus detection and improving the reproductive efficiency of lactating recipients. As well as described for fixed time artificial insemination treatments, there is a large variety of hormone combination for fixed time embryo transfer (with and without estradiol). An experiment conducted in Brazil demonstrated that protocols for fixed time embryo transfer without estradiol can be as good as with estradiol to synchronize high-producing Holstein recipients, essentially during summer. Particularities related to embryos cryopreservation, synchronization of the estrus cycle of donors and recipients and the site of embryo release into the uterine horn were also investigated. Greater conception rates were achieved when fresh embryos were transferred compared to frozen-thawed ones. Also, the tight synchronization between donor and recipient (same day of estrus) resulted more pregnancies than when recipients were one day later or in advantage in relation to donors. Moreover, the site of embryo release into the uterine horn (ipsilateral to the corpus luteum) had no effect on pregnancy rates after in vivo produced embryo transfer. Conclusion: Both fixed time artificial insemination and fixed time embryo transfer are important tools to improve reproductive efficiency of high-producing dairy cows. These biotechnologies help bypassing some of the greatest challenges of dairy cattle reproduction: the difficulties of estrus detection, and the low fertility associated to heat stress and repeat breeding.

Correlação entre os dismorfismos oocitários e os resultados da fertilização in vitro

In assisted reproduction, the selection of gametes to achieve better clinical outcomes is a crucial task of embryologists. The quality of the oocyte is a key factor in female fertility, reflecting the intrinsic potential of gamete development, and has a vital role not only in conception but also in subsequent embryonic development. Oocyte dysmorphisms are classified into two types: cytoplasmic, including the presence of granules and/or cytoplasmic inclusions (vacuoles, refractive bodies, and aggregates of the endoplasmic reticulum), and extracytoplasmic (changes in the shape of the oocyte, the zona pellucida, the space perivitelline changes and the polar body). Variations in oocyte morphology may occur due to factors such as the age of women, genetic problems and changes in the hormonal environment to which the oocyte is exposed in ovarian hyperstimulation. The classification of oocyte morphology and its correlation with embryo development and pregnancy rates are controversial in the literature. Several studies show no association between oocyte dysmorphisms and the results of in vitro fertilization, while others report an association between oocyte morphology and embryo development. These differences in the results can be explained by the use of different morphological criteria due to a lack of standardization of oocyte evaluation. © Todos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.

Agonistas do GnRH, antagonistas do GnRH e a reprodução assistida: Análogos do GnRH x fertilização in vitro

The agonists of gonadotropin-releasing hormone (GnRH) were introduced in ovarian stimulation for in vitro fertilization to avoid a premature surge of luteinizing hormone. Although they are accompanied by some disadvantages, GnRH agonists have become well accepted in clinical practice, and their use is associated with increased rates of pregnancy. The development of GnRH antagonists capable of blocking the pituitary immediately offered a therapeutic option. Comparative studies between the two analogs have suggested that the use of antagonists is associated with a shorter duration of ovulatory stimulus and a decreased incidence of ovarian hyperstimulation syndrome, while the type of GnRH analogues used show no significant effects on the rates of pregnancy and live birth. However, GnRH agonists have other applications in assisted reproductive technology cycles than the pituitary downregulation.

Crescimento, comportamento ingestivo e desempenho reprodutivo de novilhas mestiças holandês x zebu, em pastejo, submetidas à suplementação protéica durante a época das águas

The objective of this study was to evaluate the effect of supplemental protein during the rainy season on body growth, ingestive behavior and reproductive performance of crossbred Gir x Holstein dairy heifers, with mean age of 21 ± 4.1 months and average initial body weight of 296.7 ± 57.3 kg, distributed in a completely randomized design with four treatments and six replicates per treatment. Heifers remained on Brachiaria brizantha cv. Marandu pasture, managed according to a rotational grazing system and, as treatment, it was supplemented with protein concentrate (34%, 43%, 56% and 66% BW) and level of supply of 0.30% body weight (BW). The animals were weighed and the mean weight of the lot was used for the calculation of adjustment of the amount of concentrate offered. Heifers that reached 330.0 kg of live weight were artificially inseminated and, 45 days after insemination, pregnancy diagnosis was performed for the calculation of pregnancy rate and age at conception. No significant difference of protein levels was observed on grazing, eating behavior, productive performance and age at conception of dairy heifers on pasture. The average daily weight gain of BW and age at conception were, on average, 0.907 kg/animal and 24.03 months, respectively.

Progesterone-based strategies to induce ovulation in prepubertal Nellore heifers

Four experiments were conducted to evaluate hormonal strategies to induce ovulation in Nellore heifers. In experiment 1, heifers (N = 1039) received a controlled internal drug release (CIDR) of fourth use (CIDR-4) on Day -12 or no CIDR (CIDR-0). The CIDR was removed on Day 0 in the CIDR-4 treatment, and estrus detection and AI were performed from Days 1 to 7. On Day 8, heifers not detected in estrus were evaluated for CL presence and received the same treatment again, followed by estrus detection and AI from Days 21 to 27. All heifers in experiments 2 (N = 896), 3 (N = 839), and 4 (N = 948) received the CIDR-4 treatment on Day -12. In experiment 2, heifers were randomly assigned to a control group (no additional treatment) or to receive equine chorionic gonadotropin (eCG; 200 IU eCG im) on Day 0. In experiment 3, heifers received the same treatments as in experiment 2, or a treatment that included eCG and estradiol cypionate (ECP) (eCG+ECP; 200 IU im eCG plus 0.5 mg ECP im) on Day 0. In experiment 4, heifers received the treatments described in experiment 3 or only ECP (0.5 mg) on Day 0. In experiments 2 and 3, estrus detection and AI was performed from Days 1 to 7 and on Day 8, heifers not detected in estrus were evaluated for CL presence. In experiment 4, heifers were evaluated for presence of a CL between Days 10 and 14. In experiment 1 heifers treated with CIDR-4 had greater estrus detection, ovulation induction, and pregnancy rates than in the CIDR-0 group. In experiment 2, heifers treated with eCG had greater estrus detection, ovulation induction, and pregnancy rates in 7 days than heifers in the control group. In experiment 3, heifers treated with eCG+ECP had greater estrus detection, ovulation induction, and pregnancy rates than the control and eCG treatments. In experiment 4, ovulation induction was greater for heifers treated with eCG and eCG+ECP relative to control, but did not differ from the ECP treatment. In conclusion, the use of a CIDR of fourth use for 12 days and the addition of eCG and/or ECP at CIDR removal efficiently induced ovulation and increased pregnancy rates in prepubertal Nellore heifers. © 2013 Elsevier Inc.

Hormonal treatment of dairy goats affected by hydrometra associated or not with ovarian follicular cyst

Hydrometra is considered a very important pathological condition, because it represents one of the main causes of temporary infertility in dairy goats. The objective was (i) to evaluate a protocol for the treatment of hydrometra associated (n=2) or not (n=17) with follicular ovarian cyst in 19 dairy goats and (ii) to assess its reproductive efficiency after treatment. For this purpose, 10. mg of dinoprost (PGF) divided in two equal doses were administered to all animals intravulvosubmucosally on Days 0 and 10. In addition, 500. IU hCG were administered on Day 7. Ultrasound exams were performed in all females from Days 0 to 3, 7 and 10 to 13 of treatment, in order to evaluate uterus drainage after each treatment. Goats were monitored for estrus after both treatments and mated after the second dose of PGF. Blood samples were collected from 11 goats to determine plasma progesterone concentrations before, during and after treatment. Of the 19 goats treated, 16 lost weight after the first dose, probably due to uterine discharge. Complete drainage of uterine fluid was observed in 11/19 (57.9%) and 17/19 (89.5%) after the first and second doses, respectively. Afterwards, we diagnosed 2 more goats with follicular cysts, for a total of 21.1% (4/19) of animals exhibiting hydrometra and ovarian cyst concomitantly. In one doe the diagnosis was on Day 2 and in the other on Day 11. All does showed progesterone concentrations superior to 1. ng/mL at Day 0, with an average of 10.6 ± 1.4. ng/mL. Out of the 10 goats mated, only two became pregnant after treatment, corresponding to 10.5% of the total (2/19). Although prostaglandin was effective to drain the uterine fluid and led to the onset of estrus, it did not improve the pregnancy rate. The use of hCG in female goats was not effective in luteinizing the cysts. It can be concluded that hydrometra alone or associated with ovarian follicular cyst may adversely affect goat reproductive performance. © 2012 Elsevier B.V.