Hypogonadism in HIV-1-infected men is common and does not resolve during antiretroviral therapy

OBJECTIVES: To assess the prevalence of abnormal testosterone and gonadotropin values in HIV-infected men before and after 2 years of combination antiretroviral therapy (cART). DESIGN: Multicentre cohort of HIV-infected adults. METHODS: We identified 139 Caucasian antiretroviral-naive male patients who started zidovudine/ lamivudine-based cART that was virologically successful over a 2 year period. Ninety-seven were randomly chosen and plasma hormone determinations of free testosterone (fT) and luteinizing hormone (LH) at baseline and after 2 years of cART were evaluated. RESULTS: At baseline 68 patients (70%) had subnormal fT levels. In these, LH levels were low in 44%, normal in 47% and high in 9%. There was a trend for an association between lower CD4+ T-cell counts and hypogonadism. Most participants had normal FSH levels. No significant changes of fT, LH and FSH levels were observed after 2 years of cART. CONCLUSIONS: Low fT levels, mainly with normal or low LH levels and thus indicating secondary hypogonadism, are found in the majority of HIV-infected men and do not resolve during 2 years of successful cART.

Anti-Müllerian hormone and inhibin B as predictors of pregnancy after treatment by in vitro fertilization/intracytoplasmic sperm injection

OBJECTIVE: To evaluate anti-Müllerian hormone (AMH) as a marker of reproductive outcome after IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Longitudinal study. SETTING: University hospital. PATIENT(S): Two hundred seventy-six consecutive women undergoing IVF/ICSI. INTERVENTION(S): Ovarian stimulation, oocyte retrieval, IVF, ICSI, embryo transfer, AMH, and inhibin B determinations in serum and follicular fluid (FF). MAIN OUTCOME MEASURE(S): The AMH and inhibin B concentrations in 276 matched FF/serum pairs have been determined. Different outcome groups have been compared and set in relation to the oocyte count, morphological parameters, and steroid hormone levels. RESULT(S): The concentrations of AMH and inhibin B in both serum and FF were significantly higher in the group of women who became pregnant in the corresponding treatment cycle than in those who did not conceive. Positive correlations were observed between serum inhibin B concentrations and embryo morphology (r = 0.126, 95% confidence interval 0.026-0.284). Serum and FF AMH or inhibin B correlated positively with the oocyte count and negatively with the pretreatment cycle day 3 FSH level and the total administered gonadotropin dose. CONCLUSION(S): The AMH and inhibin B levels on the day of oocyte retrieval are correlated to reproductive outcome.

Aromatase deficiency in a female who is compound heterozygote for two new point mutations in the P450arom gene: impact of estrogens on hypergonadotropic hypogonadism, multicystic ovaries, and bone densitometry in childhood

We report on a female who is compound heterozygote for two new point mutations in the CYP19 gene. The allele inherited from her mother presented a base pair deletion (C) occurring at P408 (CCC, exon 9), causing a frameshift that results in a nonsense codon 111 bp (37 aa) further down in the CYP19 gene. The allele inherited from her father showed a point mutation from G-->A at the splicing point (canonical GT to mutational AT) between exon and intron 3. This mutation ignores the splice site and a stop codon 3 bp downstream occurs. Aromatase deficiency was already suspected because of the marked virilization occurring prepartum in the mother, and the diagnosis was confirmed shortly after birth. Extremely low levels of serum estrogens were found in contrast to high levels of androgens. Ultrasonographic follow-up studies revealed persistently enlarged ovaries (19.5-22 mL) during early childhood (2 to 4 yr) which contained numerous large cysts up to 4.8 x 3.7 cm and normal-appearing large tertiary follicles already at the age of 2 yr. In addition, both basal and GnRH-induced FSH levels remained consistently strikingly elevated. Low-dose estradiol (E2) (0.4 mg/day) given for 50 days at the age of 3 6/12 yr resulted in normalization of serum gonadotropin levels, regression of ovarian size, and increase of whole body and lumbar spine (L1-L4) bone mineral density. The FSH concentration and ovarian size returned to pretreatment levels shortly (150 days) after cessation of E2 therapy. Therefore, we recommend that affected females be treated with low-dose E2 in amounts sufficient to result in physiological prepubertal E2 concentrations using an ultrasensitive estrogen assay. However, E2 replacement needs to be adjusted throughout childhood and puberty to ensure normal skeletal maturation and adequate adolescent growth spurt, normal accretion of bone mineral density, and, at the appropriate age, female secondary sex maturation.

Strategies for Artificial Insemination of Cattle at Synchronized Ovulation or Synchronized Estrus

Two synchronization protocols in lactating dairy and beef cows and in dairy heifers were tested for efficacy of breeding by artificial insemination (AI) with or without estrus detection. Controls received three prostaglandin F2a (PGF2a) injections 14 days apart before AI at observed estrus. Pregnancy rates were compared with animals on the Ovsynch protocol that combined gonadotropin releasing hormone (GnRH) and PGF2a treatments with a timed AI 16 to 20 hours after the second GnRH injection. The pregnancy rates were similar at synchronized ovulation to fixed-time AI in lactating cows, but not effective in heifers because of the lack of synchronization.

Involvement of heparin-like glycosaminoglycans and expression of a novel heparan sulfate binding protein (p24) during human placentation and in a model for human implantation

Previous studies in our laboratory have indicated that heparan sulfate proteoglycans (HSPGs) play an important role in murine embryo implantation. To investigate the potential function of HSPGs in human implantation, two human cell lines (RL95 and JAR) were selected to model uterine epithelium and embryonal trophectoderm, respectively. A heterologous cell-cell adhesion assay showed that initial binding between JAR and RL95 cells is mediated by cell surface glycosaminoglycans (GAG) with heparin-like properties, i.e., heparan sulfate and dermatan sulfate. Furthermore, a single class of highly specific, protease-sensitive heparin/heparan sulfate binding sites exist on the surface of RL95 cells. Three heparin binding, tryptic peptide fragments were isolated from RL95 cell surfaces and their amino termini partially sequenced. Reverse transcription-polymerase chain reaction (RT-PCR) generated 1 to 4 PCR products per tryptic peptide. Northern blot analysis of RNA from RL95 cells using one of these RT-PCR products identified a 1.2 Kb mRNA species (p24). The amino acid sequence predicted from the cDNA sequence contains a putative heparin-binding domain. A synthetic peptide representing this putative heparin binding domain was used to generate a rabbit polyclonal antibody (anti-p24). Indirect immunofluorescence studies on RL95 and JAR cells as well as binding studies of anti-p24 to intact RL95 cells demonstrate that p24 is distributed on the cell surface. Western blots of RL95 membrane preparations identify a 24 kDa protein (p24) highly enriched in the 100,000 g pellet plasma membrane-enriched fraction. p24 eluted from membranes with 0.8 M NaCl, but not 0.6 M NaCl, suggesting that it is a peripheral membrane component. Solubilized p24 binds heparin by heparin affinity chromatography and $\sp{125}$I-heparin binding assays. Furthermore, indirect immunofluorescence studies indicate that cytotrophoblast of floating and attached villi of the human fetal-maternal interface are recognized by anti-p24. The study also indicates that the HSPG, perlecan, accumulates where chorionic villi are attached to uterine stroma and where p24-expressing cytotrophoblast penetrate the stroma. Collectively, these data indicate that p24 is a cell surface membrane-associated heparin/heparan sulfate binding protein found in cytotrophoblast, but not many other cell types of the fetal-maternal interface. Furthermore, p24 colocalizes with HSPGs in regions of cytotrophoblast invasion. These observations are consistent with a role for HSPGs and HSPG binding proteins in human trophoblast-uterine cell interactions. ^

Regression of the inflammatory microenvironment of the peritoneal cavity in women with endometriosis by GnRHa treatment.

OBJECTIVE To investigate the effect of gonadotropin-releasing hormone analogues (GnRHa) on the peritoneal fluid microenvironment in women with endometriosis. STUDY DESIGN Peritoneal fluid was collected from 85 women with severe endometriosis (rAFS stage III and IV) during laparoscopic surgery during the proliferative phase. Prior to surgery clinical data were collected. The concentrations of specific markers for endometriosis in the peritoneal fluid were determined using an ELISA and a comparison between peritoneal fluid markers in women using GnRHa and no hormonal treatment was performed using a non-parametric Mann-Whitney U test. RESULTS The study included peritoneal fluid from 39 patients who had been administered GnRHa (Zoladex(®)) in the three months prior to surgery and 46 from women with no hormonal treatment in this period. Concentrations of IL-8, PAPP-A, glycodelin-A and midkine were significantly reduced in the GnRHa treatment group compared to women receiving no hormonal treatment. RANTES, MCP-1, ENA-78, TNF-α, OPG, IP-10 and defensin showed no significant change between the two groups. CONCLUSIONS GnRHa mediate a significant regression in the inflammatory nature of the peritoneal microenvironment in women with endometriosis.

Ovarian and uterine development and hormonal feedback mechanism in a 46 XX patient with CYP19A1 deficiency under low dose estrogen replacement.

Abstract Background: Aromatase deficiency may result in a complete block of estrogen synthesis because of the failure to convert androgens to estrogens. In females, this results in virilisation at birth, ovarian cysts in prepuberty and lack of pubertal development but virilisation, thereafter. Objective and methods: We studied the impact of oral 17β-estradiol treatment on ovarian and uterine development, and on LH/FSH and inhibin B during the long-term follow-up of a girl harboring compound heterozygote point mutations in the CYP19A1 gene. Results: In early childhood, low doses of oral 17β-estradiol were needed. During prepuberty treatment with slowly increasing doses of E2 resulted in normal uterine and almost normal development of ovarian volume, as well as number and size of follicles. Regarding hormonal feedback mechanisms, inhibin B levels were in the upper normal range during childhood and puberty. Low doses of estradiol did not suffice to achieve physiological gonadotropin levels in late prepuberty and puberty. However, when estradiol doses were further increased in late puberty levels of both FSH and LH declined with estradiol levels within normal range. Conclusion: Complete aromatase deficiency provides an excellent model of how ovarian and uterine development in relation to E2, LH, FSH and inhibin B feedback progresses from infancy to adolescence.

Modified natural cycle in vitro fertilization an alternative in vitro fertilization treatment with lower costs per achieved pregnancy but longer treatment time

OBJECTIVE To analyze the cost and time requirement per achieved pregnancy in optimized modified natural cycle in vitro fertilization (mNC-IVF) based on a treatment protocol with very few consultations and to compare those with conventional gonadotropin-stimulated aVF (clVF) cycles. STUDY DESIGN Mono centric prospective trial. Eighty infertile patients each received 1 modified mNC-IVF cycle using low doses of the clomiphene citrate. Based on the number of consultations and the clinical pregnancy rate per cycle, the total costs and required time to achieve a pregnancy were analyzed and compared with cIVF. Calculations for cIVF were based on standard therapy protocols and outcomes of European registries. RESULTS Patients (21-42 years old, 35.4 +/- 4.7 years) undergoing mNC-IVF required on average 1.2 consultations before follicle aspiration. Pregnancy rate per transfer and per initiated cycle were 25% and 13.6%, respectively. Multiple pregnancies did not occur. According to the calculations, total costs per pregnancy rate were around 15% lower with mNC-IVF as compared to cIVF. In contrast, time to achieve an equal pregnancy rate was calculated to take around 30% longer with mNC-IVF as compared to cIVF. CONCLUSION mNC-IVF using very low dosages of clomiphene citrate avoids multiple pregnancies and is less expensive but more time consuming per achieved pregnancy when compared to clVF.

Serum but not follicular fluid cytokine levels are increased in stimulated versus natural cycle IVF: a multiplexed assay study.

Throughout follicular growth the number of immune cells increases, enhanced under stimulation with exogenous gonadotropins. This treatment, however, may adversely influence folliculogenesis and negatively affect oocyte quality through modifications in the follicular concentrations of cytokines released by these immune cells. We studied this hypothesis by systematically analysing the concentrations of cytokines present in the serum and follicular fluid at the time of follicular aspiration in conventional gonadotropin-stimulated (c-IVF) cycles in comparison with natural cycle IVF (NC-IVF) in which the follicles were naturally matured. Our study involved 37 NC-IVF and 39 c-IVF cycles including 13 women who underwent both therapies. Mean age was 35.3 ± 4.6 (SD) and 34.2 ± 3.7 years in the NC-IVF and c-IVF groups (ns). Thirteen cytokines were determined in matched serum and FF samples. Interleukin (IL)-4, TNF-α, RANTES, eotaxin and interferon-gamma-induced protein-10 concentrations were lower in FF than in serum. IL-6, -8, -10, -18, monocyte chemotactic protein-1 (MCP-1), VEGF and leukaemia inhibitory factor (LIF) showed higher median levels in FF than in serum, indicating possible ovarian production. Most of these markers were also increased in concentration in the stimulated (c-IVF) than in the NC groups in the serum, but not in the follicular fluid. This finding can be attributed to the increased number of active follicles present after controlled ovarian stimulation. IL-8 was reduced in c-IVF cycles. Our study did not reveal differences in follicular fluid but in serum cytokine concentrations, suggesting that the follicular immune system might not be significantly affected by gonadotropin stimulation.

Low-dosage clomiphene reduces premature ovulation rates and increases transfer rates in natural-cycle IVF

Natural-cycle IVF has been suggested as an alternative IVF treatment. However, efficacy is limited due to high premature ovulation rates, resulting in low transfer rates. This study investigates whether low dosages of clomiphene citrate reduce premature ovulation rate and increase transfer rate. Of 112 women included (aged 35.2 ± 4.5 years) 108 underwent one natural-cycle IVF cycle with human chorionic gonadotrophin (HCG) to induce ovulation and 103 underwent one natural-cycle IVF cycle with 25 mg/day clomiphene from about day 7 until HCG administration. Before retrieval, 1.2 monitoring consultations per cycle were required. Clomiphene reduced premature ovulation rate, from 27.8% without to 6.8% with clomiphene (P < 0.001) and increased transfer rate from 39.8% to 54.4% (P = 0.039). Clinical pregnancy rates without and with clomiphene were 27.9% versus 25.0% per transfer and 11.1% versus 13.6% per initiated cycle. Use of clomiphene resulted in mild hot flushes and headache in 5% of patients. Nausea and persisting ovarian cyst formation was not observed. In conclusion, clomiphene citrate led to very few side effects, required 1.2 monitoring consultations, significantly reduced premature ovulation rate and significantly increased transfer rate per initiated cycle, an effect which was not age dependent.

Adjuvant exemestane with ovarian suppression in premenopausal breast cancer.

BACKGROUND Adjuvant therapy with an aromatase inhibitor improves outcomes, as compared with tamoxifen, in postmenopausal women with hormone-receptor-positive breast cancer. METHODS In two phase 3 trials, we randomly assigned premenopausal women with hormone-receptor-positive early breast cancer to the aromatase inhibitor exemestane plus ovarian suppression or tamoxifen plus ovarian suppression for a period of 5 years. Suppression of ovarian estrogen production was achieved with the use of the gonadotropin-releasing-hormone agonist triptorelin, oophorectomy, or ovarian irradiation. The primary analysis combined data from 4690 patients in the two trials. RESULTS After a median follow-up of 68 months, disease-free survival at 5 years was 91.1% in the exemestane-ovarian suppression group and 87.3% in the tamoxifen-ovarian suppression group (hazard ratio for disease recurrence, second invasive cancer, or death, 0.72; 95% confidence interval [CI], 0.60 to 0.85; P<0.001). The rate of freedom from breast cancer at 5 years was 92.8% in the exemestane-ovarian suppression group, as compared with 88.8% in the tamoxifen-ovarian suppression group (hazard ratio for recurrence, 0.66; 95% CI, 0.55 to 0.80; P<0.001). With 194 deaths (4.1% of the patients), overall survival did not differ significantly between the two groups (hazard ratio for death in the exemestane-ovarian suppression group, 1.14; 95% CI, 0.86 to 1.51; P=0.37). Selected adverse events of grade 3 or 4 were reported for 30.6% of the patients in the exemestane-ovarian suppression group and 29.4% of those in the tamoxifen-ovarian suppression group, with profiles similar to those for postmenopausal women. CONCLUSIONS In premenopausal women with hormone-receptor-positive early breast cancer, adjuvant treatment with exemestane plus ovarian suppression, as compared with tamoxifen plus ovarian suppression, significantly reduced recurrence. (Funded by Pfizer and others; TEXT and SOFT ClinicalTrials.gov numbers, NCT00066703 and NCT00066690, respectively.).

Interventions for hirsutism (excluding laser and photoepilation therapy alone)

BACKGROUND Hirsutism occurs in 5% to 10% of women of reproductive age when there is excessive terminal hair growth in androgen-sensitive areas (male pattern). It is a distressing disorder with a major impact on quality of life. The most common cause is polycystic ovary syndrome. There are many treatment options, but it is not clear which are most effective. OBJECTIVES To assess the effects of interventions (except laser and light-based therapies alone) for hirsutism. SEARCH METHODS We searched the Cochrane Skin Group Specialised Register, CENTRAL (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), and five trials registers, and checked reference lists of included studies for additional trials. The last search was in June 2014. SELECTION CRITERIA Randomised controlled trials (RCTs) in hirsute women with polycystic ovary syndrome, idiopathic hirsutism, or idiopathic hyperandrogenism. DATA COLLECTION AND ANALYSIS Two independent authors carried out study selection, data extraction, 'Risk of bias' assessment, and analyses. MAIN RESULTS We included 157 studies (sample size 30 to 80) comprising 10,550 women (mean age 25 years). The majority of studies (123/157) were 'high', 30 'unclear', and four 'low' risk of bias. Lack of blinding was the most frequent source of bias. Treatment duration was six to 12 months. Forty-eight studies provided no usable or retrievable data, i.e. lack of separate data for hirsute women, conference proceedings, and losses to follow-up above 40%.Primary outcomes, 'participant-reported improvement of hirsutism' and 'change in health-related quality of life', were addressed in few studies, and adverse events in only half. In most comparisons there was insufficient evidence to determine if the number of reported adverse events differed. These included known adverse events: gastrointestinal discomfort, breast tenderness, reduced libido, dry skin (flutamide and finasteride); irregular bleeding (spironolactone); nausea, diarrhoea, bloating (metformin); hot flushes, decreased libido, vaginal dryness, headaches (gonadotropin-releasing hormone (GnRH) analogues)).Clinician's evaluation of hirsutism and change in androgen levels were addressed in most comparisons, change in body mass index (BMI) and improvement of other clinical signs of hyperandrogenism in one-third of studies.The quality of evidence was moderate to very low for most outcomes.There was low quality evidence for the effect of two oral contraceptive pills (OCPs) (ethinyl estradiol + cyproterone acetate versus ethinyl estradiol + desogestrel) on change from baseline of Ferriman-Gallwey scores. The mean difference (MD) was -1.84 (95% confidence interval (CI) -3.86 to 0.18).There was very low quality evidence that flutamide 250 mg, twice daily, reduced Ferriman-Gallwey scores more effectively than placebo (MD -7.60, 95% CI -10.53 to -4.67 and MD -7.20, 95% CI -10.15 to -4.25). Participants' evaluations in one study with 20 participants confirmed these results (risk ratio (RR) 17.00, 95% CI 1.11 to 259.87).Spironolactone 100 mg daily was more effective than placebo in reducing Ferriman-Gallwey scores (MD -7.69, 95% CI -10.12 to -5.26) (low quality evidence). It showed similar effectiveness to flutamide in two studies (MD -1.90, 95% CI -5.01 to 1.21 and MD 0.49, 95% CI -1.99 to 2.97) (very low quality evidence), as well as to finasteride in two studies (MD 1.49, 95% CI -0.58 to 3.56 and MD 0.40, 95% CI -1.18 to 1.98) (low quality evidence).Although there was very low quality evidence of a difference in reduction of Ferriman-Gallwey scores for finasteride 5 mg to 7.5 mg daily versus placebo (MD -5.73, 95% CI -6.87 to -4.58), it was unlikely it was clinically meaningful. These results were reinforced by participants' assessments (RR 2.06, 95% CI 0.99 to 4.29 and RR 11.00, 95% CI 0.69 to 175.86). However, finasteride showed inconsistent results in comparisons with other treatments, and no firm conclusions could be reached.Metformin demonstrated no benefit over placebo in reduction of Ferriman-Gallwey scores (MD 0.05, 95% CI -1.02 to 1.12), but the quality of evidence was low. Results regarding the effectiveness of GnRH analogues were inconsistent, varying from minimal to important improvements.We were unable to pool data for OCPs with cyproterone acetate 20 mg to 100 mg due to clinical and methodological heterogeneity between studies. However, addition of cyproterone acetate to OCPs provided greater reductions in Ferriman-Gallwey scores.Two studies, comparing finasteride 5 mg and spironolactone 100 mg, did not show differences in participant assessments and reduction of Ferriman-Gallwey scores (low quality evidence). Ferriman-Gallwey scores from three studies comparing flutamide versus metformin could not be pooled (I² = 62%). One study comparing flutamide 250 mg twice daily with metformin 850 mg twice daily for 12 months, which reached a higher cumulative dosage than two other studies evaluating this comparison, showed flutamide to be more effective (MD -6.30, 95% CI -9.83 to -2.77) (very low quality evidence). Data showing reductions in Ferriman-Gallwey scores could not be pooled for four studies comparing finasteride with flutamide as the results were inconsistent (I² = 67%).Studies examining effects of hypocaloric diets reported reductions in BMI, but which did not result in reductions in Ferriman-Gallwey scores. Although certain cosmetic measures are commonly used, we did not identify any relevant RCTs. AUTHORS' CONCLUSIONS Treatments may need to incorporate pharmacological therapies, cosmetic procedures, and psychological support. For mild hirsutism there is evidence of limited quality that OCPs are effective. Flutamide 250 mg twice daily and spironolactone 100 mg daily appeared to be effective and safe, albeit the evidence was low to very low quality. Finasteride 5 mg daily showed inconsistent results in different comparisons, therefore no firm conclusions can be made. As the side effects of antiandrogens and finasteride are well known, these should be accounted for in any clinical decision-making. There was low quality evidence that metformin was ineffective for hirsutism and although GnRH analogues showed inconsistent results in reducing hirsutism they do have significant side effects.Further research should consist of well-designed, rigorously reported, head-to-head trials examining OCPs combined with antiandrogens or 5α-reductase inhibitor against OCP monotherapy, as well as the different antiandrogens and 5α-reductase inhibitors against each other. Outcomes should be based on standardised scales of participants' assessment of treatment efficacy, with a greater emphasis on change in quality of life as a result of treatment.

ALTERATIONS IN HYPOTHALAMIC CONTENT OF LUTEINIZING HORMONE RELEASING HORMONE AND PITUITARY RESPONSIVENESS ASSOCIATED WITH TESTICULAR REGRESSION INDUCED BY PINEAL RELATED TREATMENTS IN THE GOLDEN HAMSTER

The adult male golden hamster, when exposed to blinding (BL), short photoperiod (SP), or daily melatonin injections (MEL) demonstrates dramatic reproductive collapse. This collapse can be blocked by removal of the pineal gland prior to treatment. Reproductive collapse is characterized by a dramatic decrease in both testicular weight and serum gonadotropin titers. The present study was designed to examine the interactions of the hypothalamus and pituitary gland during testicular regression, and to specifically compare and contrast changes caused by the three commonly employed methods of inducing testicular regression (BL,SP,MEL). Hypothalamic LHRH content was altered by all three treatments. There was an initial increase in content of LHRH that occurred concomitantly with the decreased serum gonadotropin titers, followed by a precipitous decline in LHRH content which reflected the rapid increases in both serum LH and FSH which occur during spontaneous testicular recrudescence. In vitro pituitary responsiveness was altered by all three treatments: there was a decline in basal and maximally stimulatable release of both LH and FSH which paralleled the fall of serum gonadotropins. During recrudescence both basal and maximal release dramatically increased in a manner comparable to serum hormone levels. While all three treatments were equally effective in their ability to induce changes at all levels of the endocrine system, there were important temporal differences in the effects of the various treatments. Melatonin injections induced the most rapid changes in endocrine parameters, followed by exposure to short photoperiod. Blinding required the most time to induce the same changes. This study has demonstrated that pineal-mediated testicular regression is a process which involves dynamic changes in multiply-dependent endocrine relationships, and proper evaluation of these changes must be performed with specific temporal events in mind. ^

ATTITUDES TOWARD AND UTILIZATION OF NON-INVASIVE PRENATAL TESTING FOR CHROMOSOME ANEUPLOIDY AMONG OB/GYNS

Prenatal diagnosis is traditionally made via invasive procedures such as amniocentesis and chorionic villus sampling (CVS). However, both procedures carry a risk of complications, including miscarriage. Many groups have spent years searching for a way to diagnose a chromosome aneuploidy without putting the fetus or the mother at risk for complications. Non-invasive prenatal testing (NIPT) for chromosome aneuploidy became commercially available in the fall of 2011, with detection rates similar to those of invasive procedures for the common autosomal aneuploidies (Palomaki et al., 2011; Ashoor et al. 2012; Bianchi et al. 2012). Eventually NIPT may become the diagnostic standard of care and reduce invasive procedure-related losses (Palomaki et al., 2011). The integration of NIPT into clinical practice has potential to revolutionize prenatal diagnosis; however, it also raises some crucial issues for practitioners. Now that the test is clinically available, no studies have looked at the physicians that will be ordering the testing or referring patients to practitioners who do. This study aimed to evaluate the attitudes of OB/GYN’s and how they are incorporating the test into clinical practice. Our study shows that most physicians are offering this new, non-invasive technology to their patients, and that their practices were congruent with the literature and available professional society opinions. Those physicians who do not offer NIPT to their patients would like more literature on the topic as well as instructive guidelines from their professional societies. Additionally, this study shows that the practices and attitudes of MFMs and OBs differ. Our population feels that the incorporation of NIPT will change their practices by lowering the amount of invasive procedures, possibly replacing maternal serum screening, and that it will simplify prenatal diagnosis. However, those physicians who do not offer NIPT to their patients are not quite sure how the test will affect their clinical practice. From this study we are able to glean how physicians are incorporating this new technology into their practice and how they feel about the addition to their repertoire of tests. This knowledge gives insight as to how to best move forward with the quickly changing field of prenatal diagnosis.

Influencia de la castración y la línea genética paterna sobre el rendimiento productivo y la calidad de la canal y de la carne en cerdos sacrificados a pesos elevados

El objetivo general de esta Tesis Doctoral fue estudiar la influencia del sexo, el método de castración de los machos y la línea genética paterna sobre la productividad y la calidad de la canal y de la carne en cerdos blancos sacrificados a pesos elevados con destino a la industria de los productos curados de calidad. En el experimento 1, se utilizaron 360 cerdos sacrificados a 125 kg de peso vivo (PV) para estudiar la influencia del sexo y la castración [machos inmunocastrados (MI), machos castrados quirúrgicamente (MC) y hembras enteras (HE)] de dos líneas genéticas paternas Large White (Top York y Tempo) sobre los rendimientos productivos y la calidad de la canal y de la carne. La línea materna utilizada fue Large White × Landrace en todos los casos. Los MI se inmunizaron contra el factor de liberación de gonadotropina (GnRF) mediante la utilización de Improvac a los 78 (16 d en prueba) y 126 (64 d en prueba y 48 d antes del sacrificio) d de edad. Cada uno de los 6 tratamientos experimentales fue replicado 6 veces (cuadra con 10 cerdos). Desde el inicio de la prueba hasta el día de la primera inyección con Improvac (62 a 78 d de edad) los MI y las HE crecieron menos (P < 0,001) que los MC sin que se observaran diferencias en el consumo medio diario de pienso (CMD). Los MC tuvieron peor eficiencia alimenticia que las HE con los MI mostrando valores intermedios (P < 0,01). Entre las dos inyecciones de Improvac (78 a 126 d de edad), los MI crecieron y comieron menos que los MC, mostrando las HE valores intermedios (P < 0,001). Los MI fueron más eficientes que las HE y ambos más eficientes que los MC (P < 0,001). Sin embargo, desde la segunda inyección de Improvac hasta el sacrificio (126 a 174 d de edad) los MI crecieron más y fueron más eficientes (P < 0,001) que las HE y los MC. Al final de la prueba, MI y MC crecieron más (P < 0,01) que HE. Asimismo, los MI fueron más eficientes (P < 0,001) pero presentaron menor rendimiento de canal (P < 0,001) que los MC y las HE. Por otro lado, los MI y las HE depositaron menos grasa dorsal que los MC (P < 0,001). Las hembras tuvieron mayor rendimiento de lomo y menos grasa intramuscular que MI y MC (P < 0,01). Asimismo, las HE tuvieron mayor rendimiento de jamón en fresco y perfilado que los MC con los MI mostrando valores intermedios (P < 0,05). Los cerdos híbridos procedentes de machos Tempo crecieron más (P < 0,001) que los procedentes de machos Top York, sin que se encontraran diferencias para el CMD o para la eficiencia alimenticia. Los híbridos de los cruces con Top York tuvieron mejores rendimientos de jamones frescos y perfilados (P < 0,05) pero menor rendimiento de lomo y menos grasa intramuscular que los cruces con Tempo (P < 0,01). En conclusión, los MI presentaron mejor eficiencia alimenticia, pero menor rendimiento de canal que los MC y las HE. El contenido en grasa intramuscular fue similar entre MC y MI y superior para ambos que para las HE. Los cruces procedentes de la línea paterna Tempo crecieron más y tuvieron mayor contenido en grasa intramuscular, pero un rendimiento en jamón perfilado ligeramente inferior al de los cruces procedentes de la línea paterna Top York. Se concluye que la inmunocastración de los machos es una alternativa viable a la castración quirúrgica para la producción de cerdos pesados destinados a la industria de los productos curados. Debido a su mayor potencial de crecimiento y mayor contenido en grasa intramuscular, los híbridos procedentes de la línea paterna Tempo presentan ventajas frente a los híbridos procedentes de la línea paterna Top York cuando se destinan a la industria de productos curados de calidad. En el experimento 2, se utilizaron 240 cerdos para comparar los rendimientos productivos y los parámetros de calidad de la canal de MI, MC y HE destinados a la industria de productos cárnicos curados procedentes del cruce de la línea materna Large White × Landrace con la línea genética paterna Duroc o Pietrain. Entre las 2 inyecciones de Improvac (87 a 137 d de edad), los MI y las HE crecieron menos que los MC (P < 0,01). Asimismo, los MI comieron menos pienso que las HE y ambos menos que los MC (2,33, 2,55 y 2,77 kg/d; respectivamente; P < 0,001). Como resultado, los MI fueron más eficientes que los MC y las HE (P < 0,001). Desde la segunda inyección de Improvac hasta el momento del sacrificio (137 a 164 d de edad), los MI fueron más eficientes que las HE y ambos más que los MC (0,346, 0,323 y 0,300, respectivamente; P < 0,001). Las diferencias observadas en este periodo entre los sexos en cuanto a rendimientos productivos fueron más pronunciadas en los cerdos procedentes de la línea paterna Pietrain que los de la línea Duroc (P < 0,05 para la interacción). En el global de la prueba (87 a 164 d de edad) el sexo no afectó al crecimiento en los cerdos procedentes de la línea paterna Duroc pero en los cerdos procedentes de la línea paterna Pietrain, los MI y los MC crecieron más que las HE (P < 0,05 para la interacción). Asimismo, los MI tuvieron mejor eficiencia alimenticia (0,406, 0,364 y 0,380, P < 0,001) y menor rendimiento de la canal (76,6, 78,1 y 78,8%; P < 0,001) que los MC y las HE. Las canales de las HE fueron más magras que las canales de los MC, con las canales de los MI mostrando valores intermedios (P < 0,01). El rendimiento en jamones y lomos fue mayor para las HE que para los MI y los MC (P < 0,001). El contenido en grasa intramuscular fue menor en las HE que en los MC, con los MI mostrando valores intermedios (3,5 vs. 3,9 y 3,7%; P < 0,05). Por otra parte, los híbridos procedentes de machos Duroc crecieron más rápido (1,167 vs. 0,986 kg/d; P < 0,001), consumieron más pienso (3,07 vs. 2,56 kg/d; P < 0,001) y tuvieron más grasa intramuscular (P < 0,001), pero menor rendimiento en jamones y lomos (P < 0,01) que los híbridos procedentes de machos Pietrain. Se concluye que los MI presentaron mejores productividades pero menores rendimientos de canal que MC y HE. El contenido en grasa intramuscular en el músculo longissimus dorsi fue menor para las HE que para los MC con valores intermedios para los MI. Los cruces procedentes de la genética paterna Duroc crecieron más y tuvieron más grasa intramuscular pero menos rendimiento de jamón que los cerdos procedentes de machos Pietrain. Por tanto, los MI deben ser preferidos a los MC y los cruces con la línea paterna Duroc deben ser preferidos a los cruces con Pietrain para producir canales cuando sus partes nobles están destinadas a la industria de productos cárnicos curados. En base a estos resultados, se concluye que la inmunocastración es una alternativa factible a la castración quirúrgica y que líneas genéticas paternas Tempo y Duroc son mejores para la producción de cerdo blanco pesado que las líneas Top York y Pietrain. Las interacciones entre el sexo y las líneas genéticas paternas estudiadas, sugieren que el resultado final depende en parte de la línea genética paterna utilizada. En cualquier caso, la inmunocastración es una alternativa factible a la castración quirúrgica para la producción de canales destinadas a la industria de los productos cárnicos curados. ABSTRACT The general aim of this PhD Thesis was to study the influence of sex, method of castration, and genetic background of the sire line on growth performance and carcass and meat quality merits of heavy white pigs destined to the dry-cured industry. In experiment 1, 360 pigs slaughtered at 125 kg of body weight were used to study the influence of sex and castration methodology [immunocastrated males (ICM), surgically castrated males (SCM), and intact females (IF)] of 2 terminal Large White sire lines (Top York and Tempo) on growth performance and carcass and meat quality. The female line was Large White × Landrace in all cases. The ICM pigs were immunized against gonadotropin-releasing factor with Improvac at 78 (16 d on trial) and 126 (64 d on trial and 48 d before slaughter) d of age. Each of the 6 treatments was replicated 6 times (10 pigs/pen). From the start of the experiment to the day of the first Improvac injection (62 to 78 d of age), ICM and IF grew slowlier (P < 0.001) than SCM but no differences in feed intake were detected. The SCM pigs had greater gain to feed ratio (G:F) than the IF with the ICM pigs being intermediate (P < 0.01). Between the 2 Improvac injections (78 to 126 d of age), the ICM pigs ate less feed (P < 0.001) and grew slowlier rate than the SCM pigs, with the growth of IF being intermediate. The ICM pigs were more efficient than the IF, and both were more efficient than the SCM pigs (P < 0.001). However, from the second Improvac injection to slaughter (126 to 174 d of age), the ICM pigs grew at a faster rate (P < 0.001) and were more efficient (P < 0.001) than the IF and the SCM pigs. Cumulatively, ICM and SCM pigs grew faster (P < 0.01) than IF and the ICM pigs were more efficient than the other two sexes (P < 0.001). However, the ICM pigs had reduced (P < 0.001) carcass yield compared with SCM and IF. The ICM and IF pigs also had less (P < 0.001) backfat depth than the SCM pigs. Intact females had higher (P < 0.01) loin yield but less intramuscular fat (P < 0.01) than ICM and SCM pigs and higher (P < 0.05) fresh and trimmed ham yields than SCM pigs, with ICM pigs being intermediate. Crossbreds from the Tempo sires grew faster (P < 0.001) than crossbreds from the Top York sires but no differences (P > 0.10) were detected for feed intake or feed efficiency. Crossbreds from the Top York sires had higher (P < 0.05) fresh and trimmed ham yields but less (P < 0.01) loin yield and intramuscular fat content than crossbreds from the Tempo sires. In conclusion, ICM pigs are more efficient, but have less carcass yield than SCM and IF pigs. The intramuscular fat content was lowest for the IF and similar for ICM and SCM pigs. Crossbreds from Tempo sires were heavier and had greater intramuscular fat content, but had less trimmed ham yield as compared with crossbreds from the Top York sires. Immunocastrated pigs can replace SCM pigs for the production of heavy pigs destined for the dry-cured industry. Because of increased carcass weight and the higher intramuscular content, crossbreds from Tempo sires may have an advantage over crossbreds from Top York sires for the dry-cured industry. In experiment 2, a total of 240 pigs were used to compare growth performance and carcass quality traits of immunocastrated males, surgically castrated males, and intact females of crossbreds from Large White × Landrace females and Duroc or Pietrain sires destined to the dry-cured industry. Between the 2 Improvac injections (87 and 137 d of age), ICM and IF pigs had lower average daily gain (ADG) than SCM pigs (P < 0.01). Also, ICM pigs ate less feed than IF and both type of pigs ate less than SCM pigs (2.33, 2.55, and 2.77 kg/d; P < 0.001). Consequently, ICM pigs had better G:F than SCM and IF (P < 0.001). From the second Improvac injection to slaughter (137 to 164 d of age), ICM pigs were more efficient than IF and both were more efficient than SCM pigs (0.346, 0.323, and 0.300 g/g; P < 0.001). The differences in growth performance among genders observed in this period were more pronounced for the Pietrain than for the Duroc crossbreds (P < 0.05 for the interaction). For the entire experimental period (87 to 164 d of age), gender did not affect ADG for Duroc crossbreds but for Pietrain crossbreds ICM and SCM had higher ADG than IF (P < 0.05 for the interaction). The ICM pigs had better feed efficiency (0.406, 0.364, and 0.380; g/g; P < 0.001) and lower carcass yield (76.6, 78.1, and 78.8%; P < 0.001) than SCM or IF. Carcasses from IF were leaner than carcasses from SCM with carcasses from ICM being intermediate (P < 0.01). Ham and loin (P < 0.001) yields were higher for IF than for ICM or SCM pigs. Intramuscular fat content was lower for IF than for SCM pigs with that of ICM pigs being intermediate (3.5 vs. 3.9 and 3.7%; P < 0.05). Cumulatively, crossbreds from Duroc sires had higher ADG (1.167 vs. 0.986 kg/d; P < 0.001) and average daily feed intake (3.07 vs. 2.56 kg/d; P < 0.001) and more intramuscular fat (P < 0.001) but less ham and loin yields (P < 0.01) than crossbreds from Pietrain sires. It is concluded that growth performance was better, but carcass yield lower, for ICM pigs than for SCM and IF. Intramuscular fat content in longissimus dorsi muscle was lower for IF than for SCM pigs with ICM pigs being intermediate. Crossbreds from Duroc sires grew faster and had more intramuscular fat but less ham yield than crossbreds from Pietrain sires. Therefore, ICM pigs should be preferred to SCM pigs, and Duroc crossbreds should be preferred to Pietrain crossbreds to produce carcasses destined to the production of primal cuts for the dry-cured industry. We conclude that immunocastration might be a sound alternative to surgical castration in pigs and that Tempo and Duroc might be better for the production of heavy pigs than Top York and Pietrain. The interactions reported between sex and genetic sire line, suggested that the benefits of immunocastration as an alternative to surgical castration might depend at least part on the sire line used. In any case, immunocastration is a good alternative to surgical castration for the production of carcasses destined to the dry-cured industry.