Postnatal Exposure to Exogenous progesterone Exacerbates the Prenatally-Induced Abnormal Sperms Production and Function in Rats / La exposición Posnatal a la Progesterona Exógena Exacerba la Producción y Función Anormales de Espermatozoides Inducidas Prenatalmente en Ratas

SUMMARY: This study aimed at clarifying the impact of long-term prenatal and postnatal exposure to exogenous progesterone on sperm production and function, relative sex organs weights, and the levels of the relevant hormones in rats. Sixty male Wistar rats were included and classified into three groups (n=20 in each). A test I group had mature rats born to dams treated with progesterone prenatally. A test II group included rats exposed to progesterone during prenatal as well as postnatal periods, and a control group had rats treated with a placebo (olive oil). The test groups revealed a significant reduction in sperm count, motility, and viability with higher abnormal forms than the control group (P< 0.05). Similarly, the test groups revealed significantly lower serum testosterone and higher FSH and LH levels (P< 0.001). Interestingly, the test II group showed pronounced sperm abnormalities, an alarming decrease in sperm viability and motility, and a significant accretion in the relative testicular weight compared to the test I group (p <0.001). Long-term (prenatal and early postnatal) treatment with synthetic progesterone hurts sperm quantity and quality, adversely affecting future male fertility.

Este estudio tuvo como objetivo aclarar el impacto de la exposición prenatal y posnatal a largo plazo a la progesterona exógena en la producción y función de los espermatozoides, el peso relativo de los órganos sexuales y los niveles de las hormonas relevantes en ratas. Sesenta ratas macho Wistar fueron incluidas y clasificadas en tres grupos (n=20 en cada uno). Un grupo de prueba I tenía ratas maduras nacidas de madres tratadas con progesterona prenatalmente. Un grupo de prueba II incluyó ratas expuestas a progesterona durante los períodos prenatal y posnatal, y un grupo de control tenía ratas tratadas con un placebo (aceite de oliva). Los grupos de prueba revelaron una reducción significativa en el recuento, la motilidad y la viabilidad de los espermatozoides con formas anormales más altas que el grupo de control (P < 0,05). De manera similar, los grupos de prueba revelaron niveles significativamente más bajos de testosterona sérica y niveles más altos de FSH y LH (P < 0.001). Curiosamente, el grupo de prueba II mostró anormalidades espermáticas pronunciadas, una disminución alarmante en la viabilidad y motilidad de los espermatozoides y una acumulación significativa en el peso testicular relativo en comparación con el grupo de prueba I (p <0.001). El tratamiento a largo plazo (prenatal y posnatal temprano) con progesterona sintética daña la cantidad y la calidad del esperma, lo que afecta negativamente la futura fertilidad masculina.

Intravaginal progesterone device (1. 9g) and estradiol benzoate for follicular control in the mare during spring and summer / [Implante intravaginal de progesterona (1, 9g) e benzoato de estradiol no controle folicular de éguas durante a primavera e o verão]

The objective of this study was to evaluate follicular growth and ovulatory rates in mares treated with an intravaginal progesterone device (P4) during the 10-day period, associated with the use of estradiol benzoate (EB). The results were compared during the transition period (ET) in the spring and the breeding season in the summer (ER). The variables were submitted to ANOVA (Tukey's test), considering P<0.05. No ovulation occurred during the permanence of the P4 implant in both experimental periods. The ovulatory rate in the ER was 100% (n = 8) and in the ET 62.5% (n = 5; P = 0.0547). Significant differences were observed (<0.001), in both periods, comparing follicular growth rates during the permanence of P4 device (ER: 1.33 ± 0.89mm/d; ET: 1.00 ± 0.81mm/d) to the period without P4 (ER: 3.63 ± 1.33 mm/d; ET: 3.31 ± 1.66 mm/d). The present study demonstrated applicability and efficiency of a hormonal protocol using P4 intravaginal device and EB for follicular control in mares, both during ET and ER.

O objetivo deste trabalho foi avaliar a taxa de crescimento folicular e a taxa ovulatória em éguas tratadas com dispositivo intravaginal de progesterona (P4) durante o período de 10 dias, associado à utilização de benzoato de estradiol (BE). Os resultados foram comparados durante o período de transição (ET) da primavera com a época de reprodução no verão (ER). As variáveis foram submetidas à ANOVA (teste de Tukey), considerando-se P<0,05. Nenhuma ovulação ocorreu durante a permanência do dispositivo de P4 em ambos os períodos experimentais. A taxa ovulatória na ER foi de 100% (n = 8) e na ET, de 62,5% (n=5; P=0,0547). Diferença significativas (<0,001) foram observadas, em ambos os períodos experimentais, comparando as taxas de crescimento folicular durante a permanência da P4 (ER: 1,33 ± 0,89mm/d; ET: 1,00 ± 0,81mm/d) com o período sem P4 (ER: 3,63 ± 1,33mm/d; ET: 3,31 ± 1,66mm/d). O presente estudo demonstrou aplicabilidade e eficiência do protocolo hormonal utilizando dispositivo intravaginal de P4 e BE para controle folicular de éguas, tanto na ET quanto na ER.

Use of cooled buffalo semen as a strategy to increase conception rates in fixed-time artificial insemination programs during unfavorable reproductive periods / [Uso de sêmen resfriado de búfalo como estratégia para aumentar as taxas de concepção em programas de inseminação artificial em tempo fixo, durante períodos reprodutivos desfavoráveis]

The objective of this study was to compare the reproductive efficiency of dairy buffaloes undergoing fixed-time artificial insemination (FTAI) protocols based on progesterone/estrogen (P4/E2) and eCG during unfavorable breeding season using cooled (CS) and frozen semen (FS). A total of 446 buffaloes (> 40 days postpartum) were randomly distributed into four blocks (years): B1-2014 (n = 143), B2-2015 (n = 34), B3-2016 (n = 90), and B4-2017 (n = 179). Each block was subdivided into two (AI with CS and FS using the same ejaculate of each bull). Thus, the block subdivision was as follows: B1 (CS = 71 and FS = 72); B2 (CS = 18 and FS = 16); B3 (CS = 47 and FS = 43); and B4 (CS = 90 and FS = 89). The ejaculates of eight Murrah bulls collected using an artificial vagina were divided into two aliquots: one aliquot was diluted in Botu-Bov® commercial extender and cooled (BB-CS), and the other was diluted in the same extender and frozen (BB-FS). BB-CS aliquots were cooled at 5 °C/24 h using a refrigerator. BB-FS group aliquots were also cooled, and after equilibrating at 5 °C for 4 h, were placed in a 21-L Styrofoam box, 5 cm above the surface of liquid nitrogen. In the afternoon (A) on D0 (2:00 p.m.) the animals received EB 2.0 mg IM (Estrogin®) and an ear implant (CRESTAR® 3.0 mg P4). At D9 (A), the implant was removed, and the animals received eCG 400 IU IM (Folligon® 5000) + Cloprostenol PGF2α 0.530 mg IM (Sincrocio®). At D10 (A), the animals received EB 1.0 mg IM (Estrogin®), and at D12 (8:00 a.m.), AI was performed. At D42, pregnancy was diagnosed via ultrasonography. Total CRs were 48.2% CS and 34.6% FS for years 2014 to 2017, with a significant difference of 13.7% (P<0.05). In conclusion, cooled semen resulted in higher CR than frozen semen in dairy buffaloes under the P4/E2 and eCG FTAI during the unfavorable reproductive season.(AU)

O objetivo deste estudo foi comparar a eficiência reprodutiva de búfalas leiteiras submetidas a protocolos de inseminação artificial em tempo fixo (IATF) à base de progesterona/estrogênio (P4/E2) e eCG, durante a estação reprodutiva desfavorável, usando-se sêmen resfriado (SR) e congelado (SC) Um total de 446 búfalas (> 40 dias após o parto) foi distribuído aleatoriamente em quatro blocos (anos): B1-2014 (n = 143), B2-2015 (n = 34), B3-2016 (n = 90) e B4-2017 (n = 179). Cada bloco foi subdividido em dois (IA com SR e SC utilizando-se a mesma ejaculação de cada touro). Assim, a subdivisão do bloco foi a seguinte: B1 (SR = 71 e SC = 72); B2 (SR = 18 e SC = 16); B3 (SR = 47 e SC = 43); e B4 (SR = 90 e SC = 89). Os ejaculados de oito touros Murrah coletados com vagina artificial foram divididos em duas alíquotas: uma alíquota diluída em diluente comercial Botu-Bov® e resfriada (BB-SR), e a outra diluída no mesmo diluente e congelada (BB-SC). As alíquotas de BB-SR foram resfriados a 5°C/24h usando-se um refrigerador. As alíquotas do grupo BB-SC também foram resfriadas e, após equilíbrio a 5°C por 4h, foram colocadas em uma caixa de isopor de 21L, 5 cm acima da superfície do nitrogênio líquido. À tarde (A), no D0 (14h), os animais receberam BE 2,0 mg IM (Estrogin®) e um implante auricular (Crestar® 3,0 mg P4). No D9 (A), o implante foi retirado e os animais receberam eCG 400 UI IM (Folligon® 5000) + cloprostenol PGF2α 0,530 mg IM (Sincrocio®). No D10 (A), os animais receberam BE 1,0mg IM (Estrogin®), e, no D12 (8h da manhã), foram realizadas as IAs. No D42, a gestação foi diagnosticada por ultrassonografia. As taxas de concepção (TC) totais foram 48,2% SR e 34,6% SC para os anos de 2014 a 2017, com uma diferença significativa de 13,7% (P<0,05). Em conclusão, o sêmen resfriado resultou em maior TC do que o sêmen congelado em bubalinos leiteiros sob P4/E2 e eCG FTAI durante a estação reprodutiva desfavorável.(AU)

Efectos adversos y motivos de retiro de implante subdérmico Jadelle® en usuarias de Policlínica de salud Sexual y Reproductiva del Hospital de Clínicas en período junio 2015- diciembre 2017 / Adverse effects and reasons of remove of subdermico implant Jadelle® in users of Sexual and Reproductive Health Clinics of Hospital de Clinicas in period june 2015-december 2017

INTRODUCCIÓN: La anticoncepción hormonal, a través de implantes subdérmicos, es uno de los métodos anticonceptivos reversibles de larga duración más eficaces en la actualidad que está disponible en nuestro país en forma gratuita en el sistema público. OBJETIVO: Reconocer los efectos adversos y los motivos de retiro del Implante Jadelle® en usuarias del Hospital de Clínicas, así como evaluar la información recibida por las usuarias al momento de la colocación. MATERIAL Y MÉTODOS: Un total de 160 pacientes participaron en el estudio a través de una encuesta previo consentimiento informado. Se utilizó la estadística descriptiva en números absolutos y porcentuales. Resultados: Previo al uso, recibieron información sobre los probables efectos adversos del método el 83% de ellas, y acerca de la efectividad del método el 89 %. En cuanto a efectos adversos los presentaron el 80,6% de las usuarias, siendo la irregularidad de la menstruación la causa más frecuente constituyendo un 61%. CONCLUSIONES: Es alta la frecuencia de pacientes que presentan efectos adversos y que solicitan retiro del implante antes del tiempo a causa de ello, 35% de las usuarias, siendo el principal motivo la irregularidad menstrual en un 43% de los casos. Es recomendable realizar un correcto asesoramiento previo a la colocación e incentivar a las pacientes a concurrir a los controles médicos, luego de la colocación, para brindar asesoramiento y tratamiento si se presentara algún efecto adverso, con el fin de obtener una mejor continuidad de uso del método.

INTRODUCTION: Hormonal contraception, through subdermal implants, is one of the most effective long active reversal contraceptive methods currently available in our country for free in the public system. OBJETIVE: Recognize the adverse effects and the reasons for its withdrawal in users of the Hospital de Clínicas as well as to evaluate the information received by the users at the time of placement. METHODOLOGY: A total of 160 patients participated in the work with prior informed consent through a survey. Descriptive statistics were used in absolute and percentage numbers. They received information on the probable adverse effects of the 83% pre-use method, about the effectiveness of the 89% method. RESULTS: Regarding adverse effects, they were present in 80.6% of the users; the being irregularity of menstruation is the most frequent, constituting 61%. Concluding that the frequency of patients presenting with adverse effects and requesting removal of the implant before the time is high because of it, 35% of the users who requested removal menstrual irregularities were the main reason for 43% of patients. CONCLUSIONS: It is advisable to make a correct advice prior to placement and encourage patients to attend medical controls, after placement, to provide advice and treatment if any adverse effect occurs, in order to give better use in terms of method time.

Influência da progesterona injetável na taxa de prenhez e perda gestacional de fêmeas nelore de distintas categorias reprodutivas submetidas a inseminação artificial em tempo fixo / Influence of injectable progesterone on the pregnancy rate and gestational loss of Nellore females of different reproductive categories undergoing fixed-time artificial insemination

Progesterone (P4) is essential for embryonic development and maintenance of pregnancy when deficiency causes early embryonic loss. In this study, we investigated the ability of hormonal supplementation to improve the fertility of Nellore females subjected to fixed-time artificial insemination (IATF) protocols. Here, we evaluated the effect of long-acting injectable progesterone (iP4) supplementation in the D4 after IATF on pregnancy rate and pregnancy loss in Nellore females (Bos taurus indicus) from different reproductive categories in Western Amazonia. Eight hundred thirteen Nellore females from 5 farms were selected and distributed into 2 groups: control [GC; administration of 0.5 mL of 0.9% saline solution, intramuscularly - IM] (n = 407) and a group that received injectable progesterone (iP4) that was long-acting [GiP4; administration of 0.5 mL of iP4, 300 mg, via IM four days after IATF] (n = 406). Each group contained 3 subgroups: heifers, primiparous cows, and multiparous cows. Of the 407 animals in the CG, 103 were heifers, 107 primiparous, and 197 multiparous. Of the 406 animals in the GiP4 group, there were 101 heifers, 107 primiparous, and 198 multiparous. On a random day of the estrous cycle (D0), an intravaginal device containing 1 g of P4 and 2 mg of estradiol benzoate (BE) was inserted by intramuscular injection. On D8, the P4 device was removed and 150 µg of D-cloprostenol (PGF2α), 300 IU eCG, and 1 mg BE were administered IM. Cows were inseminated at D10, 48-52 h after procedure on D8. Pregnancy diagnosis was made between 35 and 40 days after insemination through ultrasound examination. Between 80 and 90 days after insemination, a new ultrasound examination was performed to assess early pregnancy loss. The data were processed using the SAS 9.2. The conception rate, pregnancy loss, and final conception rate were analyzed using PROC GLIMMIX according to groups (CG and GiP4), categories (heifers, primiparous and multiparous), and their interactions as variables. The differences in the means of least squares were adjusted using the Tukey­Kramer method. Statistical significance was defined as P < 0.05. The general conception rate was 46% (375/816). Regardless of the animal class, GiP4 animals (51.97%) had higher conception rates (P < 0.05) than CG (40.29%). In the subgroups (heifers, primiparous and multiparous cows), there was a difference (P < 0.05) between animals treated with iP4 (52.48%, 57.94%, and 48.48%, respectively) and those who were not (39.81%, 41.12%, and 40.10%, respectively). Gestational losses, regardless of the animal class, were higher in females in the CG (7.93%) [P < 0.05] compared to those in the GiP4 group (2.84%). Regardless of treatment with iP4, the percentage of gestational loss in heifers was significantly higher (10.64%) than that in primiparous and multiparous cows (3.77% and 2.86%, respectively). The final conception rates were higher in animals that received long-acting iP4, which increased the final pregnancy in all parity categories. In the present study, the use of iP4 increased the pregnancy rate in Nellore females, regardless of the category. Although there has been no consensus on the use of iP4, there is an agreement that increases in the pregnancy rate are related to the moment of exogenous P4 application. In addition to influencing the pregnancy rate, reduction in pregnancy losses is also attributed to iP4 treatment, a fact demonstrated in the present study, where animals treated with iP4 had a lower pregnancy loss rate than normally occurs in beef cattle. Supplementation with long-acting iP4 increased the pregnancy rate at D35-40, reduced pregnancy losses, and increased the conception rate on D80-90 days in Nellore females reared in the Western Amazon, regardless of the animal category.(AU)

Effect of the subdose of human chorionic gonadotropin applied in the Hou Hai acupoint on ovulation induction in mares / [Efeito da subdose de gonadotrofina coriônica humana aplicada no acuponto Hou Hai sobre a indução da ovulação em éguas]

The objective of this study was to evaluate the effects of an hCG sub dose applied at the Hou Hai acupoint on corpus luteum (CL) quality and ovulation induction in mares. Fifteen crossbred mares were distributed in randomized blocks and used in three periods with each period employed as the blocking factor in three treatments: T1 = 1500 IU of hCG via intravenous (IV); T2 = 450 IU of hCG applied at the false acupoint (IV); and T3 = 450 IU of hCG applied at the Hou Hai acupoint. Mean diameter of the CL, serum concentration of progesterone (P4), vascularization of the pre-ovulatory follicle and CL were evaluated. Females administered 450 IU of hCG at the Hou Hai acupoint exhibited greater ovulation rates (33.33%) 48h after induction; The minimum number of colored pixel (NCP) of the pre-ovulatory follicle of control females was superior (40.33) to that of mares administered 450 IU of hCG IV at the false acupoint (36.84) and similar to that of those administered hCG at the Hou Hai acupoint (39.31). Further, moderately positive correlations were found between the CL diameter and the P4 concentration on D8 (P<0.05). IV administration of 450 IU of hCG or at the Hou Hai acupoint was efficient at inducing ovulation and ensuring the quality of CL in mares.(AU)

O objetivo foi avaliar os efeitos de uma subdose de hCG aplicada no acuponto Hou Hai na qualidade do corpo lúteo (CL) e na indução da ovulação em éguas. Quinze éguas mestiças foram distribuídas em blocos ao acaso, sendo o período utilizado como fator de blocagem, em: T1 = 1500 UI de hCG por via intravenosa (IV); T2 = 450 UI de hCG aplicado no falso acuponto (IV) e T3 = 450 UI de hCG aplicada no acuponto Hou Hai. Avaliou-se diâmetro médio do CL, concentração sérica de progesterona (P4), vascularização do folículo pré-ovulatório e do CL. As fêmeas que receberam 450 UI de hCG no acuponto Hou Hai apresentaram maiores taxas de ovulação (33,33%) 48h após a indução. O número de pixels coloridos (NPC) mínimo do folículo pré-ovulatório das fêmeas do grupo controle foi superior (40,33) ao das éguas que receberam 450 UI de hCG IV no falso acuponto (36,84) e semelhante ao das éguas que receberam hCG no acuponto Hou Hai (39,31); correlações moderadamente positivas foram encontradas entre o diâmetro do CL e a concentração de P4, ambos no D8 (P <0,05). A administração IV de 450 UI de hCG ou no acuponto Hou Hai foi eficiente na indução da ovulação e na garantia da qualidade do CL nas éguas.(AU)

El defecto inherente del endometrio causa fallo de implantación en Técnica de Reproducción Asistida / Inherent defect of the endometrium causes implantation failure in Assisted Reproductive Technique

Introduction. Implantation failure appears to be a significant factor in Assisted reproductive technique (ART) procedures. Even a mature endometrium may be non-receptive, preventing implantation or rejection of implanted embryo in early months of pregnancy, resulting in miscarriage or unexplained infertility with or without other associated factors. Objective. To investigate causes of failed implantation inspite of uneventful Grade I embryo transfer in ART procedure Material and Method. 90 women aged range between 25-40 yr old who visited Department of Reproductive Medicine at Calcutta Fertility Mission, over a period of 24 months(January 2017 to December 2019) , satisfying the inclusion criteria, were enrolled in this observational study. Endometrial aspirate histopathology was done along with ∞5ß3 integrin expression. They were treated with natural micronized progesterone (NMP) or oral dydrogesterone and results of endometrial changes were statistically analyzed. Results. 28.89% and 31.11% of women were seen to have mid-secretory changes of the endometrium after being treated with NMP and dydrogesterone respectively. Integrins were expressed in only 59.26% of women with mid-secretory endometrium and 5.41% of early secretory endometrium, which was statistically significant (p value <0.001). Conclusion. About 70% patients even after treatment with estrogen and progestin did not have adequate response in endometrial maturation. Not all patients with mid-secretory endometrium had integrin positive, when tested. NMP and oral Dydrogesterone have similar effect in endometrial maturation as well as in yielding successful pregnancy in some patients with previously failed In-vitro fertilization embryo transfer (IVF-ET).

Cervical pessary plus progesterone for twin pregnancy with short cervix compared to unselected and non-treated twin pregnancy: a historical equivalence cohort study (EPM twin pessary study) / Pessário cervical associado a progesterona em gestações gemelares com colo curto comparado a gestações gemelares não selecionadas e não tratadas: estudo de coorte histórica de equivalência (Estudo de Pessário em Gêmeos EPM)

Abstract Objective The present study aims to determine if the use of cervical pessary plus progesterone in short-cervix (≤ 25 mm) dichorionic-diamniotic (DC-DA) twin pregnancies is equivalent to the rate of preterm births (PBs) with no intervention in unselected DC-DA twin pregnancies. Methods A historical cohort study was performed between 2010 and 2018, including a total of 57 pregnant women with DC-DA twin pregnancies. The women admitted from 2010 to 2012 (n = 32) received no treatment, and were not selected by cervical length (Non-Treated group, NTG), whereas those admitted from 2013 to 2018 (n = 25), were routinely submitted to cervical pessary plus progesterone after the diagnosis of short cervix from the 18th to the 27th weeks of gestation (Pessary-Progesterone group, PPG). The primary outcome analyzed was the rate of PBs before 34 weeks. Results There were no statistical differences between the NTG and the PPG regarding PB < 34 weeks (18.8%; versus 40.0%; respectively; p = 0.07) and the mean birthweight of the smallest twin (2,037 ± 425 g versus 2,195 ± 665 g; p = 0.327). The Kaplan-Meyer Survival analysis was performed, and there were no differences between the groups before 31.5 weeks. Logistic regression showed that a previous PB (< 37 weeks) presented an odds ratio (OR) of 15.951 (95%; confidence interval [95%;CI]: 1.294-196.557; p = 0.031*) for PB < 34 weeks in the PPG. Conclusion In DC-DA twin pregnancies with a short cervix, (which means a higher risk of PB), the treatment with cervical pessary plus progesterone could be considered equivalent in several aspects related to PB in the NTG, despite the big difference between these groups.

Resumo Objetivo Este estudo tem como objetivo determinar se o uso de pessário cervical associado a progesterona em gestações de gêmeos dicoriônicos-diamnióticos (DC-DAs) com colo do útero curto (≤ 25 mm) apresenta taxa de parto prematuro (PP) equivalente à de gestações gemelares DC-DA sem nenhuma intervenção/não selecionadas. Métodos Um estudo de coorte histórica foi realizado entre 2010 e 2018, incluindo um total de 57 mulheres grávidas com gestações gemelares DC-DA. As mulheres admitidas de 2010 a 2012 (n = 32) não receberam tratamento, e não foram selecionadas pelo comprimento cervical (grupo Não Tratado, GNT), enquanto as admitidas de 2013 a 2018 (n = 25) receberam pessário cervical rotineiramente associado a progesterona após o diagnóstico de colo curto entre a 18a e a 27ª semanas de gestação (grupo Pessário-Progesterona, GPP). O desfecho primário analisado foi a taxa de PP antes de 34 semanas. Resultados Não houve diferenças estatísticas entre o GNT e o GPP em relação ao PP < 34 semanas (respectivamente, 18,8%; versus 40,0%;; p = 0,07) e ao peso médio ao nascer do gêmeo menor (2.037 ± 425 g versus 2.195 ± 665 g; p = 0,327). A análise de Kaplan-Meyer foi realizada, e não houve diferenças entre os grupos antes de 31,5 semanas. A regressão logística demonstrou que o nascimento prematuro anterior (< 37 semanas) apresentou razão de probabilidades (odds ratio, OR) de 15,951 (intervalo de confiança de 95%; [IC95%;]: 1,294-196,557; p = 0,031*) para o nascimento prematuro < 34 semanas no GPP. Conclusão Em gêmeos DC-DA com colo uterino curto (o que significa maior risco de nascimento prematuro), o tratamento com pessário cervical associado a progesterona pode ser considerado equivalente em diversos aspectos relacionados à prematuridade no GNT, apesar da grande diferença entre os grupos.

Revisión de la utilidad del uso de progesterona en aborto recurrente de causa no precisada / Review of the usefulness of the use of progesterone in recurrent abortion of unknown cause

Resumen Introducción El AR de causa no precisada es un problema de salud reproductiva que impacta importantemente a las parejas. En casi el 50% de los casos de AR no se encuentra una etiología clara, por lo que es necesario lograr encontrar estrategias de tratamiento que puedan ayudar a mejorar las probabilidades de lograr un embarazo de término. Objetivo analizar la bibliografía existente en cuanto a la utilidad de la progesterona para reducir tasa de aborto en las parejas con AR de causa no precisada en ciclos naturales Métodos: Revisión sistemática cualitativa respecto al uso de progesterona en casos de aborto recurrente de causa no precisada. Resultados Se encontraron 3 artículos. Todos usaron progesterona vaginal, 2 desde el inicio de la fase lútea con disminución de los abortos, uno no demostró este efecto con inicio más tardío de la intervención. Conclusiones Los estudios encontrados orientan a que el uso de progesterona vaginal podría ser de utilidad para disminuir abortos en pacientes con AR iniciando la suplementación al comienzo de la fase lútea.

Establishment of a rat model for uterine leiomyomas based on Western and traditional Chinese medicine theories

Uterine leiomyomas (ULs) are benign monoclonal tumors that arise from the underlying myometrial tissue in the uterus. Effective therapies are still lacking because of poor understanding of the pathophysiology and epidemiology. Hence, it is urgent to establish efficient animal models to screen novel anti-UL therapies. In this study, for the first time, traditional Chinese medicine and Western medicine were combined to establish an animal model of ULs in rats. In order to evaluate the function and value of the novel model, it was compared with other models. The long-term and short-term rat models for ULs were established using progesterone and diethylstilbestrol. Rats in Qi stagnation and blood stasis group were injected with epinephrine hydrochloride and received chronic unpredictable stress for two weeks. Rats in combining disease with syndrome group (CDWSG) received not only epinephrine hydrochloride injection and chronic unpredictable stress but also progesterone and diethylstilbestrol treatment. We analyzed differences in organ coefficient, uterus size, uterine pathology, concentrations of progesterone, estradiol, progesterone receptor, estrogen receptor, expression of desmin, α-smooth muscle actin, and vimentin among the five groups. The animal model of ULs was successfully constructed by loading the rats with estrogen and progesterone. The rat model of CDWSG was more stable than other groups and the method was the most efficient.

Sangramento anormal durante terapia hormonal na pré e perimenopausa: racional para manejo clínico / Abnormal bleeding during perimenopause hormone therapy: insights for clinical management

Este estudo tem como objetivo rever o estado da arte e racional para guiar a conduta no sangramento anormal durante a terapia hormonal combinada sequencial na perimenopausa. Antes de iniciar a terapia, é essencial excluir qualquer condição pélvica anormal, identificar as mulheres com maior risco de sangramento e moldar o regime às características clínico-laboratoriais de cada paciente. Na perimenopausa, particularmente na mulher que ainda mantém secreção ovariana de estrogênio ou mesmo estrogênio-progesterona, o regime de escolha é o combinado sequencial. Tatear a dose individualmente é recomendável nos primeiros meses de uso. Qualquer ação para parar o sangramento deve ser baseada na identificação correta da causa subjacente. É importante observar se o sangramento ocorre na fase estrogênica ou progestogênica da combinação utilizada, se o seu início foi precedido de longo tempo de sangramento normal, se houve introdução de medicação concomitante e se a ingesta tem sido regular. O tratamento consiste no ajuste da dose do estrogênio ou do progestogênio, na troca do progestogênio para outro com maior impacto sobre o endométrio, ou na troca do regime combinado sequencial para o combinado contínuo, como medida de exceção.(AU)

The current study aimed to review the state of art and provide a rational approach to the diagnosis and treatment of abnormal bleeding during combined sequential hormone therapy (HT). Before starting, it is essential to exclude any pelvic abnormal condition, to identify those women with higher risk of bleeding and to tailor the regimen to the needs of individual women. During perimenopause, particularly in women still keeping ovarian secretion, the choice is the combined sequential regimen. It is recommended to titer the dosis individually. Any action to stop the bleeding must be based on correct identification of the underlying cause. It is important to consider whether the bleeding started in the strogenic or progestogenic phases of the combined regimen, if the abnormal bleeding was preceded of long-term normal bleeding or if any concomitant medication was prescribed. The core treatment consists of estrogen/progestogen dose adjustment, change of the progestogen, or change of the sequential to the combined continuos regimen an exceptional measure.(AU)

Comportamento de éguas após a inserção de dispositivo intravaginal impregnado com progesterona / Behavior of mares after insertion of intravaginal progesterone device / Comportamiento en yeguas después de la inserción del dispositivo intravaginal impregnado con progesterona

Considerando a escassez de estudos sobre o temperamento ou reatividade de equinos, objetivou-se com esse estudo avaliar o comportamento de éguas após a inserção do implante intravaginal de progesterona, para utilização em bovinos, por meio da observação de comportamentos individuais e coletivos. Para tanto, utilizou-se sete éguas que receberam dispositivo intravaginal impregnado com progesterona e agente luteolítico. Após a colocação dos implantes e soltura das éguas, se iniciou a observação (cinco observadores sem contato entre eles) de seus comportamentos até o tempo de 120 minutos, seguindo o modelo proposto por Heleski et al. (2002). Os resultados indicaram que durante os 120 minutos de observação todas as éguas demonstraram estar alertas, pelo menos em uma observação; que o ato de comer foi observado em todos os animais durante o período estudado e que o ato de urinar e defecar foram observados, em aproximadamente, 70 e 60%, respectivamente, dos comportamentos avaliados. Comportamentos prováveis da indicação de dor e/ou desconforto, como bater da cauda, mímica de urinar, eversão do clitóris e urinando foram observados até 65 minutos, sendo que os três primeiros cessaram aos 55 minutos. De todos os comportamentos analisados, nenhum deles foi visualizado após 65 minutos de observação. Concluiu-se que a inserção do dispositivo intravaginal impregnado com progesterona não afeta negativamente o comportamento de éguas, podendo ser utilizado sem comprometer o bem-estar desses animais.

Considering the scarcity of studies on the behavior or reactivity of horses, this study aimed to assess the behavior of mares after insertion of intravaginal progesterone implant for use in cattle, through the observation of individual and collective behavior. In order to do so, seven mares received intravaginal devices impregnated with progesterone and luteolitic agent. After the implant was placed, the mares were released, and their behavior was observed (five observers with no contact between them) for a period of 120 minutes, following the model proposed by Heleski et al. (2002). The results indicated that during the 120-minute period, all mares were alert, in at least one observation; that all animals ate during the study period, and urination and defecation were observed in approximately 70 and 60%, respectively, of the assessed behavior. Behaviors that were likely an indication of pain and/or discomfort, like hitting the tail, miming to urinate, eversion of the clitoris and urinating were observed in up to 65 minutes, with the first three symptoms ceasing after 55 minutes. None of the analyzed behaviors were viewed after 65 minutes of observation. It can be concluded that the insertion of the intravaginal device impregnated with progesterone does not adversely affect the behavior of mares, and therefore, it can be used without compromising the well-being of the animals.

Teniendo en cuenta la escasez de estudios sobre el temperamento o la reactividad de equinos, este estudio buscó evaluar el comportamiento de yeguas después de la inserción del implante de progesterona intravaginal, para su uso en ganado, a través de observación de conductas individuales y colectivas. Para ello, se utilizó siete yeguas que recibieron dispositivo intravaginal impregnado con progesterona y agente luteolítico. Después de los implantes y la liberación de las yeguas, comenzó la observación (cinco observadores sin contacto entre ellos) de sus comportamientos hasta el tiempo de 120 minutos, siguiendo el modelo propuesto por Heleski et al. (2002). Los resultados indicaron que durante los 120 minutos de observación todas las yeguas demostraron estar alertas, por lo menos en una observación; el acto de comer se observó en todos los animales durante el periodo de estudio y que el acto de la micción y la defecación, en aproximadamente, 70 y 60%, respectivamente, de los comportamientos evaluados. Comportamientos probables de indicación de dolor y/o malestar, como golpear la cola, la mímica de orinar, eversión del clítoris y orinando, observados hasta 65 minutos, siendo que los tres primeros cesaron después de 55 minutos. De todos los comportamientos analizados, ninguno de ellos se visualizó después de la observación de 65 minutos. Se concluyó que la inserción del dispositivo intravaginal impregnado con progesterona no afecta negativamente el comportamiento de yeguas, que puede ser utilizado sin comprometer el bienestar de esos animales.

Influence of monoolein on progesterone transdermal delivery

abstract This work aimed to investigate in vitro the influence of monoolein (MO) on progesterone (PG) transdermal delivery and skin retention. Information about the role of MO as an absorption enhancer for lipophilic molecules can help on innovative product development capable of delivering the hormone through the skin in a consistent manner, improving transdermal therapy of hormonal replacement. MO was dispersed in propylene glycol under heat at concentrations of 0% (control), 5% w/w, 10% w/w and 20% w/w. Then, 0.6% of PG (w/w) was added to each formulation. Permeation profile of the hormone was determined in vitro for 48 h using porcine skin in Franz diffusion cells. PG permeation doubled when 5% (w/w) of MO was present in formulation in comparison to both the control and higher MO concentrations (10% and 20% w/w). An equal trend was observed for PG retention in stratum corneum (SC) and reminiscent skin (E+D). PG release rates from the MO formulations, investigated using cellulose membranes, revealed that concentrations of MO higher than 5% (w/w) hindered PG release, which indeed negatively reflected on the hormone permeation through the skin. In conclusion, this work demonstrated the feasibility of MO addition (at 5% w/w) in formulations as a simple method to increase transdermal PG delivery for therapies of hormonal replacement. In contrast, higher MO concentrations (from 10% to 20% w/w) can control active release, and this approach could be extrapolated to other lipophilic, low-molecular-weight molecules.

resumo Este trabalho teve como objetivo investigar in vitro a influência de monooleína (MO) na permeação transdérmica de progesterona (PG), bem como sobre a retenção cutânea desse hormônio a fim de (i) liberar de maneira mais consistente hormônio através da pele para melhorar a terapia transdérmica de reposição hormonal e (ii) trazer mais informações sobre o papel da MO como promotor da absorção cutânea de moléculas lipofílicas, tema ainda pouco explorado na literatura. MO foi dispersa em propilenoglicol, a concentrações de 0% (controle), 5%, 10% e 20% (p/p). Adicionou-se, em seguida, 0,6% (p/p) de PG a cada uma das formulações. O perfil de permeação do hormônio foi então determinado in vitro durante 48 h, utilizando pele de porco em células de difusão do tipo Franz. MO a 5% (p/p) foi capaz de duplicar a permeação de PG em comparação ao controle e às concentrações mais elevadas de MO, assim como a retenção de PG no estrato córneo (SC) e epiderme e derme remanescentes (E+D). A velocidade de liberação de PG a partir das formulações foi investigada usando membranas de celulose e este estudo revelou que concentrações de MO superiores a 5% (p/p) impediram a liberacão de PG, o que de fato refletiu de forma negativa na permeação cutânea do hormônio. Concluindo, este trabalho demonstrou a viabilidade da adição de MO a uma formulação como um método simples para aumentar a permeação transdérmica de PG para uso em terapias de reposição hormonal. Por outro lado, altas concentrações de MO (de 10% a 20% p/p) controlam a liberação de PG e este efeito pode ser extrapolado para outras moléculas lipofílicas de baixa massa molecular.

Perfil de progesterona em novilhas com diferente atividade luteal e tratadas com implantes vaginais / Serum progesterone in heifers with different luteal activity treated with vaginal devices

O dispositivo de liberação de progesterona (DLP) é muito importante em protocolos de Inseminação Artificial em Tempo Fixo (IATF). Representa cerca de 43% dos custos e é objeto de estudos sobre a eficiência da sua reutilização. No entanto, perfis de liberação de progesterona (P4) em animais com diferentes concentrações endógenas desse esteroide não são claramente descritos. Este estudo teve como objetivo avaliar a concentração sérica de P4 em fêmeas com diferentes situações de atividade luteal, tratadas com DLP novo (1g de P4) por 8 dias. Trinta novilhas mestiças cíclicas foram divididas em três grupos: em G1 e G2, o DLP foi inserido (D0) sete dias após a ovulação induzida. Adicionalmente, 0,15mg de D-cloprostenol foi administrado três dias depois para promover a luteólise em G2. Para G3, o corpo lúteo foi lisado antes da inserção do DLP para que a P4 exógena fosse a única fonte desse hormônio. O sangue foi coletado no D0, D3, D5 e D8, e a P4 avaliada por RIA. Médias de P4 foram comparadas entre os grupos em cada dia e dentro do grupo, entre os dias, utilizando o teste Tukey. Antes da inserção do implante (D0), os níveis de P4 foram, nos grupos, semelhantes em G1 e G2, e superiores a G3 (5,3±3,1a e 5,3±1,4avs 0,6±0.3bng/mL, respectivamente-P<0,05). No D3, ocorreu o mesmo perfil (5,7±2,6a e 5,4±2,0a e 3,6±0.8bng/mL, respectivamente para G1 e G2 vs G3, P<0,05). Trinta e seis horas (D5) após a PGF, a P4 no G2 caiu para níveis semelhantes aos do grupo G3 e ambos diferiram (P<0,05) de G1 (3,3±1,6b vs 2,4±0,9b e 2,1±0.7bng/mL). Essa diferença se manteve (P<0,05) em D8 (3,1±1,3a, 1,8±0,8b e 1,6±0.6b ng/mL). O aumento da P4 após a inserção (D3 - D0) foi maior (P<0,05) em G3 que em G1 e G2 (2,8±0,9a vs 0,4±1,8b e 0,2±1.4bng/mL). Os animais com maior P4 endógena levam a menor liberação de P4 exógena a partir do DLP. Portanto, os níveis remanescentes de P4 no DLP após o uso dependem da concentração endógena de P4 do animal e possíveis alterações durante a permanência.(AU)

The progesterone (P4) device is a very important step in the ovulation control in Timed Artificial Insemination (TAI) protocols. It represents about 43% of the hormone costs, thus it has been the subject of several studies on efficiency of the reused device as an alternative to reduce TAI costs. However, to our knowledge, profiles for P4 release in animals with different endogenous concentrations of P4 are not clearly described. This study aimed to evaluate serum concentration of P4 in females with different ovarian conditions - related to luteal activity - and treated with a new intravaginal device (1g of P4) for 8 days. Thirty normally cyclic crossbred heifers were divided into three groups: for G1 and G2, P4 device was inserted (D0) seven days after ovulation (7 day old CL). Additional PGF (0.15 mg of D-cloprostenol) was given three days later to promote luteolysis in the G2 group. For G3, CL was killed before P4 insertion and the exogenous progesterone was the only source of this hormone. Blood samples were collected on D0, D3, D5 and D8 and P4 concentration was measured by radioimmunoassay (RIA). Means for P4 concentration were compared among groups in each day and within the group among days using the Tukey test. Before P4 device insertion (D0), P4 levels were higher (P<0.05) in G1 and G2 when compared to G3 (5.3±3.1 and 5.3±1.4 vs. 0.6±0.3ng/mL, respectively). Three days later (D3), the same pattern was observed (5.7±2.6 and 5.4±2.0 and 3.6±0.8ng/mL, respectively for G1 and G2 vs. G3, P<0.05). Thirty-six hours (D5) after PGF injection (G2), P4 in G2 dropped to levels similar to the G3 group and both differed (P<0.05) from G1 (3.3±1.6 vs. 2.4±0.9 and 2.1±0.7ng/mL, G1 vs. G2 and G3, respectively). There were no differences (P>0.05) among groups on D8 (3.1±1.3, 1.8±0.8 and 1.6±0.6ng/mL, respectively, for G1, G2 and G3). Progesterone increase after P4 insertion (D3 - D0) was higher (P<0.05) in G3 compared to G1 and G2 (2.8±0.9 vs. 0.4±1.8 and 0.2±1.4ng/mL, respectively). The interpretation was that animals with higher endogenous P4 promote less release of the exogenous P4 from the device. Therefore, the remaining P4 levels from used progesterone devices depend on the physiological condition of the animal at the time of insertion and possible changes during the treatment.(AU)

Eficácia da progesterona na prevenção do trabalho de parto prematuro gemelar: revisão sistemática / Progesterone efficacy for twin preterm labor prevention: a systematic review

Este estudo teve como objetivo realizar uma revisão sistemática de ensaios clínicos randomizados que analisaram a eficácia do uso da progesterona em reduzir o parto pré-termo na gravidez gemelar no período de 1994 até 2014. Segundo critérios pré-estabelecidos, foram incluídos dez artigos, com um total de 3.432 gestantes de gêmeos randomizadas para tratamento com progesterona versus placebo ou nenhum tratamento, entre os quais somente um estudo demonstrou algum benefício, mas com amostragem muito pequena. Concluímos, com o presente estudo, que as evidências não comprovam a eficácia da progesterona na prevenção de parto prematuro gemelar, em geral. São necessários estudos com maior número de gestantes gemelares que tenham fatores de risco para parto prematuro, tais como aquelas com colo curto e/ou história de parto prematuro prévio.

The goal of our study was to make a systematic review of randomized controlled trials that analyzed the efficacy of progesterone to reduce preterm birth in twin pregnancies published from 1994 to 2014. According to predetermined criteria, ten studies were included, with a total of 3,432 pregnant woman with twins randomized either to treatment with progesterone versus placebo or no treatment, among which only one study showed benefits, but with a very small sample. We conclude, from this study, that there is no evidence that progesterone prevents twin preterm birth, in general. More studies, that focus the use of progesterone in high risk twin pregnancies, such as short cervix or/and preterm birth history, are required.

Factors affecting the success of resynchronization protocols with or without progesterone supplementation in dairy cows

The objective of this study was to investigate factors that influence the success of resynchronization protocols for bovines with and without progesterone supplementation. Cow synchronized and not found pregnant were randomly assigned to two resynchronization protocols: ovsynch without progesterone (P4) supplementation (n = 66) or with exogenous P4 administered from Days 0 to 7 (n = 67). Progesterone levels were measured on Days 0 and 7 of these protocols as well as 4 and 5 days post-insemination. Progesterone supplementation raised the P4 levels on Day 7 (p 3.5 had increased P/AI values while cows with BCS < 2.75 had decreased P/AI rates after P4 supplementation. Primiparous cows had higher P4 values on Day 7 than pluriparous animals (p = 0.04) and tended to have higher RRs (p = 0.06). Results of this study indicate that progesterone supplementation in resynchronization protocols has minimal effects on outcomes. Parity had an effect on the levels of circulating progesterone at initiation of the protocol, which in turn influenced the RR.

Efectividad del tratamiento de la amenaza de parto pretérmimo con progesterona natural micronizada / Effectiveness of treatment of threatened labor preterm micronized natural progesterone

Objetivo: Evaluar la efectividad de la progesterona natural micronizada administrada vía oral y del fenoterol administrado vía endovenosa, en el tratamiento de las pacientes con diagnóstico de amenaza de parto pretérmino. Métodos: Estudio experimental tipo ensayo terapéutico en pacientes que acudieron al Hospital Universitario de Caracas. Resultados: 15 pacientes del grupo estudio con progesterona presentaron resultados satisfactorios (X² = 155,837, df = 18); del grupo control, 13 pacientes con resultados satisfactorios (X² = 133,093, df = 18). La efectividad absoluta en el grupo de estudio fue de 0,68 contra 0,59 del grupo control (X² = 0,393; df = 1; P < 0,531). Conclusiones: Los tratamientos con progesterona natural micronizada y fenoterol demostraron ser inhibitorios de la dinámica uterina, a partir de la segunda hora de iniciado el tratamiento, evitando su progreso hacia trabajo de parto en un 90 %. La progesterona natural micronizada es efectiva en el tratamiento de la amenaza de parto pretérmino y se debe considerar su uso como alternativa terapéutica.

Objective: To evaluate the effectiveness of micronized natural progesterone administered orally and intravenously administered fenoterol in the treatment of patients with a diagnosis of preterm labor. Method: The type of therapeutic trial in patients attended at the Hospital Universitario de Caracas. Results: 15 patients in the progesterone study showed satisfactory results (X² = 155.837 df = 18); the control group, 13 patients with satisfactory results (X² = 133.093 df = 18). The absolute effectiveness in the study group was 0.68 against 0.59 in the control group (X² = 0.393 df = 1, P < 0.531). Conclusions: Treatment with micronized natural progesterone and fenoterol proved inhibitory uterine dynamics from the second hour of starting treatment preventing its progress toward labor by 90 %. The micronized natural progesterone is effective in the treatment of preterm labor and should be considered as an alternative therapeutic use.

[Side effects of sustained-release vaginal suppository progesterone in pregnant women: gestational diabetes mellitus]

Evaluation of the potential impact of vaginal progesterone on both mother and fetus is necessary before expanding the indication of this drug especially throughout pregnancy. To evaluate the potential impact of vaginal progesterone on both mother and fetus. This case-control study was designed to collect data on the potential gestational diabetes mellitus complication associated with progesterone use comparing maternal and neonatal outcomes between 245pregnant women receiving vaginal suppository of Cyclogest [200mg] and 808controls without progesterone. The incidence of gestational diabetes was 9.8% and 5.2% in case and control groups, respectively [p=0.039]. According to linear regression analysis, there was a direct association between duration of progesterone usage and impairment of glucose tolerance test in group of cases [r=0.43; p=0.002]. The use of progesterone for the prevention of recurrent preterm delivery could associate with an increased risk of developing gestational diabetes

Leiomiomatose uterina: revisão / Uterine leiomyomatosis: review

Os leiomiomas uterinos são tumores monoclonais que se originam de uma mutação somática em um miócito progenitor. Representam a neoplasia benigna mais comum do útero. A causa precisa relacionada ao seu desenvolvimento ainda não foi totalmente esclarecida. As apresentações clínicas mais frequentes são o sangramento anormal, a dor e pressão pélvicas, massa pélvica não diagnosticada anteriormente e infertilidade. O diagnóstico baseia-se na história clínica, no exame físico, que pode ser completamente normal em alguns casos, e nos achados de exames complementares, como a ultrassonografia endovaginal, a histerossonografia e a ressonância magnética. O tratamento varia de acordo com a apresentação clínica e pode ser expectante, clínico ou cirúrgico.

The uterine leiomyomas are monoclonal tumors that originate from a somatic mutation in a myocyte progenitor and are the most common benign tumor of the uterus. The precise cause related to its development has not been fully clarified. The most common clinical presentations are abnormal vaginal bleeding, pelvic pain and pressure, previously undiagnosed pelvic mass, and infertility. The diagnosis is based on clinical history, physical examination, which may be completely normal in some cases, and the findings of laboratory tests such as transvaginal ultrasound, the sonohysterography, MRI. Treatment varies according to clinical presentation and may be expectant, medical or surgical.

Comparison of oral dydrogesterone with suppository vaginal progesterone for luteal-phase support in in vitro fertilization [IVF]: a randomized clinical trial

Luteal phase support is mandatory in assisted reproductive technologies [ART] for optimizing outcome, so the luteal phase is supported with either progesterone, addition of estradiol to progesterone, hCG or gonadotropin releasing hormone [GnRH] agonists. Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. To compare oral dydrogestrone with vaginal progesterone for luteal-phase support in IVF. We performed this prospective, randomized trial in a tertiary infertility care unit in Taleghani Hospital, Tehran, Iran. In total 80 Women with a history of male factor infertility undergoing controlled ovarian stimulation for IVF treatment [fresh cycle] randomly were divided in two groups [group A or oral dydrogesterone group and group B or vaginal progesterone group]. The inclusion criteria were the use of GnRH analogue down-regulation and age less than 40 years old with regular menstrual cycles. All women were euthyroid and normoprolactinemic. Group A [n=40] received 10 mg dydrogesterone QID [40mg daily] and group B [n=40] received 400 mg suppository vaginal progesterone [cyclogest] twice per day [800 mg daily]. Clinical pregnancy rate in cyclogest group was higher than dydrogesterone group but the difference was not significant [p=0.52], furthermore the miscarriage rate in two group was the same .The difference between two groups regarding antral follicle, embryo number, luteal-phase duration, endometrial thickness, oocyte number and metaphase-II was not significant [p>0.05]. The results showed that oral dydrogesterone is as effective as vaginal progesterone for luteal-phase support in women undergoing IVF