The effect of single dose of gonadotropin-releasing hormone agonist injection in frozen-thawed embryo transfer on pregnancy outcomes: A systematic review and meta-analysis.

This systematic review and meta-analysis of randomized controlled trials aimed to evaluate the effect of a single-dose gonadotropin-releasing hormone agonist administration in the frozen-thawed embryo transfer cycle on pregnancy outcomes. A literature search was strategically conducted using PubMed, EMBASE, and the Cochrane Controlled Trials Register. The primary outcome was the clinical pregnancy rate. The secondary outcomes combined chemical pregnancy rate, implantation rate, ongoing pregnancy rate, live birth rate, miscarriage rate, and extrauterine pregnancy rate. Out of the 1594 citations that were found, only six met the criteria for being included in the meta-analysis. The clinical pregnancy rate was higher in the treatment group than in the control group (52.05% vs. 47.29%; p=0.04; RR=1.09; 95% CI=1.00-1.18). According to subgroup analysis based on the natural cycle, the clinical pregnancy rate with the agonist administration is significantly higher (43.75% vs. 27.35%; p=0.01; RR=1.6; 95% CI=1.10-2.32). However, there was no difference between the groups in terms of artificial cycles (p=0.80; 95% CI=0.96-1.20). The secondary outcomes did not show significant differences. We concluded that supplementing with a single dose of gonadotrophin-releasing hormone agonist can marginally increase the clinical pregnancy rate, particularly in the natural cycle. Other pregnancy outcomes do not improve with the treatment.

Effect of the estrous cycle on zinc transporter expression in bovine cumulus-oocyte complexes and oviduct epithelial cells.

During the luteal and follicular phases of the estrous cycle, cumulus-oocyte complexes (COC) and oviduct epithelial cells (OEC) undergo notable physiological and morphological changes. Maintaining proper zinc (Zn) homeostasis is crucial in both somatic and germinal mammalian cells. This study aimed to assess the impact of the estrous phase (luteal or follicular) on Zn transporter expression in bovine COC and OEC (BOEC). The expression of Zn transporters Slc39a6 (ZIP6), Slc39a8 (ZIP8), Slc39a14 (ZIP14), Slc30a3 (ZnT3), Slc30a7 (ZnT7), and Slc30a9 (ZnT9) was analyzed in COC and BOEC from cows during the luteal or follicular phases. Gene expression of ZIP6, ZIP14, and ZnT9 was quantified in COC and BOEC. The gene expression in the remaining transporters could not be quantified due to low mRNA levels (ZIP8 and ZnT3 in COC and BOEC; ZnT7 in BOEC) or absence of expression (ZnT7 in COC). In COC, the relative expression (RE) of all three transporters was higher in the luteal phase compared to the follicular phase (P ≤ 0.05). In BOEC, the luteal phase increased the RE of ZIP 6 (P ≤ 0.05), decreased the RE of ZnT9 (P ≤ 0.05), and did not modify the RE of ZIP14 (P > 0.05) compared to the follicular phase. In conclusion, the study reveals differences in the gene expression of ZIP6, ZIP14, and ZnT9 according to the estrous cycle phase in ex vivo samples of bovine COC and OEC.

Is prolonged luteal phase a problem in lactating Holstein cows?

In this study, the main objective was to assess if long luteal phases could have causes other than pregnancy loss. We enrolled Holstein dairy cows ≥50 DIM from a commercial herd in Brazil from October 2016 to August 2017. All cows received an estradiol-based synchronization protocol, and, on the day of insemination (d 0), were randomly assigned either an AI or a placebo insemination (PBO) in a 3:1 ratio. An ultrasound was used to assess the presence of a corpus luteum (CL) on d 17, 24, and 31, which, combined to the information from patches for the detection of estrus, was used to determine the length of the luteal phase following AI or PBO. Pregnancy was assessed by ultrasound on d 31 and cows that were pregnant were excluded from the analyses. The length of the estrous cycles was categorized as short (<17 d), normal (17-23 d), long (24-30 d), and very long (≥31 d). We compared the proportion of cows in each category between the AI and PBO groups using a cumulative ordinal mixed model. We define prolonged luteal phase as estrous cycles ≥24 d and tested its association with potential risk factors (parity, season, DIM, uterine size and position score, milk production, BCS, and the presence of a CL at enrollment to the synchronization protocol) using mixed logistic regression models. Results are presented as odds ratio (OR) and 95% Bayesian credible intervals (BCI). Data from 876 inseminations (AI: n = 616, PBO: n = 260) was collected. Overall, 12% of estrous cycles were short, 31% were normal, 19% were long, and 38% were very long. There was no difference in the odds of being in longer estrous cycle categories for the AI compared with the PBO group (OR = 0.92; 95% BCI = 0.76-1.10). Season and presence of a CL at enrollment were associated with prolonged luteal phase. In the AI group, there was a possible effect of early pregnancy losses on the lifespan of the CL, but not the PBO group, which led us to conclude that long and very long estrous cycles were not all caused by the embryonic loss. In fact, the high prevalence of cows with an extended CL lifespan in the present study suggests this could be an under- or miss-reported characteristic of high-producing lactating Holstein cows. This finding may have important repercussions in the understanding of the CL function physiology of lactating Holstein cows.

Effect of Menstrual Cycle Phase on Perceived Exertion During Aerobic Exercise in Eumenorrheic Women: A Systematic Review and Meta-analysis.

Background: The rating of perceived exertion (RPE) is a readily available and practical tool widely used in exercise science to monitor exercise load, but a rigorous review of the effect of menstrual cycle (MC) phases on RPE within continuous aerobic exercise has not yet been completed. Objective: This study investigated the effects of the MC phase on RPE during aerobic exercise. Study Design: This was a systematic review and meta-analysis. Methods: The search strategy was carried out using the 5 most common scientific databases. While qualitative analyses were performed in all included studies, random effects to standard mean difference were calculated and meta-analysis was performed where possible. This study addresses comparison for RPE at the beginning, middle, and end of the exercise adopting 2 mains analysis. The first adopted early cycle (first session of the cycle) as control compared with the subsequent phases, and the second adopted days 1 to 5 (early follicular) as control compared with the subsequent phases. Results: A total of 17 studies (n = 160) were included in the qualitative synthesis. The meta-analysis showed that MC phases did not impact RPE (P > .05). Conclusions: The current meta-analysis showed that MC does not impact RPE. Although acute RPE is not impacted by MC phases, future studies and practitioners should pay attention to the impact of RPE session by session throughout the MC.

Frozen-thawed embryo transfer: does the addition of low-dose choriogonadotropin alfa to progesterone in the luteal phase of artificial cycles improve the endometrium and increase the chances of pregnancy?

OBJECTIVE: Primary: To evaluate the effect of low doses of recombinant hCG (choriogonadotropin alfa) in the luteal phase of frozen-thawed embryo transfers (FET) of artificial cycles on the chances of pregnancy in patients aged ≤38years. Secondary: To assess the chances of pregnancy in the FET groups of artificial cycles using micronized vaginal progesterone (VP) versus injectable intramuscular progesterone (IMP) and the chances of pregnancy in type-1 embryo transfers (two top embryos). METHODS: This retrospective cohort study included 122 cycles of FET and compared two groups of patients aged 38 years or younger, one given hCG in the luteal phase and one not administered hCG. RESULTS: The clinical pregnancy rates (CPR) in the control and hCG groups were 45% and 45.16%, respectively (p=0.9999). The live birth rates (LBR) were 33.33% and 32.25%, respectively, (p=0.99909). The CPR in the VP group (83 patients) was 46.89% versus 41.02% in the IMP group, (p=0.5459). The LBR was 33.73% in the VP group and 30.76% in the IMP group (39 patients), (p=0.7559). CONCLUSIONS: The CPR and LBR of patients undergoing FET in groups prescribed and not prescribed low doses of recombinant hCG were similar. No significant difference was found between patients given VP or IMP.

Progesterone levels on the day of embryo transfer using a single pessary of 400mg of vaginal progesterone vs. 200mg x2 pessaries in hormonal replacement cycles.

OBJECTIVE: Does the use of 400mg pessaries of micronized progesterone provide comparable results as pessaries of 200mg x2, in terms of progesterone levels in hormonal replacement cycles for embryo transfer?. METHODS: Retrospective cohort study based on 299 embryo transfer treatments under artificial endometrial preparation carried out at Instituto Bernabeu. 131 patients received 1 pessary of 400 mg b.i.d. (group A) and 168 received 2 pessaries of 200 mg b.i.d. (group B). RESULTS: Mean serum progesterone levels were similar between groups (A: 13.64±4.47ng/mL vs. B: 13.88±7.17ng/mL). There were no differences in suboptimal progesterone levels between groups (A: 11.5% vs. B: 16.8%). In terms of patients receiving additional progesterone supplementation, there were no differences between groups (A: 26% vs. B: 35.3%.). No differences between groups were observed in clinical outcomes: pregnancy rate (PR) (A: 55% vs. B: 54.8%), biochemical pregnancy loss rate (BPLR) (A: 13.4% vs. B: 17.6%), miscarriage rate (MR) (A: 17.9% vs. B: 19.8%) and ongoing pregnancy rate (OPR) (A: 36.5% vs. B: 34.1%). CONCLUSIONS: One progesterone pessary of 400mg (Cyclogest®) twice daily appears to be non-inferior to the use of two-200mg pessaries twice daily in terms of progesterone levels in HRT cycles.

Economic Decisions, Attractiveness, and Intrasexual Competition during Menstrual Cycle in the Ultimatum Game.

Introduction: it seems that, in the phase of greatest fertility, women's intrasexual competition (toward attractive women who live nearby) increases due to access to resources, status, and biologically desirable partners. Objective: to compare the economic decisions (ED) during the ovulatory (OP) and luteal (LP) phases of the menstrual cycle (MC) with exposure to two stimuli: a photograph of a more attractive woman and a photograph of a less attractive woman, through the ultimatum game (UG). Methodology: the research followed a cross-sectional design between subjects to see group differences by contrasting hypotheses. The sampling was probabilistic, with a sample of 100 heterosexual women, students at a public university with an age range of 18 to 24 years, with regular MC, who did not use hormonal contraceptive methods and did not have any endocrine condition. The inverse counting method with confirmation was applied to identify CM phases; and the UG to evaluate the DE. Results: the phases of the MC had no effect on the ED; the women behaved similarly in their decisions, regardless of the phase of the cycle they were in or the type of stimulus to which they were exposed. Conclusion: OP and LP do not affect the ED of women when they are exposed to an attractive stimulus. The discussion is made considering the evolutionary theory of the ovulatory shift hypothesis.

Introducción: parece ser que, en su fase de mayor fertilidad, la competencia intrasexual de la mujer (con mujeres atractivas y que viven cerca) aumenta por el acceso a recursos, estatus y parejas biológicamente deseables. Objetivo: comparar las decisiones económicas (DE) en las fases ovulatoria (FO) y lútea (FL) del ciclo menstrual (CM) con exposición a dos estímulos: fotografía de una mujer de mayor atractivo y fotografía de una mujer de menor atractivo, a través del juego del ultimátum (UG). Metodología: la investigación tuvo un diseño cross-sectional entre sujetos para ver diferencia de grupos mediante contraste de hipótesis. El muestreo fue probabilístico, con una muestra de 100 mujeres heterosexuales, estudiantes de una universidad pública con un rango de edad de 18 a 24 años, con CM regulares, que no usaran métodos anticonceptivos hormonales y no tuvieran ninguna afección endocrina. Resultados: las fases del CM no tuvieron efectos sobre las DE; las mujeres se comportaron de forma similar en sus decisiones, sin importar la fase del ciclo en la que se encontraban o el tipo de estímulo al que fueron expuestas. Conclusión: las FO y FL no afectan las DE de las mujeres cuando son expuestas a un estímulo atractivo. La discusión se hace a la luz de la teoría evolutiva de la hipótesis del cambio ovulatorio.

Understanding Progestins: From Basics to Clinical Applicability.

Progestin is a term used to describe a synthetic progestogen. The activity and potency of synthetic progestins are mostly evaluated via parameters associated with their endometrial effects, which are related to their interactions with progesterone, estrogen, androgen, glucocorticoid, and mineralocorticoid receptors. The chemical structure of progestins is the key to understanding their interactions with these receptors and predicting the other effects associated with these drugs. Due to their endometrial effect, progestins are used for different gynecological conditions, such as endometriosis, contraception, hormonal replacement therapy, and artificial reproduction techniques. This review is focused on improving our knowledge of progestins (from their history and biochemical effects related to their chemical structures to clinical applications in gynecological conditions) in order to improve clinical practice.

Ovulation Induced by Intrauterine Seminal Plasma Increases Total Protein, PGE2, IL-8, and IL-1ß in Uterine Fluid of Llamas (Lama glama).

The establishment of a state of immunotolerance in the female reproductive tract is important for embryo development, implantation and placentation. Llamas are induced ovulators and more than 98% of pregnancies occur in the left uterine horn. The objective of this study was to determine the uterine immune response of llamas in different stages of the reproductive cycle. Adult llamas (n = 20) were examined daily by transrectal ultrasonography to determine follicular growth and then randomly assigned to four groups: Follicular phase (n = 5); Luteal phase induced by an intramuscular administration of 50 ug of GnRH analogue (n = 5); Luteal phase induced by intrauterine infusion of seminal plasma (n = 5); and Luteal phase induced by mating (n = 5). Uterine fluid was collected separately from both uterine horns by non-surgical flushing to determine the presence of cells, total proteins and concentration of IL-1ß, IL-6, IL-8, IFN γ, TNF-α and PGE2. Inflammatory cells were not observed in the uterine fluid and total protein pattern and inflammatory mediators did not differ between the left and the right horn amongst groups. Llamas treated with an intrauterine infusion of seminal plasma showed the highest concentration of total proteins, inflammatory cytokines PGE2, IL-8 and IL-1ß in the uterine fluid. In conclusion, seminal plasma is made up of significant numbers of signaling molecules that are able to modify the uterine immune response in llamas.

Serum progesterone level in luteal phase improves pregnancy rate in fresh cycles with blastocyst embryo transfer.

OBJECTIVE: To assess the association between serum level of progesterone during stimulation and in the luteal phase with pregnancy rate in a cohort of patients undergoing in vitro fertilization and embryo transfer (IVF-ET) on day 5. METHODS: Retrospective Cohort Study. Patients: 62 infertile women, aged 24-42 years, undergoing ART at our center from May 2019 to May 2021. Progesterone was evaluated during ovarian stimulation on Day 2, Day 6, and Day 8 of stimulation, day of trigger (P4dhCG), and on the day of blastocyst transfer with 5 days of progesterone supplementation (P4d5+). We also calculated the difference of P4d5+ with P4dhCG. (∆P4). Then we divided the patients into two groups based on progesterone serum levels at P4d5+; <10ng/ml (Group A), ≥10ng/ml (Group B). The Student's t-test was performed for continuous variables; Mann-Whitney's Test and Spearman's Test were used where appropriate for categorical variables. p<0.05 was considered statistically significant. RESULTS: There were positive correlations between ßhCG positive with P4d5+ (p<0.001; Rho 0.770) and ∆P4 (p<0.001; Rho 0.703). The pregnancy rate doubled when the serum progesterone level was ≥10ng/ml on the fifth day of progesterone supplementation compared with P4<10ng/ml (44% vs. 21%, respectively). CONCLUSIONS: The pregnancy rate was positively correlated with the serum P4 level on the fifth day of progesterone supplementation and with the difference between the serum progesterone level in the Dd5+ / dhCG. A higher pregnancy rate was observed when serum progesterone level on the fifth day of progesterone supplementation was ≥10ng/ml.

El anillo vaginal de progesterona como soporte de la fase lútea en fertilización in vitro

Objetivo. Comparar la efectividad del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Métodos. Estudio retrospectivo que evaluó los resultados de embarazo en mujeres receptoras de embriones logrados de donación de ambos gametos al comparar la efectividad del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Resultados. 38 mujeres usaron el anillo vaginal y 46 aplicaron las cápsulas vaginales como soporte de la fase lútea. Se halló tasas similares de implantación (36,5% versus 36,9%), embarazo clínico (52,6% versus 50,0%) y nacido vivo (50,0% versus 45,7%). Conclusiones. Se halló tasas similares de implantación, embarazo clínico y nacido vivo con el empleo del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Debido a la comodidad de su uso y a las adecuadas tasas de embarazo, el anillo vaginal de progesterona se constituye como una alternativa importante en el soporte de la fase lútea en la fertilización in vitro.

Objective: To compare the effectiveness of the vaginal ring and vaginal progesterone capsules in supporting the luteal phase in in vitro fertilization procedures. Methods: Retrospective study that evaluated pregnancy outcomes in female recipients of embryos obtained from donation of both gametes by comparing the effectiveness of the vaginal ring and vaginal progesterone capsules in supporting the luteal phase in in vitro fertilization procedures. Results: Thirty-eight women used the vaginal ring and 46 applied vaginal capsules as luteal phase support. Similar rates of implantation (36.5% versus 36.9%), clinical pregnancy (52.6% versus 50.0%) and live birth (50.0% versus 45.7%) were found. Conclusions: Similar implantation, clinical pregnancy and live birth rates were found with the use of the vaginal ring and vaginal progesterone capsules in the support of the luteal phase in in vitro fertilization procedures. Due to the convenience of its use and adequate pregnancy rates, the progesterone vaginal ring is an important alternative in the support of the luteal phase in in vitro fertilization.

The Addition of Dydrogesterone after Frozen Embryo Transfer in Hormonal Substituted Cycles with Low Progesterone Levels / Uso adicional de didrogesterona após transferência de blastocisto em ciclos substituídos com valores baixos de progesterona

Abstract Objective To determine whether a rescue strategy using dydrogesterone (DYD) could improve the outcomes of frozen embryo transfer cycles (FET) with low progesterone (P4) levels on the day of a blastocyst transfer. Methods Retrospective cohort study including FET cycles performed between July 2019 and October 2020 following an artificial endometrial preparation cycle using estradiol valerate and micronized vaginal P4 (400 mg twice daily). Whenever the serum P4 value was below 10 ng/mL on the morning of the planned transfer, DYD 10 mg three times a day was added as supplementation. The primary endpoint was ongoing pregnancy beyond 10 weeks. The sample was subdivided into two groups according to serum P4 on the day of FET: low (< 10 ng/mL, with DYD supplementation) or normal (above 10 ng/mL). We performed linear or logistic generalized estimating equations (GEE), as appropriate. Results We analyzed 304 FET cycles from 241 couples, 11.8% (n = 36) of which had serum P4 below 10 ng/mL on the FET day. Baseline clinical data of patients was comparable between the study groups. Overall, 191 cycles (62.8%) had a biochemical pregnancy, of which 131 (44,1%) were ongoing pregnancies, with a 29,8% miscarriage rate. We found no statistically significant differences in the hCG positive (63 vs 64%) or ongoing pregnancy rates (50 vs 43,3%) between those FETs with low or normal serum P4 values, even after multivariable logistic regression modelling. Conclusion Our results indicate that DYD 10 mg three times a day administered in women who perform FET with P4 serum levels < 10 ng/mL, allows this group to have pregnancy rates beyond 12 weeks at least as good as those with serum levels above 10 ng/mL.

Resumo Objetivo Determinar se uma estratégia de resgate usando didrogesterona (DYD) pode melhorar os resultados dos ciclos de transferência de embriões congelados (TEC) com baixos níveis de progesterona (P4) no dia de uma transferência de blastocisto. Métodos Estudo de coorte retrospectivo que incluiu ciclos TEC realizados entre julho de 2019 e outubro de 2020 após um ciclo de preparação endometrial artificial usando valerato de estradiol e P4 vaginal micronizado (400 mg duas vezes ao dia). Sempre que o valor de P4 sérico estava abaixo de 10 ng/mL na manhã da transferência planejada, adicionou-se 10 mg de DYD tri-diário como suplementação. O desfecho primário foi gravidez evolutiva após 10 semanas. A amostra foi subdividida em dois grupos de acordo com o P4 sérico no dia da TEC: baixo (< 10 ng/mL, com suplementação de DYD) ou normal (acima de 10 ng/mL). Realizamos equações de estimativa generalizada linear ou logística (GEE), conforme apropriado. Resultados Analisaram-se 304 ciclos de FET de 241 casais, dos quais 11,8% (n = 36) tinham valores de P4 sérico abaixo de 10 ng/mL no dia da TEC. Os dados clínicos e demográficos dos pacientes eram comparáveis entre os grupos. Globalmente, 191 ciclos (62,8%) tiveram uma gravidez bioquímica, dos quais 131 (44,1%) foram gestações em curso, com uma taxa de aborto espontâneo de 29,8%. Não encontramos diferenças estatisticamente significativas na taxa de gravidez bioquímica (63 vs. 64%) ou nas taxas de gravidez evolutiva (50 vs. 43,3%) entre TEC com valores séricos de P4 baixos ou normais, mesmo após modelação com regressão logística multivariável. Conclusão Nossos resultados indicam que a suplementação com DYD 10 mg três vezes ao dia em mulheres com níveis séricos de P4 abaixo de 10 ng/mL em ciclos de TEC substituídos parecem conseguir resultados pelo menos tão bons como nos ciclos com valores superiores para taxas de gravidez em curso além de 12 semanas.

Menstrual cycle impacts adipokine and lipoprotein responses to acute high-intensity intermittent exercise bout.

Due to hormonal fluctuation, the menstrual cycle impacts inflammatory response and lipid metabolism; moreover, the anti-atherogenic and anti-inflammatory effects of exercise in this cycle, mainly high-intensity intermittent exercise (HIIE), need to be examined. Therefore, the aim of the current study was to investigate the influence of menstrual cycle phases on adipokine and lipoprotein responses after acute HIIE sessions in healthy women. Fourteen women (age: 24 ± 2 years; BMI: 22.79 ± 1.89 kg·m2) were recruited to perform two HIIE sessions (10 × 1 min running at 90% of maximum aerobic velocity, with 1 min recovery); one during the follicular phase (FP) and other during the luteal phase (LP), randomly. Blood samples were collected at rest, immediately, and 60 min after HIIE sessions. Macrophage inflammatory protein-1α (MIP-1α), leptin, adiponectin, total cholesterol, triacylglycerol (TAG), HDL-c, and glucose concentrations were analyzed. At rest, higher MIP-1α concentrations were observed during the LP compared to FP (p = 0.017). Likewise, leptin (p = 0.050), LDL-c (p = 0.015), and non-HDL (p = 0.016) were statistically higher in the LP. In contrast, the adiponectin/leptin ratio was lower in the LP compared to the ratio found in the FP (p = 0.032). Immediately post-HIIE sessions, in both menstrual phases, higher TAG (p = 0.001) and HDL-c (p = 0.001) concentrations were found, which returned to resting levels after 60 min. In conclusion, adipokine and lipoprotein responses after a single HIIE session are regulated by the phase of the menstrual cycle, contributing to inflammatory conditions, and demonstrating the importance of considering the phases of the menstrual cycle for the periodization of physical training.

Adding Weekly Intramuscular Progesterone to a Twice Daily Vaginal Progesterone Capsule for Luteal Phase Support in IVF/ICSI Cycles Results in Similar Live Birth Rates.

OBJECTIVE: To compare pregnancy outcomes in patients undergoing artificial reproductive treatment (ART) and fresh embryo transfer (ET) who received twice-daily vaginal progesterone capsule (Cyclogest) alone verses twice daily vaginal progesterone capsule (Cyclogest) plus weekly intramuscular Hydroxyprogesterone Capronate (Proluton depot) for luteal phase support. METHODS: A retrospective cohort study that included 1162 patients who completed fresh ART/ET cycle from January 2015 to April 2018. Vaginal Cyclogest 400 mg twice daily was given to 985 patients following oocytes retrieval; whereas 177 patients received weekly intramuscular Proluton depot 250 mg in addition to twice-daily Cyclogest. The primary outcome was live birth rate. The secondary outcomes included biochemical pregnancy rate, clinical pregnancy, biochemical, and early and late pregnancy loss. RESULTS: There was no difference between the twice-daily vaginal progesterone and the addition of weekly intramuscular progesterone injections to the twice-daily vaginal progesterone regarding a positive pregnancy test (40.5% and 46.9%, respectively, p=0.112). There was no statistical difference in live birth rates between the groups (24% for group one, 26% for group two, p=0.582). CONCLUSIONS: The administration of weekly intramuscular progesterone in addition to twice-daily vaginal progesterone capsule for luteal phase support post ART cycle does not result in higher live birth rate.

Efficacy of daily GnRH agonist for luteal phase support following GnRH agonist triggered ICSI cycles versus conventional strategy: A Randomized controlled trial.

OBJECTIVE: The use of gonadotropin-releasing hormone agonist (GnRHa) as an alternative for human chronic gonadotropin (hCG) trigger has potential benefits, but the optimal luteal phase support (LPS) following GnRHa trigger remains to be elucidated. We aimed to investigate a new strategy (daily GnRH agonist for LPS following GnRH agonist trigger) as an alternative for the conventional approach to the patients undergoing intracytoplasmic sperm injection (ICSI). METHODS: In this randomized controlled trial study, 44 ICSI patients were randomly assigned into two groups: group 1, patients received standard strategy (hCG trigger [10000 IU] and progesterone bid [400 mg/BD] for LPS); group 2, patients received a dose of GnRHa (0.2 mg) for ovulation trigger and subcutaneous injection of GnRHa bid (0.2 mg) for LPS. RESULTS: The pregnancy, miscarriage, and live birth rates for the patients undergoing LPS following the GnRHa trigger were similar to those of patients undergoing the standard strategy. CONCLUSIONS: We showed that a daily subcutaneous injection of GnRHa for LPS following the GnRHa trigger can be successfully performed as an alternative to the standard strategy, with comparable pregnancy and live birth rates in ICSI patients.

DuoStim cycles potentially boost reproductive outcomes in poor prognosis patients.

AIM: To evaluate the overall performance and oocyte quality of follicular phase stimulation (FPS) vs. luteal phase stimulation (LPS) among patients undergoing double ovarian stimulation (DuoStim). MATERIALS AND METHODS: Observational retrospective two-center cohort study including 79 infertile women who underwent a total of 87 DuoStim cycles between January 2017 and May 2019. Besides assessing baseline characteristics in order to determine the patients' clinical profile, we analyzed the FPS and LPS regarding the total dose of gonadotropin received, the duration of stimulation, the number and maturity of oocytes, fertilization and blastocyst formation rates, and the number of blastocysts obtained. RESULTS: The patients' baseline characteristics were compatible with a diminished ovarian reserve and poor reproductive prognosis. While the luteal phase needed longer stimulation (12 days (5-19) vs. 11 (7-16), p < .001) and slightly higher gonadotropin doses (2946 ± 890 IU vs. 2550 ± 970 IU, p < .001), no significant differences were detected in the oocyte maturity, fertilization, and blastocyst formation rates. However, the number of oocytes retrieved (5 (0-16) vs. 4 (0-15), p = .006), mature oocytes (4 (0-15) vs. 3 (0-11), p = .032), and blastocysts obtained (70 vs. 53) were substantially greater after LPS. CONCLUSIONS: The DuoStim strategy in poor prognosis patients increases the number of oocytes and blastocysts available. Moreover, the number of oocytes and blastocysts obtained are higher after LPS when compared to FPS. Thus, it should be considered for selected patients in order to not only improve reproductive outcomes but also shorten the time to pregnancy.

Ultrasonographic aspects of the uterus and ovaries of bitches during the estrous cycle paper review / Aspectos ultrassonográficos do útero e ovários de cadelas durante o ciclo estral revisão de literatura

The ultrasonographic exam is of great value in animal reproduction and veterinary obstetrics, because it allows gestational diagnosis and monitoring, as well as the evaluation of the female reproductive system, providing diagnosis of the reproductive state and estrous phase of females. One of the techniques that has been employed in the field of theriogenology is the Doppler Mode, which allows qualitative and quantitative evaluation of the hemodynamics of reproductive organs. Several studies were carried out in attempt to elucidate the ultrasonographic aspect of the uterus and ovaries of bitches during the different phases of the estrous cycle in B mode and Doppler mode. The objective of the present study is to review the information present in the literature regarding the sonographic changes of the reproductive organs of bitches during the different hormonal phases.(AU)

O exame ultrassonográfico tem grande importância na reprodução animal e obstetrícia veterinária, pois permite o diagnóstico e acompanhamento gestacional, bem como a avaliação do sistema reprodutor, proporcionando o diagnóstico do status reprodutivo e fase do ciclo estral. Uma das técnicas ultrassonográficas que vêm sendo empregadas no ramo da teriogenologia é o modo Doppler, que permite avaliações qualitativas e quantitativas da hemodinâmica dos órgãos da reprodução. Diversos estudos foram realizados na tentativa de elucidar o aspecto ultrassonográfico do útero e dos ovários das cadelas durante as diferentes fases do ciclo estral ao modo-B e ao modo Doppler. O presente trabalho tem como objetivo revisar as informações presentes na literatura a respeito das mudanças ultrassonográficas dos órgãos reprodutores da cadela durante as diferentes fases hormonais.(AU)

Ultrasonographic aspects of the uterus and ovaries of bitches during the estrous cycle – paper review / Aspectos ultrassonográficos do útero e ovários de cadelas durante o ciclo estral – revisão de literatura

The ultrasonographic exam is of great value in animal reproduction and veterinary obstetrics, because it allows gestational diagnosis and monitoring, as well as the evaluation of the female reproductive system, providing diagnosis of the reproductive state and estrous phase of females. One of the techniques that has been employed in the field of theriogenology is the Doppler Mode, which allows qualitative and quantitative evaluation of the hemodynamics of reproductive organs. Several studies were carried out in attempt to elucidate the ultrasonographic aspect of the uterus and ovaries of bitches during the different phases of the estrous cycle in B mode and Doppler mode. The objective of the present study is to review the information present in the literature regarding the sonographic changes of the reproductive organs of bitches during the different hormonal phases.

O exame ultrassonográfico tem grande importância na reprodução animal e obstetrícia veterinária, pois permite o diagnóstico e acompanhamento gestacional, bem como a avaliação do sistema reprodutor, proporcionando o diagnóstico do status reprodutivo e fase do ciclo estral. Uma das técnicas ultrassonográficas que vêm sendo empregadas no ramo da teriogenologia é o modo Doppler, que permite avaliações qualitativas e quantitativas da hemodinâmica dos órgãos da reprodução. Diversos estudos foram realizados na tentativa de elucidar o aspecto ultrassonográfico do útero e dos ovários das cadelas durante as diferentes fases do ciclo estral ao modo-B e ao modo Doppler. O presente trabalho tem como objetivo revisar as informações presentes na literatura a respeito das mudanças ultrassonográficas dos órgãos reprodutores da cadela durante as diferentes fases hormonais.

How effective are the non-conventional ovarian stimulation protocols in ART? A systematic review and meta-analysis.

PURPOSE: To compare the effectiveness of starting the ovarian stimulation on the early follicular phase ("Conventional") with the newer range of non-conventional approaches starting in the luteal phase ("Luteal"), random-start, and studies implementing them in DuoStim ("Conventional"+"Luteal"). METHODS: Systematic review. We searched CENTRAL, PubMed, and Embase, on March 2020. We included randomized and non-randomized controlled trials that compared "Luteal," random-start ovarian stimulation or DuoStim with "Conventional"; we analyzed them by subgroups: oocyte freezing and patients undergoing ART treatments, both, in the general infertile population and among poor responders. RESULTS: The following results come from a sensitivity analysis that included only the low/moderate risk of bias studies. When comparing "Luteal" to "Conventional," clinically relevant differences in MII oocytes were ruled out in all subgroups. We found that "Luteal" probably increases the COH length both, in the general infertile population (OR 2.00 days, 95% CI 0.81 to 3.19, moderate-quality evidence) and in oocyte freezing cycles (MD 0.85 days, 95% CI 0.53 to 1.18, moderate-quality evidence). When analyzing DuoStim among poor responders, we found that it appears to generate a higher number of MII oocytes in comparison with a single "Conventional" (MD 3.35, 95%CI 2.54-4.15, moderate-quality evidence). CONCLUSION: Overall, this systematic review of the available data demonstrates that in poor responders, general infertile population and oocyte freezing for cancer stimulation in the late follicular and luteal phases can be utilized in non-conventional approaches such as random-start and DuoStim cycles, offering similar outcomes to the conventional cycles but potentially with increased flexibility, within a reduced time frame. However, more well-designed trials are required to establish certainty.