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Fertility of dairy cattle following oestrus and ovulation controlled with cloprostenol, oestradiol benzoate and progesterone or progesterone and cloprostenol.

There have been several approaches to the control of the timing of the oestrous cycle and ovulation in dairy cattle in the last three decades. The first phase involved the use of progestins which were administered in various forms for prolonged periods. Although the timing of oestrus was controlled in most animals after withdrawal of the treatment, this control was not very precise and pregnancy rates from insemination at the first oestrus after treatment were reported to be below normal. Attempts were then made to combine short-term progestin treatments with oestrogens as luteolytic agents to gain better control of the timing of oestrus and ovulation. These studies resulted in some cases in better synchronization of oestrus and improved pregnancy rates. The discovery that prostaglandin F2 alpha (PGF2 alpha) and its synthetic analogue, cloprostenol were potent luetolytic agents in the cow led in the past decade to the use of these agents for oestrus and ovulation control in cattle. Prostaglandins for this purpose are ineffective in anovulatory cows, in cows with deficient luteal function and in the first 5 days of the oestrus cycle when a new corpus luteum is being formed. This limitation in their use has encouraged investigations into the combined use of short-term progestin treatment with prostaglandins to give more effective control of the timing of oestrus and ovulation and to avoid the adverse effects on fertility of long-term progestin treatment. Short-term progestin treatment combined with prostaglandins should mean that fewer cows would have ovulation suppressed for long periods and fertility of treated cows should be improved. A comparison of three procedures of ovulation control and fertility results shows the short-term progestin treatment combined with prostaglandin to be the most effective.

Animals↗

Efficacy and tolerability of vaginal progesterone capsules (Utrogest 200) compared with progesterone gel (Crinone 8%) for luteal phase support during assisted reproduction.

OBJECTIVE: To demonstrate the comparative efficacy and tolerability of capsules containing 200 mg of P (Utrogest 200) or Crinone 8% gel for luteal phase and early pregnancy support during assisted reproduction techniques (ART). DESIGN: Prospective, multicenter, randomized, controlled, open, parallel-group Phase III trial. SETTING: Seventeen German IVF centers. PATIENT(S): Four hundred thirty women who underwent their first IVF or intracytoplasmic sperm injection cycle were randomized after successful transfer of two or three embryos from July 1999 through September 2001. INTERVENTION(S): Patients vaginally applied capsules containing 200 mg of P (Utrogest 200) three times per day or containing Crinone 8% gel twice per day. Therapy was started in the evening of the ET day and continued up to 10 weeks in pregnant women. If the pregnancy test proved to be negative, application was stopped. MAIN OUTCOME MEASURE(S): Ongoing pregnancy rate at the end of the study (12th week of gestation). Secondary outcomes were rate of implantation and abortion, number and reasons of withdrawals, as well as adverse events, assessment of tolerability, and acceptance. RESULT(S): There were no relevant differences in demographic and other characteristics between the two groups. Ongoing pregnancy rates were 25.2% in the Utrogest 200 group and 22.2% in the Crinone 8% group when patients were analyzed who normally completed the trial. In the Utrogest 200 vs. the Crinone 8% group, the implantation rate (14.7% vs. 11.9%) and abortion rate (18.2% vs. 19.1%) were not statistically different. The rate of withdrawals at the individual visits also did not differ between treatment groups. Tolerability of both drugs was good, and very few study drug-related adverse events were observed in both groups. CONCLUSION(S): The luteal phase support in ART cycles with Utrogest 200 capsules (three times per day) or Crinone 8% gel (two times per day) by the vaginal route resulted in similar outcomes with respect to implantation, ongoing pregnancy, and abortion rates. The two recommended regimens of P supplementation in ART proved to be equivalent and safe.

Administration, Intravaginal↗

The luteal phase of recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in vitro fertilization cycles during supplementation with progesterone or progesterone and estradiol.

OBJECTIVE: To explore luteal phase hormone profiles in patients stimulated with recombinant FSH and GnRH antagonist for IVF under two different modes of luteal support: P and P with E(2). DESIGN: Prospective randomized study. SETTING: Patients in an academic reproductive medicine unit. PATIENT(S): One hundred and three patients undergoing ovarian stimulation with a fixed dose of 200 IU recombinant FSH and GnRH antagonist. INTERVENTION(S): Patients were randomized to receive luteal phase supplementation, either P vaginally (n = 49) or P and 4 mg E(2) orally (n = 54). MAIN OUTCOME MEASURE(S): Hormonal assessment during the luteal phase on days 1, 4, 7, and 10 after the administration of hCG. RESULT(S): Hormone levels did not differ during the luteal phase between the two groups with the exception of E(2) concentration on day 10 after hCG, which was significantly higher in the E(2)-supplemented group compared with the P group (median 760 pg/mL, range 2,496 vs. median 589.50 pg/mL, range 2,098). CONCLUSION(S): Addition of 4 mg E(2) for luteal support after stimulation with recombinant FSH and GnRH antagonist does not alter significantly the endocrine profile of the luteal phase until day 7 after hCG. At day 10 after hCG, the E(2) levels are significantly higher in the E(2)-supplemented group.

Adult↗

The role of estrogen support during the luteal phase of in vitro fertilization-embryo transplant cycles: a comparative study between progesterone alone and estrogen and progesterone support.

OBJECTIVE: To evaluate the possible role for estrogen supplementation to the P luteal phase support of GnRH agonists (GnRH-a)- and hMG-induced IVF-ET cycles. SETTING: In vitro fertilization unit in a tertiary care university hospital. DESIGN: A prospectively randomized study. PATIENTS: One hundred consecutive patients undergoing ET after IVF were assigned into one of two luteal supplementation regimens. INTERVENTIONS: In all patients enrolled in the study, ovulation was induced using the midluteal regimen for pituitary down regulation with GnRH-a followed by follicular stimulation with hMG. The first group received IM P 50 mg/d, as luteal phase support, starting the day of ET. The second group received the same dosage of P, combined with oral E2 valerate, 2 mg/d. Serum levels of P and E2 were monitored every 4 days for 16 days after ET. MAIN OUTCOME MEASURES: Pregnancy rates (PRs) and live birth rates per ET. RESULTS: No significant difference in E2 or P levels throughout the cycle was observed between groups. Similar PRs per ET and the live birth rates were also observed between group A and B (28% versus 26.5% and 78.6% versus 76.1%, respectively). CONCLUSION: No advantage was found in the addition of E2 valerate to P luteal phase support of GnRH-a- and hMG-induced IVF-ET cycles.

Adult↗