Corpus luteum is a transient endocrine structure formed from the ruptured ovarian follicle. Its main function is to secrete P4, a pro-gestational hormone, essential for establishment and maintenance of pregnancy in mammals. The modulators of CL structure and function are classified as trophic and lytic factors. The luteotrophic factors include pituitary hormones, growth factors, intra luteal factors and cytokines, while luteolytic factors include PGF2α and oxytocin. The interplay between luteotrophic and luteolytic factors regulates luteal steroidogenesis. The precise timing of expression of various enzymes/proteins required for synthesis and metabolism of P4 constitutes an important process in the overall regulation of CL function. The three hormones LH/CG, E2 and PRL are regarded as luteotrophic factors crucial for control of CL function in mammals. Depending on species, either individually or all three hormones in the form of luteotrophic complex have been shown to participate in the regulation of CL function. In addition to the well-established endocrine role of E2, its secretion is the hallmark of the ovulating follicle, has an important role in the intraovarian growth, differentiation and survival of cells. Chapter I provides a comprehensive review of literature on CL structure and function with emphasis on factors that influence its growth, development, function and demise in bovines and rodents. In Chapter II, studies have been carried out to examine 20α-HSD expression and its activity in the CL of buffalo cow. During induced and spontaneous luteolysis, rapid fall in circulating P4 is one of the early signs of initiation of luteolytic process in several species. In rodents, it is well recognized that during luteolysis, P4 is catabolized into inactive metabolite, 20α-OHP by the reaction of 20α-HSD enzyme during luteolysis. Experiments were carried out to determine 20α-HSD expression and activity throughout the luteal phase and during induced luteolysis in the buffalo cow. Circulating P4 concentration declined rapidly in response to PGF2α treatment, but HPLC analysis of serum samples did not reveal changes in circulating 20α-OHP levels in buffalo cows. In contrast, pseudo pregnant rats receiving PGF2α treatment showed higher 20α-OHP levels at 24 h post treatment. qPCR expression of 20α-HSD in CL during different stages of luteal phase and PGF2α-treated buffalo cows was carried out and higher expression of 20α-HSD was observed at 3 and 18 h post treatment, but its activity was not altered post PGF2α treatment at other time points examined. The expression of the transcription factor Nurr77 which is involved in increased expression of 20α-HSD increased several fold 3 h post PGF2α treatment similar to the observation in PGF2α-treated pseudo pregnant rats. The results suggested that the synthesis rather than catabolism of P4 appears to be primarily affected by PGF2α treatment in buffalo cows in contrast to increased metabolism of P4 as seen in rodents. In bovines, to date no luteotropic actions for E2 has been demonstrated and whether E2 has direct effect on CL function has also not been reported. Expression of CYP19A1 gene that encodes aromatase enzyme although gets down regulated post ovulation but its expression recovers in the CL and also E2 biosynthesis has been reported in the bovine CL. Recently it was observed that CYP19A1 expression was consistently down regulated following administration of luteolytic dose of PGF2α. Experiments were conducted to examine the expression of ERα and ERβ in the CL throughout the buffalo estrous cycle as well as examined the luteal E2 levels post PGF2α treatment. The results indicated that ER expression was detectable during different stages of CL and that circulating and luteal E2 levels declined post PGF2α treatment. It was hypothesized that decrease in luteal E2 levels leads to down regulation of ER signaling and changes in expression of E2 responsive genes in the CL. To test the hypothesis, 89 genes which were regarded as E2 responsive genes were selected and the previously published global gene expression data of the buffalo CL was mined for E2 responsive genes. It was observed that 57 of 89 genes regarded as E2 responsive genes were found to be differentially expressed. Since non pregnant buffalo CL is not regarded as major site of E2 production, to validate the authenticity of differentially E2 expressed genes post PGF2α, CL of another species, the macaque, which is known to secrete abundant E2 was included for the analysis. Incidentally, the global gene expression data for the PGF2 α treated macaques (in which CYP19A1 gene expression also gets down regulated) has previously been reported from the laboratory. Here again, it was observed that nearly 79 of 89 genes were identified to be differentially expressed. To further determine the consequences of decreased ER signaling, molecules associated with survival and apoptosis were examined. The results indicated decreased expression (both mRNA and protein levels) of Akt, Bax and Bcl-2 genes. The results suggested an important role for E2 on CL function in the buffalo cow. In Chapter III, several experiments were conducted in another model system, pregnant rat, in which aromatase expression and therefore E2 production is high in the CL. Experiments were conducted to examine the effects of E2 inhibition and E2 replacement on the expression of genes. For this purpose, pregnant rats were treated with a specific aromatase inhibitor on day 12-15 of pregnancy. Together with AI, exogenous E2 was administered to another group of pregnant rats. The CL collected from different groups of rats on day 16 of pregnancy was subjected to microarray analysis. The analysis post validation of microarray data has shown that clusters of genes could be segregated into various pathways involving luteal steroidogenesis, immune system, various growth factors and apoptotic processes, all directed towards the regulation of CL function. The involvement of E2 in luteal cell proliferation and lipid deposition well corroborated with protein levels for cyclin D1 and ki67 and the results of oil red O staining, respectively. There have been reports implicating PI3K/Akt signaling in cyclin D1 accumulation, but mechanism of action does not appear to involve transcriptional activation of cyclin D1. The results of the present study indicate a decrease in cyclin D1 protein levels due to inhibition of PI3K/Akt signaling by AI treatment which is prevented upon administration of E2 during AI treatment. The findings provide a comprehensive overview for the mechanisms associated with the cell survival, progression, etc. The bioinformatics approach provided complete landscape of functional changes affected by the upstream regulators of genes associated with survival and apoptosis. Also, the findings further strengthen the hypothesis of involvement of E2 in the regulation of CL function by way of activation of Akt, the primary mediator of PI3K signaling in the regulation of cellular component that affect cell survival. In the present study, IGFBP5 which was up regulated during luteal inhibition of E2 with AI treatment was selected for further studies. Although IGFBP5 is known to be associated with follicular atresia in the rat ovary, there is limited data for the involvement of IGFBP5 in either a growth stimulatory or inhibitory action on ovarian cells. Based on present findings, a causal link between reduced ERα transcriptional activities resulting in inhibition of Akt/PKB in the presence of IGFBP5 expression could be proposed. Further, the cellular hypertrophy mediated by E2 has been speculated due to increased proliferation of vascular endothelial cells, blood supply and thus nutrients. E2, together with PRL and placental lactogens, regulates steroidogenesis and cell hypertrophy in the rat CL of pregnancy. In CL, the prominent IGFBP5 mRNA expression in different types of luteal cells has not been reported. The mRNA expression for IGFBP5 across the two types of luteal cells showed higher expression in SLC. Hence, in the present study, it has been speculated that prevention of conversion of SLC to LLC due to lack of E2 biosynthesis in presence of AI might be acting as a source for the increased IGFBP5 levels during mid pregnancy in rat CL and brings about changes associated with lack of E2. Various receptor studies on rat CL have demonstrated the lack of progesterone receptor (PR) mRNA expression in the rat CL negating its involvement as an autocrine/paracrine regulator of CL function through an intracellular receptor, but the involvement of non-PR involvement in mediating such mechanism further strengthens the role of ERs. The luteotrophic complex formation in pregnant rat principally by PRL and E2 has been discussed at length in Chapter III. PRL appears to maintain luteal ER content in the CL during rat pregnancy which further determines the luteotrophic and luteolytic actions of E2. Further, study on expression of E2 responsive genes would help in identifying E2 regulating molecules to get a clear picture on the role of E2 in understanding regulation of the CL function. The interaction of E2 with growth factor signaling including the IGF pathway has been well established in different species and this interaction is tightly linked to ERα expression, an observation interpreted as physiological coupling of growth factor and stress signaling pathways. Attempts were made towards understanding cross talk between the E2 signaling and the IGF1 signaling in few experiments carried out in Chapter IV. Based on the results, it can be proposed that a causal link exists between reduced ERα transcriptional activity and inhibition of Akt/PKB in the presence of IGFBP5. The present study has shown the activity of IGF on ERα activity mediated partly via PI3K/Akt pathway. Hence, the finding further speculates that inhibitory effect of IGFBP5 on E2 induced ERα function was due to sequestration of IGF1, possibly present in serum or produced within the cells. Another striking observation was the down regulation of glucocorticoid receptor (GR) gene, NR3C1, in the data of earlier studies [Priyanka, 2009, GEO accession number GSE8371 and Kunal, 2014, GEO accession number GSE27961] and the present study has been compared and discussed in this thesis. Glucocorticoids provide key signals for differentiation of fetal and placental tissues. Therefore, regulation of glucocorticoid access to the placenta and fetus is recognized as an important determinant of prognosis outcome and subsequent development of the postnatal phenotype. Differential regulation of these genes in CL post E2 deprivation and replacement further emphasize the regulation of CL via various biological, cellular and molecular functions. Interestingly, besides transcriptional regulation of IGF axis components, E2 activated ERα also rapidly influence the activity of IGF axis related to signaling proteins in a non-genomic manner, especially by the PI3K/Akt pathway. PI3K/Akt pathway analysis has been carried out in E2 inhibition and replacement experiments. To further confirm the observations of E2 and growth factor interaction, experiments have been set up with exogenous GH for increasing circulating levels of IGF in the system. The findings suggest that the non-genomic signaling pathway activated by the phosphorylation of ERα induced by E2 gets inhibited in the presence of AI result in increased expression of IGFBP5. The reduction in circulating IGF1 in pregnant rats may be associated with the effect on IGFBP, important for determining biological action of IGF1. The changes observed in the present study emphasize the exclusive effects of the IGFBP5 on the CL function brought about perturbations in luteal E2 content. The experiments described in the present thesis aim at understanding the mechanism responsible for decreased serum and luteal P4 post PGF2α treatment in buffalo cows, i.e. whether PGF2α acts on biosynthetic or catabolic process of P4. In the present study, experiments were designed to elucidate the role of E2 in regulation of CL function, since down regulation of CYP19A1 gene mRNA was one of the early events observed in buffalo cows post PGF2α treatment. This line of research work was extended to rodents, a species that secretes high levels of E2 during pregnancy. Genome wide transcriptional changes data revealed differential expression of several E2 responsive genes following E2 inhibition and replacement treatments. The results revealed importance of ER-mediated PI3K/Akt signaling essential for regulation of many transcriptional regulatory molecules in the CL and an interesting involvement of IGFBP5 as a link between E2 and IGF signaling. These findings further provide an insight into the role of IGFBP5 in E2-mediated actions in rat CL during pregnancy. In conclusion, the present findings suggest inhibitory effect of IGFBP5 on E2-induced ERα function and hence, its selection as a target molecule for regulation of CL function and for many beneficial processes involved in anti-carcinogenic properties can be thought of.

Thesis (MSc)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: Premature luteal regression occurs on average in 30% of superovulated sheep ewes. This phenomenon occurs early in the cycle before the embryo’s can be collected and is a major contributor to failure in embryo transfer programs. This research was done to understand the physiological mechanisms involved. Chapter two provides a general background of the physiology of natural luteolysis and the maternal recognition of pregnancy. The chapter introduces some new concepts on the topic of cell death and provides a recent literature review on research done on the phenomenon of premature luteal regression. This chapter forms the base of ideas and arguments that follows in the two studies containing new original work in this field. The research contained in this thesis comprises of two in vivo studies. The first study (Chapter 3) compare premature luteal regression to Prostaglandin F2α (PGF2α) induced regression with emphasis on the changes in levels of the steroid hormones progesterone (P4) and estradiol - 17β (E2-17β) and changes in structure and ultra structure. The following conclusions were made: 1. Premature luteal regression is not merely inadequate luteal support, but indeed early luteal regression, since seasonal influences could merely be nutritional influences, and a definitive increase in P4 were recorded in animals exhibiting the phenomena. 2. Nutritional influences could play a role, but the type and quality of nutrients and mechanism involved, is still unclear. 3. PGF2α-induced regression differs from premature luteal regression in that: a) The progression of functional and structural regression in PGF2α -induced regression is slower than in premature luteal regression. b) Regressed corpora lutea do not occur with normal functioning corpora lutea. 4. There is a distinct second E2-17β peak preceding the decline in P4 in animals that exhibits signs of premature luteal regression. A threshold initiating premature luteal regression was not established. The second study (Chapter 4) compares the changes in the ovine β estradiol - 17 β receptor (oERβ) between premature luteal regression and PGF2α induced regression. The study concludes that there could be a potential role for oERβ in premature luteal regression. The findings of these two studies raise some questions about the conventional perception that early release of PGF2α is the cause of premature luteal regression. The thesis concludes in a hypothesis (Chapter 4) explaining the phenomenon. / AFRIKAANSE OPSOMMING: Premature luteale regressie kom gemiddeld in 30% van gesuperovuleerde skaap-ooie voor. Die verskynsel kom vroeg in die siklus voor, voor die embrios gekollekteer kan word, en is een van die belangrikste oorsaake van mislukkings in ‘n embrio-oorplaasingsprogram. Die huidige navorsing poog om die fisiologiese meganismes betrokke by premature luteale regressie te verstaan. Hoofstuk twee verskaf ‘n algemene agtergrond van die fisiologiese aspekte betrokke by natuurlike luteale regressie en maternale herkenning van swangerskap. Die hoofstuk stel nuwe konsepte voor oor sel afsterwing en verskaf ‘n opgedateerde literatuuroorsig met betrekking tot die navorsing wat in die veld oor die verskynsel gedoen is. Die hoofstuk vorm die basis vir die idees en argumente, wat volg in die twee studies en wat oorspronklike nuwe navorsing bevat oor die onderwerp. Die navorsing in die tesis bestaan uit twee in vivo studies. Die eerste studie (Hoofstuk 3) vergelyk premature luteale regressie en prostaglandien F2α (PGF2α) ge-induseerde regressie met ‘n klem op die vlakke van die steröiedhormone progesteroon (P4) en estradiol - 17β (E2-17β) en veranderinge in die mikroskopiese struktuur en ultra struktuur van die corpus luteum. Die studie bevind: 1. Premature luteale regressie is nie slegs onvoldoende luteale funksie nie, maar vroë luteale regressie aangesien seisoenale invloede eitlik voedings invloede kan wees en P4 gestyg het in diere waar die verskynsel voorgekom het. 2. Voeding kan ‘n rol speel maar die tiepe en gehalte van die voedingstowwe en die meganismes betrokke is nie duidelik nie. 3. PGF2α - ge-induseerde regressie verskil van premature regressie in dat: a) Die verloop van funksionele en strukturele regressie is stadiger in PGF2α - ge-induseerde regressie in vergelyking met premature luteale regressie. b) Corpora lutea wat regressie ondergaan het kom nie voor saam met corpora lutea wat normal voorkom nie. 4. Daar die ‘n duidelike tweede piek van E2-17β gaan die afname in P4 vooraf in diere waar premature regressie voorkom. 5. Daar is nie geslaag om ‘n drempel vas te stel waar premature regressie ge-inisieer word nie. Die tweede studie vergelyk die veranderinge in estradiol-17β reseptore (oERβ) in die skaap tydens premature luteale regressie en PGF2α geinduseerde regressie. Die studie bevind dat daar ‘n moontlike rol is vir ERβ in premature luteale regressie. Die bevindinge van die twee studies bevraagteken die konvensionele opvatting dat vroë vrystelling van PGF2α verantwoordelik is vir premature luteale regressie. Die tesis sluit af met ‘n nuwe hipotese om die verskynsel te verduidelik.

Justificativa: Há evidências de que o uso de progesterona para suporte de fase lútea melhora os resultados reprodutivos em mulheres submetidas a técnicas de reprodução assistida (TRA). Há várias hipóteses para justificar a deficiência de fase lútea após a estimulação ovariana controlada (EOC) para TRA. Atualmente, acredita-se que os níveis supra-fisiológicos de esteroides alcançados durante a EOC persistem após a aspiração folicular, graças à formação de múltiplos corpos lúteos. Dessa forma, ocorre um feedback negativo prematuro na secreção de hormônio luteinizante (LH), causando um defeito da fase lútea e baixos níveis de progesterona. A progesterona natural por via intramuscular ou vaginal apresenta efeitos comparáveis sobre os parâmetros de gravidez clínica e gravidez em curso, embora as pacientes possam apresentar vários efeitos colaterais, como dor e abscesso local com a progesterona intramuscular, e corrimento vaginal, irritação perineal e interferência com o coito com a progesterona vaginal. Desta forma, a didrogesterona, uma progesterona sintética com boa biodisponibilidade oral, vem sendo estudada como uma alternativa para suporte de fase lútea em mulheres submetidas à TRA. Objetivo: Comparar a didrogesterona oral com a progesterona vaginal como suporte de fase lútea em ciclos de reprodução assistida. Métodos de busca: As buscas por ensaios clínicos randomizados (ECRs) foram realizadas nos principais bancos eletrônicos de dados; além disso, examinamos manualmente as listas de referências dos estudos incluídos em revisões semelhantes. A última busca eletrônica foi feita em 18 de outubro de 2015. Critérios de Seleção: Apenas estudos verdadeiramente randomizados que comparassem o uso da didrogesterona com a progesterona como suporte de fase lútea foram considerados elegíveis. Os estudos que permitiam a inclusão de uma mesma paciente duas vezes foram incluídos apenas se os dados do primeiro ciclo estivessem disponíveis. Coleta e Análise de Dados: Dois revisores avaliaram, independentemente, a elegibilidade dos estudos, extração de dados e os riscos de vieses dos estudos incluídos. Quaisquer discordâncias foram resolvidas por consenso. Quando necessário, os autores dos estudos incluídos foram contatados para maiores informações. Resultados: A busca selecionou 343 registros, 8 dos quais eram elegíveis. Nenhum estudo relatou nascidos vivos. Não há diferença relevante entre didrogesterona oral e progesterona vaginal para gravidez em curso, (RR 1.04, IC 95% 0.92 a 1.18, I² = 0%, p = 0.53, 7 ECRs, 3,134 mulheres), gravidez clínica (RR 1.07, IC 95% 0.93 a 1.23, I² = 34%, p = 0.35, 8 ECRs, 3,809 mulheres), e para abortamento (RR 0.77, IC 95% 0.53 a 1.10, I² = 0%, p = 0.15, 7 ECRs, 906 gestações clínicas). Três estudos reportaram o grau de insatisfação com o tratamento. Dois deles mostraram uma redução importante na insatisfação entre as mulheres que utilizaram didrogesterona em comparação com a progesterona vaginal: didrogesterona oral = 2/79 (2.5%) vs. progesterona vaginal em cápsulas = 90/351 (25.6%), e didrogesterona oral = 19/411 (4.6%) vs. progesterona vaginal em gel = 74/411 (18.0%); o outro estudo não mostrou diferença na taxa de insatisfação: didrogesterona oral = 8/96 (8.3%) vs. progesterona vaginal em cápsulas = 8/114 (7.0%). Conclusão: As evidências atuais sugerem que o uso de didrogesterona oral é tão eficaz quanto a progesterona vaginal como suporte de fase lútea em ciclos de reprodução assistida. Em relação ao grau de satisfação com o tratamento, a didrogesterona oral parece causar menos insatisfação entre as pacientes, em comparação ao uso de progesterona vaginal. / Background: There is evidence that using progesterone for LPS improves the reproductive outcomes in women undergoing ART. There are several hypotheses to justify the lutheal phase deficiency (LPD) after controlled ovarian stimulation (COS) for ART. Currently, it is believed that the supra-physiological levels of steroids achieved during COS and sustained after oocyte aspiration by the multiple corpora lutea causes a prematurely negative feedback in pituitary LH secretion, consequently causing a luteal phase defect and low progesterone levels. Both intramuscular and vaginal routes of natural progesterone exhibit comparable effect on the endpoints of clinical pregnancy and ongoing pregnancy, although patients may exhibit multiple side effects, such as pain and local abscess with intramuscular progesterone, and vaginal discharge, perineal irritation and interference with coitus with vaginal progesterone. In this way, dydrogesterone, a synthetic progesterone with good oral availability, has being studied as an alternative for LPS in women undergoing ART. Objectives: To compare dydrogesterone and progesterone for luteal-phase support in women undergoing assisted reproduction technique. Search methods: The searches for randomized controlled trials (RCT) were performed in the main electronic databases; in addition, we handsearched the reference lists of included studies and similar reviews. We performed the last electronic search on October 18, 2015. Selection criteria: Only truly randomized controlled trials comparing oral dydrogesterone to vaginal progesterone as luteal phase support were considered eligible. We included studies that permitted the inclusion of the same participant more than once (cross-over or \'per cycle\' trials) only if data regarding the first treatment of each participant were available. Data collection and analysis: Two reviewers independently performed study eligibility, data extraction, and assessment of the risk of bias and we solved disagreements by consensus. We corresponded with study investigators in order to resolve any queries, as required. Results: The search retrieved 353 records; eight studies were eligible. No study reported live birth. There is evidence of no relevant difference between oral dydrogesterone and vaginal progesterone on ongoing pregnancy (RR 1.04, 95% CI 0.92 to 1.18, I² = 0%, 7 RCTs, 3,134 women), on clinical pregnancy (RR 1.07, 95% CI 0.93 to 1.23, I² = 34%, 8 RCTs, 3,809 women), and on miscarriage (RR 0.77, 95% CI 0.53 to 1.10, I² = 0%, 7 RCTs, 906 clinical pregnancies). Three studies reported dissatisfaction rate with the treatment. Two of them reported a large reduction in dissatisfaction among women using oral dydrogesterone than among women using vaginal progesterone: oral dydrogesterone = 2/79 (2.5%) vs. vaginal progesterone capsules = 90/351 (25.6%), and oral dydrogesterone = 19/411 (4.6%) vs. vaginal progesterone gel = 74/411 (18.0%). The other included study showed no difference in the dissatisfaction rate: oral dydrogesterone = 8/96 (8.3%) vs. vaginal progesterone capsules = 8/114 (7.0%). Authors\' conclusions: Oral dydrogesterone is as effective as vaginal progesterone for luteal-phase supplementation in ART cycles. Regarding dissatisfaction with treatment, oral dydrogesterone seems to cause less dissatisfaction among patients, in comparison to vaginal progesterone.

Justificativa: Há evidências de que o uso de progesterona para suporte de fase lútea melhora os resultados reprodutivos em mulheres submetidas a técnicas de reprodução assistida (TRA). Há várias hipóteses para justificar a deficiência de fase lútea após a estimulação ovariana controlada (EOC) para TRA. Atualmente, acredita-se que os níveis supra-fisiológicos de esteroides alcançados durante a EOC persistem após a aspiração folicular, graças à formação de múltiplos corpos lúteos. Dessa forma, ocorre um feedback negativo prematuro na secreção de hormônio luteinizante (LH), causando um defeito da fase lútea e baixos níveis de progesterona. A progesterona natural por via intramuscular ou vaginal apresenta efeitos comparáveis sobre os parâmetros de gravidez clínica e gravidez em curso, embora as pacientes possam apresentar vários efeitos colaterais, como dor e abscesso local com a progesterona intramuscular, e corrimento vaginal, irritação perineal e interferência com o coito com a progesterona vaginal. Desta forma, a didrogesterona, uma progesterona sintética com boa biodisponibilidade oral, vem sendo estudada como uma alternativa para suporte de fase lútea em mulheres submetidas à TRA. Objetivo: Comparar a didrogesterona oral com a progesterona vaginal como suporte de fase lútea em ciclos de reprodução assistida. Métodos de busca: As buscas por ensaios clínicos randomizados (ECRs) foram realizadas nos principais bancos eletrônicos de dados; além disso, examinamos manualmente as listas de referências dos estudos incluídos em revisões semelhantes. A última busca eletrônica foi feita em 18 de outubro de 2015. Critérios de Seleção: Apenas estudos verdadeiramente randomizados que comparassem o uso da didrogesterona com a progesterona como suporte de fase lútea foram considerados elegíveis. Os estudos que permitiam a inclusão de uma mesma paciente duas vezes foram incluídos apenas se os dados do primeiro ciclo estivessem disponíveis. Coleta e Análise de Dados: Dois revisores avaliaram, independentemente, a elegibilidade dos estudos, extração de dados e os riscos de vieses dos estudos incluídos. Quaisquer discordâncias foram resolvidas por consenso. Quando necessário, os autores dos estudos incluídos foram contatados para maiores informações. Resultados: A busca selecionou 343 registros, 8 dos quais eram elegíveis. Nenhum estudo relatou nascidos vivos. Não há diferença relevante entre didrogesterona oral e progesterona vaginal para gravidez em curso, (RR 1.04, IC 95% 0.92 a 1.18, I² = 0%, p = 0.53, 7 ECRs, 3,134 mulheres), gravidez clínica (RR 1.07, IC 95% 0.93 a 1.23, I² = 34%, p = 0.35, 8 ECRs, 3,809 mulheres), e para abortamento (RR 0.77, IC 95% 0.53 a 1.10, I² = 0%, p = 0.15, 7 ECRs, 906 gestações clínicas). Três estudos reportaram o grau de insatisfação com o tratamento. Dois deles mostraram uma redução importante na insatisfação entre as mulheres que utilizaram didrogesterona em comparação com a progesterona vaginal: didrogesterona oral = 2/79 (2.5%) vs. progesterona vaginal em cápsulas = 90/351 (25.6%), e didrogesterona oral = 19/411 (4.6%) vs. progesterona vaginal em gel = 74/411 (18.0%); o outro estudo não mostrou diferença na taxa de insatisfação: didrogesterona oral = 8/96 (8.3%) vs. progesterona vaginal em cápsulas = 8/114 (7.0%). Conclusão: As evidências atuais sugerem que o uso de didrogesterona oral é tão eficaz quanto a progesterona vaginal como suporte de fase lútea em ciclos de reprodução assistida. Em relação ao grau de satisfação com o tratamento, a didrogesterona oral parece causar menos insatisfação entre as pacientes, em comparação ao uso de progesterona vaginal. / Background: There is evidence that using progesterone for LPS improves the reproductive outcomes in women undergoing ART. There are several hypotheses to justify the lutheal phase deficiency (LPD) after controlled ovarian stimulation (COS) for ART. Currently, it is believed that the supra-physiological levels of steroids achieved during COS and sustained after oocyte aspiration by the multiple corpora lutea causes a prematurely negative feedback in pituitary LH secretion, consequently causing a luteal phase defect and low progesterone levels. Both intramuscular and vaginal routes of natural progesterone exhibit comparable effect on the endpoints of clinical pregnancy and ongoing pregnancy, although patients may exhibit multiple side effects, such as pain and local abscess with intramuscular progesterone, and vaginal discharge, perineal irritation and interference with coitus with vaginal progesterone. In this way, dydrogesterone, a synthetic progesterone with good oral availability, has being studied as an alternative for LPS in women undergoing ART. Objectives: To compare dydrogesterone and progesterone for luteal-phase support in women undergoing assisted reproduction technique. Search methods: The searches for randomized controlled trials (RCT) were performed in the main electronic databases; in addition, we handsearched the reference lists of included studies and similar reviews. We performed the last electronic search on October 18, 2015. Selection criteria: Only truly randomized controlled trials comparing oral dydrogesterone to vaginal progesterone as luteal phase support were considered eligible. We included studies that permitted the inclusion of the same participant more than once (cross-over or \'per cycle\' trials) only if data regarding the first treatment of each participant were available. Data collection and analysis: Two reviewers independently performed study eligibility, data extraction, and assessment of the risk of bias and we solved disagreements by consensus. We corresponded with study investigators in order to resolve any queries, as required. Results: The search retrieved 353 records; eight studies were eligible. No study reported live birth. There is evidence of no relevant difference between oral dydrogesterone and vaginal progesterone on ongoing pregnancy (RR 1.04, 95% CI 0.92 to 1.18, I² = 0%, 7 RCTs, 3,134 women), on clinical pregnancy (RR 1.07, 95% CI 0.93 to 1.23, I² = 34%, 8 RCTs, 3,809 women), and on miscarriage (RR 0.77, 95% CI 0.53 to 1.10, I² = 0%, 7 RCTs, 906 clinical pregnancies). Three studies reported dissatisfaction rate with the treatment. Two of them reported a large reduction in dissatisfaction among women using oral dydrogesterone than among women using vaginal progesterone: oral dydrogesterone = 2/79 (2.5%) vs. vaginal progesterone capsules = 90/351 (25.6%), and oral dydrogesterone = 19/411 (4.6%) vs. vaginal progesterone gel = 74/411 (18.0%). The other included study showed no difference in the dissatisfaction rate: oral dydrogesterone = 8/96 (8.3%) vs. vaginal progesterone capsules = 8/114 (7.0%). Authors\' conclusions: Oral dydrogesterone is as effective as vaginal progesterone for luteal-phase supplementation in ART cycles. Regarding dissatisfaction with treatment, oral dydrogesterone seems to cause less dissatisfaction among patients, in comparison to vaginal progesterone.

Studies of prophylactic salpingectomy specimens from BRCA1/2 mutation carriers, at risk for tubal and ovarian high-grade serous carcinoma (SerCa), have consistently revealed occult carcinomas and putative histological cancer precursors in the distal fallopian tube epithelium (FTE), supporting the FTE as the source of SerCa. In this thesis I molecularly characterized and compared non-malignant FTE from mutation carriers (FTEb) and control patients (FTEn) to identify alterations that may predispose to malignant transformation. Gene expression profiling of laser capture microdissected FTEn, FTEb and SerCa indicated that SerCa have similar molecular profiles whether of presumed ovarian or tubal origin, supporting the notion they share a common cell of origin within the FTE. Furthermore, FTEb samples obtained during the post-ovulatory luteal phase showed gene expression profiles closely resembling SerCa samples, suggesting that the luteal phase milieu may contribute to serous carcinogenesis. An initial hypothesis was that FTEb may respond differently to luteal progesterone compared to FTEn, via differential expression of progesterone receptor (PR) isoforms. However, similar relative isoform expression in FTEn and FTEb samples suggested that a luteal phase-associated factor other than progesterone directs gene expression changes in FTEb. The possibility that FTEb respond differently to ovulation-associated inflammatory cytokines that are locally elevated during the luteal phase was next investigated. Importantly, FTEb specimens previously found to cluster with SerCa based on their global gene expression profiles showed evidence of increased nuclear factor-κB (NFκB)-dependent (pro-inflammatory) signalling and diminished glucocorticoid receptor (GR)-dependent (anti-inflammatory) signalling. Furthermore, I demonstrate that disabled homolog 2 (DAB2), an adaptor molecule decreased in SerCa and FTE luteal samples, enhances both GR-mediated transactivation and suppression of NFκB signalling, implicating DAB2 as a crucial determinant of inflammatory signalling and ovarian cancer risk. Altogether, this thesis identifies gene expression changes in FTE from BRCA mutation carriers during the post-ovulatory luteal phase that parallel those detected in SerCa. The data support a proposed novel testable model for predisposing events contributing to SerCa that centres on an altered ability to quickly resolve the pro-inflammatory environment created by the ovulatory event.

Studies of prophylactic salpingectomy specimens from BRCA1/2 mutation carriers, at risk for tubal and ovarian high-grade serous carcinoma (SerCa), have consistently revealed occult carcinomas and putative histological cancer precursors in the distal fallopian tube epithelium (FTE), supporting the FTE as the source of SerCa. In this thesis I molecularly characterized and compared non-malignant FTE from mutation carriers (FTEb) and control patients (FTEn) to identify alterations that may predispose to malignant transformation. Gene expression profiling of laser capture microdissected FTEn, FTEb and SerCa indicated that SerCa have similar molecular profiles whether of presumed ovarian or tubal origin, supporting the notion they share a common cell of origin within the FTE. Furthermore, FTEb samples obtained during the post-ovulatory luteal phase showed gene expression profiles closely resembling SerCa samples, suggesting that the luteal phase milieu may contribute to serous carcinogenesis. An initial hypothesis was that FTEb may respond differently to luteal progesterone compared to FTEn, via differential expression of progesterone receptor (PR) isoforms. However, similar relative isoform expression in FTEn and FTEb samples suggested that a luteal phase-associated factor other than progesterone directs gene expression changes in FTEb. The possibility that FTEb respond differently to ovulation-associated inflammatory cytokines that are locally elevated during the luteal phase was next investigated. Importantly, FTEb specimens previously found to cluster with SerCa based on their global gene expression profiles showed evidence of increased nuclear factor-κB (NFκB)-dependent (pro-inflammatory) signalling and diminished glucocorticoid receptor (GR)-dependent (anti-inflammatory) signalling. Furthermore, I demonstrate that disabled homolog 2 (DAB2), an adaptor molecule decreased in SerCa and FTE luteal samples, enhances both GR-mediated transactivation and suppression of NFκB signalling, implicating DAB2 as a crucial determinant of inflammatory signalling and ovarian cancer risk. Altogether, this thesis identifies gene expression changes in FTE from BRCA mutation carriers during the post-ovulatory luteal phase that parallel those detected in SerCa. The data support a proposed novel testable model for predisposing events contributing to SerCa that centres on an altered ability to quickly resolve the pro-inflammatory environment created by the ovulatory event.

Transrectal ovarian ultrasonography and hormone measurements were used to study ovarian antral follicular dynamics and development of luteal structures during the middle portion of the breeding season in non-prolific cross-bred Western white-faced ewes and prolific Finn sheep. Studies were also done on ovarian activity in Western white-faced ewes during the transition to seasonal anoestrus and at the onset of the breeding season. Lastly, two experiments were carried out to examine ovulatory responses and subsequent luteal function in Western white-faced ewes treated with luteolysin (PgF 2á) and progestogen (medroxyprogesterone acetate-MAP) during the luteal phase of the oestrous cycle and after ovulation induction with gonadotrophin-releasing hormone (GnRH) in mid-anoestrus. The results of the present experiments showed that the growth of ovine antral follicles reaching ovulatory sizes of >=5 mm in diameter occurred in a wave-like pattern throughout the oestrous cycle in both breeds of sheep under study. There were typically 3 or 4 waves of follicle production throughout the 17-day interovulatory period. Ovarian follicular emergence, or beginning of growth from the pool of 3-mm follicles, appeared to be primarily controlled by changes in circulating concentrations of follicle-stimulating hormone (FSH). In cyclic ewes, the largest ovarian follicles acquired the ability to secrete oestradiol from the day of emergence and a peak of oestradiol secretion occurred about the time they reached their maximum diameter. The high ovulation rate in prolific Finn sheep appeared to be achieved mainly by the ovulation of follicles emerging in the last two waves of the interovulatory interval. Interestingly, prolific Finn ewes produced more but smaller corpora lutea (CL) and had lower serum concentrations of progesterone during the luteal phase of the oestrous cycle as compared to non-prolific Western white-faced ewes. During the transition into seasonal anoestrus in Western white-faced ewes, FSH secretion resembled that during the breeding season but the pattern of emergence of sequential follicular waves was dissociated from FSH and oestradiol secretion. Prior to the first ovulation of the breeding season, there was a distinct elevation in circulating concentrations of progesterone produced by luteinized unovulated follicles and/or interstitial tissue of unknown origin. This increase in serum levels of progesterone, heralding the resumption of ovulatory cycles, did not alter the rhythmic pattern FSH secretion or follicular wave emergence. Treatment of non-prolific Western white-faced ewes with PgF2á and MAP applied late in the oestrous cycle changed follicular dynamics and increased ovulation rate to resemble that in prolific Finn sheep. Effects of MAP on the recruitment and growth of ovulatory follicles in Western white-faced ewes did not have a clear gonadotrophic dependancy, suggesting a possible local regulation of ovarian activity by progestins in ewes. Following the induction of ovulation with GnRH in anoestrous Western white-faced ewes, an array of ovarian responses were detected with ultrasonography, including failure of ovulation of large antral follicles, normal (fall-lifespan) and short-lived CL post-ovulation, and luteinized cystic-like follicles. The normal luteinization of ovulated follicles appeared to be related to the amplitude of episodic elevations in daily serum FSH concentrations before induction of ovulation and characteristics of the preovulatory LH surge.

La première ovulation induite par effet mâle chez la brebis anovulatoire en anoestrus saisonnier est souvent accompagnée d’un développement de cycles courts qui peuvent être contrecarrés par un traitement progestatif préalable. Nos travaux ont montré que la réponse au mâle est plus rapide en fin d’anoestrus en raison d’une sélection à J0 de follicules dont le stade de développement est plus avancé. En parallèle, ils apportent de nouvelles connaissances sur le mécanisme d’action par lequel la progestérone parvient à supprimer les cycles courts induits par effet mâle, en modulant certaines caractéristiques de la dynamique de croissance folliculaire et en améliorant l’activité stéroïdogénique des follicules préovulatoires. Cependant, d’autres études sont nécessaires pour étudier l’impact de ces effets sur la qualité ovocytaire et la fertilité de ces premières ovulations induites par effet mâle sur un plus grand nombre d’animaux. / The first ovulation induced by male effect in anestrous ewes during the non-breeding season usually result in the development of short cycles that can be avoided by progesterone priming. Our results show that ewes ovulate earlier in June due to selection at J0 of follicles in a more advanced stage of development. However, these observations seem to be unrelated to the luteal outcome after male effect. In parallel, we demonstrate the positive effect of progesterone on the completion of follicular growth and the improvement of the ability of these follicles to respond properly to LH surge and to synthesis ovarian steroids. However, further studies are required to understand whether these changes have functional consequences on the quality of oocytes induced by the male effect and in fertility after male effect on a large number of animals.

A morfologia e a fisiologia ovariana nos equinos têm sido motivo de estudo devido a seu córtex e medula invertidos em comparação às das outras espécies mamíferas e seu ciclo reprodutivo fotoperíodo-dependente e à existência de uma fossa de ovulação. Estes aspectos levam ao profissional do campo da reprodução equina a se interessar em aprofundar cada vez mais no desenvolvimento de pesquisas que possam auxiliar oferecendo métodos e técnicas que ajudem no trabalho de campo. Uma das melhores técnicas utilizadas para o estudo da atividade ovariana têm sido as imagens ultrassonográficas nos seus diferentes modos de operação. Uma das estruturas ovarianas que se pode avaliar e acompanhar com o ultrassom é o Corpo Lúteo (CL), sendo ele vital pela produção de Progesterona (P4), hormônio encarregado da preparação do endométrio para oferecer um ambiente ao embrião. É relatada uma relação positiva entre quantidade de células lúteas e produção de P4. O objetivo deste estudo foi testar uma metodologia que permitisse avaliar a densidade celular por meio da histologia e determinar se existe relação com o numero de pixéis lúteos numa imagem de ultrassom e assim ter um dado confiável para tomar decisões. Foram coletados 29 ovários de éguas crioulas em diferentes fases do diestro, analisados todos dentro de um único grupo. As amostras foram passadas pelo ultrassom para obter a imagem ultrasonográfica salva diretamente do ultrassom. Posteriormente, os CLs foram dessecados para fazer laminas corada pela Hematoxilina Eosina. Os resultados mostraram que entre as variáveis existe correlação inversa de R=-0.61. O coeficiente de determinação achado foi de aproximadamente R2=40% com uma probabilidade P=0.04%. Os resultados indicam que, existem variações no numero de pixéis lúteos que podem explicar em grande percentagem os valores totais do numero de células presentes no tecido lúteo. / The ovarian morphology and physiology in horses has been the subject of study due to its reversed cortex and medulla in comparison to other mammalian species, the existance of an ovulation fossa and for its photoperiod-dependent reproductive cycle. These aspects lead to the field practitioner specialist on equine to develop research that may help at fieldwork. One of the best techniques for the study of ovarian activity has been the ultrassonographic images in its different modes of operation. The corpus luteum (CL) is one of the ovarian structures that can be assessed and followed by ultrasound, being vital for the production of progesterone (P4), hormone which prepares the endometrium to provide a good environment for embryo development. A positive relationship between amount of luteal cells and P4 production has been reported before. The aim of this study was to test a methodology that would assess cell density by histology and determine whether there is a correlation between the number of ultrasound image pixels and the luteal cells concentration and thus have a really trusted ultrasound data which might help veterinarians to make decisions. Twenty nine ovaries from criollo mares were collected at different stages of diestrus, and all analyzed within a unique group. Samples were assessed by ultrasound to obtain the ultrasonographic image. After that, the CLs were dried to make microscopy slides stained with hematoxylin-eosin. The results showed that an inverse correlation (r = -0.61) exists between the variables studied. The determination coefficient found was approximately R2 = 40% with a probability of P = 0.04%. The results indicate that there are variations in the number of pixels that can explain differences in the numbers of luteal cells in the corpus luteum tissue.

A morfologia e a fisiologia ovariana nos equinos têm sido motivo de estudo devido a seu córtex e medula invertidos em comparação às das outras espécies mamíferas e seu ciclo reprodutivo fotoperíodo-dependente e à existência de uma fossa de ovulação. Estes aspectos levam ao profissional do campo da reprodução equina a se interessar em aprofundar cada vez mais no desenvolvimento de pesquisas que possam auxiliar oferecendo métodos e técnicas que ajudem no trabalho de campo. Uma das melhores técnicas utilizadas para o estudo da atividade ovariana têm sido as imagens ultrassonográficas nos seus diferentes modos de operação. Uma das estruturas ovarianas que se pode avaliar e acompanhar com o ultrassom é o Corpo Lúteo (CL), sendo ele vital pela produção de Progesterona (P4), hormônio encarregado da preparação do endométrio para oferecer um ambiente ao embrião. É relatada uma relação positiva entre quantidade de células lúteas e produção de P4. O objetivo deste estudo foi testar uma metodologia que permitisse avaliar a densidade celular por meio da histologia e determinar se existe relação com o numero de pixéis lúteos numa imagem de ultrassom e assim ter um dado confiável para tomar decisões. Foram coletados 29 ovários de éguas crioulas em diferentes fases do diestro, analisados todos dentro de um único grupo. As amostras foram passadas pelo ultrassom para obter a imagem ultrasonográfica salva diretamente do ultrassom. Posteriormente, os CLs foram dessecados para fazer laminas corada pela Hematoxilina Eosina. Os resultados mostraram que entre as variáveis existe correlação inversa de R=-0.61. O coeficiente de determinação achado foi de aproximadamente R2=40% com uma probabilidade P=0.04%. Os resultados indicam que, existem variações no numero de pixéis lúteos que podem explicar em grande percentagem os valores totais do numero de células presentes no tecido lúteo. / The ovarian morphology and physiology in horses has been the subject of study due to its reversed cortex and medulla in comparison to other mammalian species, the existance of an ovulation fossa and for its photoperiod-dependent reproductive cycle. These aspects lead to the field practitioner specialist on equine to develop research that may help at fieldwork. One of the best techniques for the study of ovarian activity has been the ultrassonographic images in its different modes of operation. The corpus luteum (CL) is one of the ovarian structures that can be assessed and followed by ultrasound, being vital for the production of progesterone (P4), hormone which prepares the endometrium to provide a good environment for embryo development. A positive relationship between amount of luteal cells and P4 production has been reported before. The aim of this study was to test a methodology that would assess cell density by histology and determine whether there is a correlation between the number of ultrasound image pixels and the luteal cells concentration and thus have a really trusted ultrasound data which might help veterinarians to make decisions. Twenty nine ovaries from criollo mares were collected at different stages of diestrus, and all analyzed within a unique group. Samples were assessed by ultrasound to obtain the ultrasonographic image. After that, the CLs were dried to make microscopy slides stained with hematoxylin-eosin. The results showed that an inverse correlation (r = -0.61) exists between the variables studied. The determination coefficient found was approximately R2 = 40% with a probability of P = 0.04%. The results indicate that there are variations in the number of pixels that can explain differences in the numbers of luteal cells in the corpus luteum tissue.