Made available in DSpace on 2016-01-26T18:55:29Z (GMT). No. of bitstreams: 1 Dissertacao.pdf: 349806 bytes, checksum: 1fd0f5db382ba931252ba16e3de9a860 (MD5) Previous issue date: 2010-03-03 / The technique of timed artificial insemination (TAI) can be used as a tool to optimize reproductive efficiency. Among the alternative protocols hormone, prostaglandin (PGF2&#945;) and estradiol benzoate (EB) have been used frequently, or combined with progesterone and GnRH analogues. This work aimed to evaluate the influence of follicular diameter on the pregnancy rate using BE or GnRH on the placement of the implant of progesterone (D0) in beef cows divided into two groups: G-BE (n = 32) and G-GnRH (n = 29). The D0 was placed implant P4 (CIDR ®) and applied 2 ml of BE (G-BE) or 2.5 mL of GnRH (GnRH-G). In D9 the implant was removed, concomitant administration of 2.5 mL of 0.25 mL PGF2&#945; and estradiol cypionate (ECP ®) followed by removal of calves. After 48 h all the cows were inseminated and the calves returned. At D0 and D9 was held ultrasound to measure the dominant follicle (DF) present in the ovary. There was no difference (p&gt; 0.05) in pregnancy rate between treatments, BE (55%) and GnRH (41%), but the follicular diameter was significantly higher (p &lt;0.05) in pregnant cows treated with EB (10.7 mm vs. 8.5 mm) and in cows treated with GnRH there was no difference (p&gt; 0.05) between pregnant and empty (11.6 mm vs. 10.2 mm). We also evaluate the postpartum period (&gt; or &lt;45 days), the application of eCG or temporary removal of the calves (RTB) and the influence of genetic group on TAI. We used the 678 cows being: Nelore (n = 234), Nelore, Brahman (n = 159) and ¾ Nellore-Red Angus (n = 285) divided into G-Early (GP, n = 151) and G-Late (GT, n = 527). Again divided into GP-RTB (n = 93) and GT-RTB (n = 299), GP-eCG (n = 58) and GT-eCG (n = 228). The animals received CIDR ® + 2 mL of BE (D0). In D8, the device was removed and all groups received 2.5 mL PGF2&#945; &#61472;, and 1.5 mL eCG (GP-GT-eCG and eCG) or removal of calves (GP-GT-RTB and RTB). In D9 the animals received 1 mL BE and 24 hours after held IATF. The pregnancy rate did not change (p&gt; 0.05), and 40% (GP) and 48% (GT). Also did not change (p&gt; 0.05) in groups: GP-eCG (37.9%), GP-RTB (41.9%), GT-eCG (51.7%) and GT-RTB (45.1 %). The pregnancy rate in Nelore cows - Brahman (37%) was lower (p &lt;0.05) than the Nellore (52%) and ¾ Nellore Red - Angus (45%). It was concluded that the use of GnRH in D0 does not improve pregnancy rate in cows in the postpartum period, even increasing follicular diameter, which females with less than 45 days postpartum are able to IATF, regardless of the use of eCG or RTB and race influence of mothers on pregnancy rate. / A técnica da inseminação artificial em tempo fixo (IATF) pode ser utilizada como ferramenta para otimização da eficiência reprodutiva. Entre as alternativas de protocolos hormonais, a prostaglandina F2&#945; (PGF2&#945;), seus análogos e o benzoato de estradiol (BE) têm sido utilizados com freqüência, combinados à progesterona (P4) ou análogos e GnRH ou análogos. Neste trabalho objetivou-se avaliar a influência do diâmetro folicular sobre a taxa de prenhez, utilizando BE ou GnRH no dia da colocação do implante de progesterona (D0) em vacas de corte divididas em dois grupos: G-BE (n=32) e G-GnRH (n=29). No D0 foi colocado um dispositivo intravaginal de P4 (CIDR®) e aplicado 2mL de BE (G-BE) ou 2,5 mL de GnRH (G-GnRH). No D9 foi retirado o implante, concomitante à administração de 2,5 mL de PGF2&#945; e 0,25 mL de cipionato de estradiol (E.C.P.®) seguido de remoção dos bezerros. Após 48h todas as vacas foram inseminadas e os bezerros retornados. No D0 e D9 foi realizada ultrassonografia para medir o folículo dominante (FD) presente no ovário. Não houve diferença (p>0,05) na taxa de prenhez entre os tratamentos, BE (55%) e GnRH (41%). O diâmetro folicular foi significativamente maior (p<0,05) nas vacas prenhes tratadas com BE (10,7mm vs 8,5mm) e nas vacas tratadas com GnRH não houve diferença (p>0,05) entre as prenhes e vazias (11,6mm vs 10,2mm). Em outro experimento, avaliou-se o período pós-parto (> ou <45 dias), a aplicação de eCG ou remoção temporária dos bezerros (RTB) e influência do grupo genético na IATF. Utilizou-se 678 vacas sendo: Nelore (n=234), ½ Nelore-Brahman (n=159) e ¾ Nelore-Red Angus (n=285) divididas em G-Precoce (G-P, n=151) e G-Tardio (G-T, n=527). Novamente divididas em G-P-RTB (n=93) e G-T-RTB (n=299); G-P-eCG (n=58) e G-T-eCG (n=228). Os animais receberam CIDR® + 2 mL de BE (D0). No D8, o dispositivo foi retirado e todos os grupos receberam 2,5 mL PGF2&#945;&#61472;, e 1,5 mL eCG (G-P-eCG e G-T-eCG) ou remoção dos bezerros (G-P-RTB e G-T-RTB). No D9 os animais receberam 1 mL BE e 24h após realizou-se IATF. A taxa de prenhez não variou (p>0,05), sendo 40% (G-P) e 48% (G-T). Também não variou (p>0,05) nos grupos: G-P-eCG (37,9%), G-P-RTB (41,9%), G-T-eCG (51,7%) e G-T-RTB (45,1%). A taxa de prenhez nas vacas ½ Nelore Brahman (37%) foi inferior (p<0,05) que os da raça Nelore (52%) e ¾ Nelore Red Angus (45%). Foi concluído que o uso de GnRH no D0 não melhorou a taxa de prenhez em vacas no pós-parto, mesmo aumentando o diâmetro folicular, que fêmeas com menos de 45 dias pós-parto estão aptas para IATF, independente do uso de eCG ou RTB e a raça das matrizes influencia nas taxas de prenhez, sendo a raça Nelore a que apresentou a maior taxa.

Made available in DSpace on 2016-07-18T17:53:07Z (GMT). No. of bitstreams: 1 Dissertacao.pdf: 349806 bytes, checksum: 1fd0f5db382ba931252ba16e3de9a860 (MD5) Previous issue date: 2010-03-03 / The technique of timed artificial insemination (TAI) can be used as a tool to optimize reproductive efficiency. Among the alternative protocols hormone, prostaglandin (PGF2&#945;) and estradiol benzoate (EB) have been used frequently, or combined with progesterone and GnRH analogues. This work aimed to evaluate the influence of follicular diameter on the pregnancy rate using BE or GnRH on the placement of the implant of progesterone (D0) in beef cows divided into two groups: G-BE (n = 32) and G-GnRH (n = 29). The D0 was placed implant P4 (CIDR ®) and applied 2 ml of BE (G-BE) or 2.5 mL of GnRH (GnRH-G). In D9 the implant was removed, concomitant administration of 2.5 mL of 0.25 mL PGF2&#945; and estradiol cypionate (ECP ®) followed by removal of calves. After 48 h all the cows were inseminated and the calves returned. At D0 and D9 was held ultrasound to measure the dominant follicle (DF) present in the ovary. There was no difference (p&gt; 0.05) in pregnancy rate between treatments, BE (55%) and GnRH (41%), but the follicular diameter was significantly higher (p &lt;0.05) in pregnant cows treated with EB (10.7 mm vs. 8.5 mm) and in cows treated with GnRH there was no difference (p&gt; 0.05) between pregnant and empty (11.6 mm vs. 10.2 mm). We also evaluate the postpartum period (&gt; or &lt;45 days), the application of eCG or temporary removal of the calves (RTB) and the influence of genetic group on TAI. We used the 678 cows being: Nelore (n = 234), Nelore, Brahman (n = 159) and ¾ Nellore-Red Angus (n = 285) divided into G-Early (GP, n = 151) and G-Late (GT, n = 527). Again divided into GP-RTB (n = 93) and GT-RTB (n = 299), GP-eCG (n = 58) and GT-eCG (n = 228). The animals received CIDR ® + 2 mL of BE (D0). In D8, the device was removed and all groups received 2.5 mL PGF2&#945; &#61472;, and 1.5 mL eCG (GP-GT-eCG and eCG) or removal of calves (GP-GT-RTB and RTB). In D9 the animals received 1 mL BE and 24 hours after held IATF. The pregnancy rate did not change (p&gt; 0.05), and 40% (GP) and 48% (GT). Also did not change (p&gt; 0.05) in groups: GP-eCG (37.9%), GP-RTB (41.9%), GT-eCG (51.7%) and GT-RTB (45.1 %). The pregnancy rate in Nelore cows - Brahman (37%) was lower (p &lt;0.05) than the Nellore (52%) and ¾ Nellore Red - Angus (45%). It was concluded that the use of GnRH in D0 does not improve pregnancy rate in cows in the postpartum period, even increasing follicular diameter, which females with less than 45 days postpartum are able to IATF, regardless of the use of eCG or RTB and race influence of mothers on pregnancy rate. / A técnica da inseminação artificial em tempo fixo (IATF) pode ser utilizada como ferramenta para otimização da eficiência reprodutiva. Entre as alternativas de protocolos hormonais, a prostaglandina F2&#945; (PGF2&#945;), seus análogos e o benzoato de estradiol (BE) têm sido utilizados com freqüência, combinados à progesterona (P4) ou análogos e GnRH ou análogos. Neste trabalho objetivou-se avaliar a influência do diâmetro folicular sobre a taxa de prenhez, utilizando BE ou GnRH no dia da colocação do implante de progesterona (D0) em vacas de corte divididas em dois grupos: G-BE (n=32) e G-GnRH (n=29). No D0 foi colocado um dispositivo intravaginal de P4 (CIDR®) e aplicado 2mL de BE (G-BE) ou 2,5 mL de GnRH (G-GnRH). No D9 foi retirado o implante, concomitante à administração de 2,5 mL de PGF2&#945; e 0,25 mL de cipionato de estradiol (E.C.P.®) seguido de remoção dos bezerros. Após 48h todas as vacas foram inseminadas e os bezerros retornados. No D0 e D9 foi realizada ultrassonografia para medir o folículo dominante (FD) presente no ovário. Não houve diferença (p>0,05) na taxa de prenhez entre os tratamentos, BE (55%) e GnRH (41%). O diâmetro folicular foi significativamente maior (p<0,05) nas vacas prenhes tratadas com BE (10,7mm vs 8,5mm) e nas vacas tratadas com GnRH não houve diferença (p>0,05) entre as prenhes e vazias (11,6mm vs 10,2mm). Em outro experimento, avaliou-se o período pós-parto (> ou <45 dias), a aplicação de eCG ou remoção temporária dos bezerros (RTB) e influência do grupo genético na IATF. Utilizou-se 678 vacas sendo: Nelore (n=234), ½ Nelore-Brahman (n=159) e ¾ Nelore-Red Angus (n=285) divididas em G-Precoce (G-P, n=151) e G-Tardio (G-T, n=527). Novamente divididas em G-P-RTB (n=93) e G-T-RTB (n=299); G-P-eCG (n=58) e G-T-eCG (n=228). Os animais receberam CIDR® + 2 mL de BE (D0). No D8, o dispositivo foi retirado e todos os grupos receberam 2,5 mL PGF2&#945;&#61472;, e 1,5 mL eCG (G-P-eCG e G-T-eCG) ou remoção dos bezerros (G-P-RTB e G-T-RTB). No D9 os animais receberam 1 mL BE e 24h após realizou-se IATF. A taxa de prenhez não variou (p>0,05), sendo 40% (G-P) e 48% (G-T). Também não variou (p>0,05) nos grupos: G-P-eCG (37,9%), G-P-RTB (41,9%), G-T-eCG (51,7%) e G-T-RTB (45,1%). A taxa de prenhez nas vacas ½ Nelore Brahman (37%) foi inferior (p<0,05) que os da raça Nelore (52%) e ¾ Nelore Red Angus (45%). Foi concluído que o uso de GnRH no D0 não melhorou a taxa de prenhez em vacas no pós-parto, mesmo aumentando o diâmetro folicular, que fêmeas com menos de 45 dias pós-parto estão aptas para IATF, independente do uso de eCG ou RTB e a raça das matrizes influencia nas taxas de prenhez, sendo a raça Nelore a que apresentou a maior taxa.

Institute for Rural Development / MRDV

Des facteurs masculins sont identifiés dans près de la moitié des cas d’infertilité. À ce jour, les tests évaluant la fertilité masculine demeurent peu prédictifs de la survenue d’une grossesse. Dans le but de pallier cette lacune, nous avons mis au point deux nouveaux tests mesurant l’intégrité de l’ADN et le temps de survie des spermatozoïdes. Nous avons effectué une étude prospective portant sur 42 couples infertiles suivis en fécondation in vitro (FIV). Le spermogramme a été effectué selon les critères de l’Organisation Mondiale de la Santé (OMS) et le temps de survie des spermatozoïdes exposés à un détergent cationique a été mesuré en observant la mobilité sous microscope. L’intégrité de l’ADN des spermatozoïdes a été vérifiée par la nouvelle méthode de marquage radioenzymatique et par analyse de la structure de la chromatine (SCSA). Tous les tests ont été réalisés sur la partie des échantillons de sperme non utilisée par la clinique de fertilité. Le projet a été approuvé par le comité d’éthique du Centre Hospitalier Universitaire de Montréal (CHUM) et les patients ont préalablement signé un formulaire de consentement éclairé. L’analyse des paramètres du spermogramme et de l’intégrité de l’ADN n’a montré aucune différence statistiquement significative entre les données chez les couples avec ou sans grossesse. Cependant, le taux de grossesse biochimique était statistiquement plus élevé chez les couples dont le temps de survie des spermatozoïdes était long (>250 s) comparativement à ceux dont ce temps était court (≤250 s): 66% vs 27% respectivement (p<0,05). Les taux de grossesse clinique et d’implantation étaient aussi plus élevés, mais les différences n’atteignaient pas le seuil de signification statistique. Nos résultats confirment que le spermogramme et la mesure de la fragmentation de l’ADN des spermatozoïdes ne sont pas de bons facteurs prédictifs des résultats de la FIV. Par contre, le test de survie des spermatozoïdes serait un meilleur indicateur de la possibilité d’une grossesse en FIV. L’amélioration de sa spécificité et un plus grand nombre de sujets sont nécessaires avant de proposer son application en clinique de fertilité. / Male factors are known to be involved in almost half of the couples consulting for infertility. To date, the tests for evaluating male fertility are poor predictors of pregnancy. We developed two new tests to evaluate sperm function: a sperm survival test and a new method to measure sperm DNA integrity. This prospective study was conducted on 42 infertile couples undergoing in vitro fertilization (IVF). Assessment of sperm parameters was done according to the World Health Organization (WHO) criteria, and sperm survival upon exposure to a cationic detergent was measured by observing motility under the microscope. Sperm DNA integrity was verified by our new radioenzymatic method as well as by the sperm chromatin structure analysis (SCSA) method. All testing was performed on a remainder aliquot of the semen samples. The study was approved by the ethics committee of the Centre Hospitalier Universitaire de Montréal (CHUM), and informed consent was obtained before inclusion. Neither conventional semen analysis, nor sperm DNA fragmentation showed statistically significant difference between conception and non-conception cycles. However, the biochemical pregnancy rate was statistically higher in couples where the sperm survival time was long (>250 s) compared to short (≤250 s): 66% vs. 27% respectively, (p < 0.05). The clinical pregnancy rate and implantation rate were also higher but the differences did not reach statistical significance. Our study confirms that conventional semen analysis and the assay for sperm DNA integrity are not reliable indicators of IVF outcome. In contrast, our new sperm survival test seems to be a better predictor of the pregnancy rate after IVF. Improvement of its specificity and a larger cohort of patients are necessary before proposing its regular application in IVF clinics.

Des facteurs masculins sont identifiés dans près de la moitié des cas d’infertilité. À ce jour, les tests évaluant la fertilité masculine demeurent peu prédictifs de la survenue d’une grossesse. Dans le but de pallier cette lacune, nous avons mis au point deux nouveaux tests mesurant l’intégrité de l’ADN et le temps de survie des spermatozoïdes. Nous avons effectué une étude prospective portant sur 42 couples infertiles suivis en fécondation in vitro (FIV). Le spermogramme a été effectué selon les critères de l’Organisation Mondiale de la Santé (OMS) et le temps de survie des spermatozoïdes exposés à un détergent cationique a été mesuré en observant la mobilité sous microscope. L’intégrité de l’ADN des spermatozoïdes a été vérifiée par la nouvelle méthode de marquage radioenzymatique et par analyse de la structure de la chromatine (SCSA). Tous les tests ont été réalisés sur la partie des échantillons de sperme non utilisée par la clinique de fertilité. Le projet a été approuvé par le comité d’éthique du Centre Hospitalier Universitaire de Montréal (CHUM) et les patients ont préalablement signé un formulaire de consentement éclairé. L’analyse des paramètres du spermogramme et de l’intégrité de l’ADN n’a montré aucune différence statistiquement significative entre les données chez les couples avec ou sans grossesse. Cependant, le taux de grossesse biochimique était statistiquement plus élevé chez les couples dont le temps de survie des spermatozoïdes était long (>250 s) comparativement à ceux dont ce temps était court (≤250 s): 66% vs 27% respectivement (p<0,05). Les taux de grossesse clinique et d’implantation étaient aussi plus élevés, mais les différences n’atteignaient pas le seuil de signification statistique. Nos résultats confirment que le spermogramme et la mesure de la fragmentation de l’ADN des spermatozoïdes ne sont pas de bons facteurs prédictifs des résultats de la FIV. Par contre, le test de survie des spermatozoïdes serait un meilleur indicateur de la possibilité d’une grossesse en FIV. L’amélioration de sa spécificité et un plus grand nombre de sujets sont nécessaires avant de proposer son application en clinique de fertilité. / Male factors are known to be involved in almost half of the couples consulting for infertility. To date, the tests for evaluating male fertility are poor predictors of pregnancy. We developed two new tests to evaluate sperm function: a sperm survival test and a new method to measure sperm DNA integrity. This prospective study was conducted on 42 infertile couples undergoing in vitro fertilization (IVF). Assessment of sperm parameters was done according to the World Health Organization (WHO) criteria, and sperm survival upon exposure to a cationic detergent was measured by observing motility under the microscope. Sperm DNA integrity was verified by our new radioenzymatic method as well as by the sperm chromatin structure analysis (SCSA) method. All testing was performed on a remainder aliquot of the semen samples. The study was approved by the ethics committee of the Centre Hospitalier Universitaire de Montréal (CHUM), and informed consent was obtained before inclusion. Neither conventional semen analysis, nor sperm DNA fragmentation showed statistically significant difference between conception and non-conception cycles. However, the biochemical pregnancy rate was statistically higher in couples where the sperm survival time was long (>250 s) compared to short (≤250 s): 66% vs. 27% respectively, (p < 0.05). The clinical pregnancy rate and implantation rate were also higher but the differences did not reach statistical significance. Our study confirms that conventional semen analysis and the assay for sperm DNA integrity are not reliable indicators of IVF outcome. In contrast, our new sperm survival test seems to be a better predictor of the pregnancy rate after IVF. Improvement of its specificity and a larger cohort of patients are necessary before proposing its regular application in IVF clinics.

No description available.

Abstract The first aim of this randomized, placebo-controlled and double-blind study was to investigate whether low-dose aspirin therapy, started prior to controlled ovarian hyperstimulation, improves ovarian stimulation response, uterine haemodynamics and clinical pregnancy rates in unselected patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The second aim was to examine if the maternal serum placental proteome is different in IVF/ICSI pregnancies compared with spontaneous pregnancies, and whether low-dose aspirin modifies maternal serum placental protein expression and uteroplacental haemodynamics during the first half of pregnancy. Finally, the effect of low-dose aspirin therapy on the incidence of hypertensive pregnancy complications among women who became pregnant after IVF/ICSI was investigated. Low-dose aspirin therapy did not increase the number of oocytes retrieved, the total number of embryos or number of top-quality embryos, endometrial thickness or uterine haemodynamics on the day of embryo transfer (ET) or clinical pregnancy rates compared with placebo-treated IVF/ICSI women. On the day of ET, low-dose aspirin did not affect UtA vascular impedance, but the incidence of non-optimal uterine artery haemodynamics (UtA PI&#8805;3.0) was statistically significantly lower (p&#60;0.05) in the aspirin group compared with the placebo group. In the placebo-treated IVF/ICSI patients, maternal serum proteome analysis showed altered protein expression compared with women with spontaneous pregnancies. Between aspirin- and placebo-treated IVF/ICSI patients, proteome analysis showed a unique and distinct pattern of differentially expressed proteins including extra-cellular matrix, complement and transport proteins. At 6 weeks’ gestation, arcuate artery PI and at 18 weeks’ gestation, UtA PI values were lower (p&#60;0.05) in the aspirin group than in the placebo group. In conclusion, low-dose aspirin therapy, when started concomitantly with controlled ovarian hyperstimulation, did not improve ovarian responsiveness, uterine receptivity, pregnancy outcome in unselected IVF/ICSI women or affect UtA vascular impedance on the day of ET. Low-dose aspirin modified the early placentation process and reduced uteroplacental vascular impedance in mid-pregnancy, but did not decrease the incidence of hypertensive pregnancy complications. / Tiivistelmä Keinoalkuisten hedelmöityshoitojen seurauksena keskimäärin reilu kolmannes naisista tulee raskaaksi hoitokertaa kohti. Näissä raskauksissa äidin seerumista määritettyjen istukkaperäisten merkkiaineiden pitoisuuksissa on eroavaisuuksia verrattuna spontaanisti raskaaksi tulleiden naisten seerumipitoisuuksiin ensimmäisen ja toisen raskauskolmanneksen aikana. Pre-eklampsian eli raskausmyrkytyksen riski on myös lisääntynyt. Syyksi arvellaan istukan verisuonipuuston poikkeavaa kehitystä. Pre-eklampsiaan liitetään intravaskulaarisen prostasykliinin ja tromboksaanin epätasapaino, joka johtaa verihiutaleiden aggregaation lisääntymiseen ja verisuonten supistumiseen. Matala-annoksinen asetyylisalisyylihappo (ASA) vähentää tromboksaanituotantoa ja korjaa tromboksaani- ja prostasykliinituotannon epätasapainoa, mutta sen ei ole todettu merkittävästi vähentävän näiden raskauskomplikaatioiden esiintyvyyttä edes riskiryhmillä, kun lääkitys on aloitettu toisen raskauskolmanneksen aikana. Tämän satunnaistetun ja plasebo-kontrolloidun kaksoissokkotutkimuksen tavoitteena oli tutkia keinoalkuisia hedelmöityshoitoja saavilla naisilla matala-annoksisen ASA-hoidon (100 mg/vrk) merkitystä munasarjojen stimulaatiovasteeseen, alkion kiinnittymiseen, istukan muodostumiseen ja kehittymiseen sekä lääkehoidon vaikutusta kohdun, istukan ja sikiön verenkiertoon, kun lääkitys aloitettiin munasarjojen stimulaatiohoidon alkaessa. Lisätavoitteena oli selvittää, onko lapsettomuushoitoja saavien naisten raskauksissa todettavissa spesifinen istukkaproteomiikkalöydös (istukan tuottamat valkuaisaineet) verrattuna spontaanisti raskaaksi tulleisiin naisiin ja voidaanko siihen vaikuttaa matala-annoksisella ASA-hoidolla. Toisena lisätavoitteena oli selvittää matala-annoksisen ASA-hoidon vaikutus pre-eklampsian esiintyvyyteen loppuraskaudessa. Matala-annoksinen asetyylisalisyylihappo (ASA) ei paranna keinoalkuisten hedelmöityshoitojen hoitotuloksia eikä vaikuta kohdun verenkiertoon tai kohdun limakalvon paksuuteen ultraäänellä arvioituna alkion siirtopäivänä. Matala-annoksista ASA-hoitoa käyttäneiden potilaiden ryhmässä todettiin kuitenkin merkitsevästi vähemmän naisia, joilla oli huonoa hoitotulosta keinoalkuisissa hedelmöityshoidoissa ennakoiva korkea molemminpuolinen kohtuvaltimoiden verenvirtausvastus alkion siirtopäivänä verrattuna plasebo-ryhmään. Raskaaksi tulleilla naisilla, jotka käyttivät matala-annoksista ASA-hoitoa, todettiin kohdun verenvirtausvastus matalammaksi alku- ja keskiraskaudessa verrattuna plasebo-ryhmän naisiin. Istukkaproteomiikkatutkimusten mukaan varhaisistukan proteiinituotanto on erilainen keinoalkuisissa raskauksissa verrattuna spontaanisti alkaneisiin raskauksiin ja siihen voidaan vaikuttaa matala-annoksisella ASA-hoidolla. Pre-eklampsian ja sikiön kasvunhidastuman esiintyvyydessä ei ryhmien välillä todettu eroa. Matala-annoksinen ASA-hoito aloitettuna ennen raskautta munasarjojen stimulaatiohoidon alkaessa ei paranna munasarjojen vastetta lapsettomuushoidoissa käytettäville hormonihoidoille, raskauslukuja eikä kohdun verenkiertoa alkion siirtopäivänä. Hoidon todettiin kuitenkin vaikuttavan varhaisistukan kehittymiseen sekä parantavan kohdun verenkierto alku- ja keskiraskaudessa viitaten istukan verisuonipuuston parempaan kehittymiseen. Matala-annoksinen ASA-hoito ei vähentänyt istukkaperäisten raskauskomplikaatioiden esiintymistä.

This quantitative, explorative and descriptive survey attempted to determine factors that influence the adolescent pregnancy rate in the Greater Giyani Municipality. Data were gathered from adolescent girls attending four selected high schools. Non-probability convenient sample of 147 respondents was used with 100% return rate. Data was collected using a questionnaire which had a reliability of 0.65. Data were analysed using the SAS/Basic computer program, version 9.2. Findings indicated that 56.34% of respondents reported key psychosocial variables such as peer pressure and 58.90% of them changed values as contributory to high pregnancy rates. .Health services were reported as not freely available and relationships with nurses significantly cited as poor by 72.41% respondents with regard to maintenance of confidentiality. Recommendations were made to improve school health services, reproductive education and future research / Health Studies / M.A. (Health Studies)

Introduction: Evidences indicate that human immuno-deficiency virus (HIV) and diabetes (DM) impact pregnancy outcomes but no experience on the integrated service delivery of HIV, DM and pregnancy care. This study explored the domains and levels of integration among DM, HIV and pregnancy care to prepare a service delivery model in Ethiopia. Methods: A sequential exploratory mixed method and the integration theoretical framework guided the study. An exploratory qualitative phase used focused group discussion, in-depth interview and observation to explore the level of integration and to refine a questionnaire for the quantitative phase. The data were transcribed and coded for theme-based analysis. The descriptive quantitative phase described HIV, DM and pregnancy care services, and determined the burden of DM among HIV patients and the prevalence of pregnancy and pregnancy outcomes. Data was analysed using Epi-info. The findings were triangulated, discussed and interpreted. Results: Seven themes were generated: joint plan, shared budget, monitoring system, structural location, the need of policy guide, the practice of integrated service delivery and suggested integration approaches. A coordinated HIV and pregnancy care services were noted. There was a linkage between diabetes and HIV, and diabetes and pregnancy care. The 1.5% of diabetes among HIV, the low number of pregnancies per a mother in diabetes (1.8) and HIV (1.3); the high adverse pregnancy outcomes among HIV (13.4% abortion, 12.4% low birth weight (LBW), 3.5% pre-term birth, 2.1% congenital malformation) and diabetes (3.2% big baby, 3.2% LBW, 3.1% Cesarean-section); the respective absent and low (16.2%) diabetes screening service at anti-natal and HIV clinics, the absent pregnancy care service for diabetic females justified the development of the tripartite integrated service delivery model of diabetes, HIV and pregnancy care. Conclusions: The model suggests active diabetes screening, evaluation and treatment at HIV and antenatal clinics. It considers the coordination between non-communicable diseases (NCD), HIV and maternal health units. Pregnancy care could be coordinated at HIV and NCD units. Full integration can be practiced between HIV and pregnancy care units. Preparing policy guide, building the capacity of health providers, advocating and piloting the model may be prioritized before the implementation of the model. / Health Studies / D. Litt. et Phil. (Health Studies)

<p>Uvod: Infertilitet pogađa 10-15% parova reproduktivnog doba. Vanetesna oplodnja (VTO) je najefikasniji vid tret-mana infertiliteta, ali uprkos značajnom napretku stopa uspeha VTO u proseku iznosi oko 30% po ciklusu. Glavnim razlogom neuspeha smatra se neadekvatan kvalitet embriona, dok se pretpostavlja da u 10-20% slučajeva razlog neuspeha leži u neadekvatnoj receptivnosti uterusa. Na osnovu inicijalnih istraživanja histeroskopija, koja predstvalja zlatni standard u dijagnostici i tretmanu patologije kavuma uterusa, se često izvodi u svakodnevnoj kliničkoj praksi kako bi se povećala uspe&scaron;nost VTO. Uprkos &scaron;irokoj primeni i dalje ne postoji dovoljno kvalitetnih dokaza o realnoj ulozi histeroskopije na ishod VTO kako kod patolo&scaron;kih stanja kavuma tako i rutinski, pre prvog ili rekurentnog poku&scaron;aja VTO. Cilj disertacije bio je da se utvrdi uticaj sprovođenja histeroskopije na ishod VTO, ustanovi učestalost prethodno neprepoznate patologije kavuma uterusa, kao i da se ispitaju stavovi pacijenata o primeni rutinske histeroskopije pred VTO. Materijal i metode: Istraživanje je sprovedeno u Kliničkom centru Vojvodine, u formi prospektivne studije u dve sukcesivne etape od 01.01.2015. do 01.04.2017. U prvoj etapi poređen je ishod VTO kod pacijentkinja kojima pred postupak VTO nije sprovedena histeroskopija (Grupa A), pacijentkinja kod kojih je dobijen uredan nalaz histeroskopije pred postupak VTO (Grupa B) i pacijentkinja gde je pred postupak VTO dobijen patolo&scaron;ki nalaz kavuma na histeroskopiji koji je u istom aktu tertian (Grupa C). Druga etapa istraživanja predstavljala je randomiziranu kontrolisanu studiju (RCT &ndash; randomised controlled trial). Nakon verifikacije urednog ultrazvučnog nalaza pred prvi postupak VTO, pacijentkinje su randomizirane u Grupu A2 kojima pred postupak VTO nije sprovedena histeroskopija i Grupu B2 kojima je pred postupak VTO sprovedena rutinska histeroskopija. Statistička analiza sprovedena je upotrebom odgovarajućeg softvera (JMP Ver. 9). Poređeni su podaci o osnovnim karakteristikama pacijenata, toka i ishoda ciklusa VTO. Primarni parametar ishoda bila je stopa kliničke trudnoće po embriotransferu. Pored analize ishoda primarno konstruisanih grupa, urađena je analiza i naknadno konstruisanih subgrupa, kao i predikcioni model uspeha VTO baziran na logističkoj regresiji. Rezultati: Studija je uključila 253 pacijentkinje (52 pacijentkinja iz Grupe A, 50 iz Grupe B, 50 iz Grupe C, 51 iz Grupe A2 i 50 iz Grupe B2). Nije postojala statistički značajna razlika u karakteristikama pacijentkinja, parametrima ovarijalne rezerve, broju dobijenih jajnih ćelija ni drugim parametrima toka postupka VTO među posmatranim grupama. U prvoj etapi istraživanja dobijena je statistički značajno (p=0,013) veća stopa kliničkih trudnoća kod pacijentkinja kojima je pred postupak VTO sprovedena histeroskopija - 50 % za Grupu B i 42% za grupu C u odnosu na 30,77% kod pacijentkinja bez histeroskopije (Grupa A), bez statistički značajne razlike među histeroskopskim grupama. U drugoj etapi istraživanja stopa kliničkih trudnoća prilikom upotrebe rutinske histeroskopije pred prvu VTO (Grupa B2) iznosila je 46% naspram 31,37% kod pacijentkinja bez histeroskopije pred prvu VTO (Grupa A2), iako uočena razlika nije dostigla statističku značajnost (p =0,089), uz relativan rizik (RR) za ostvarivanje kliničke trudnoće nakon primene histeoskopije uiznosio od 1,47 (95% CI 0,88-2,43) (p=0,13). Analizon subgrupa kod 100 pacijentkinja sa rutinski sprovedenom histeroskopijom pred VTO i 103 pacijentkinje bez histeroskopije pred VTO, dobijena je statistički značajnao veća stopa kliničkih trudnoća (48% naspram 31,07%, istim redom), uz RR od 1,54 (95% CI 1,08-2,20) (p=0,013), kao i stopa tekućih trudnoća od RR 1,49 (CI 1,01-2,19) (p= 0,039). Analiza ukupnog uticaja izvođenja histeroskopije pred VTO dobila je statistički značanjno veću stopu kliničkih trudnoća po ET za grupu histeroskopije uz RR 1,48 (CI 1,06-2,07) (p=0,017). Histeroskopijom je nakon urednog ultrazvučnog nalaza ustanovljeno postojanje patolo&scaron;kog nalaza kod 34,65% pacijenata i to 22,7% major patologije i 11,88% minor patologije kavuma. Nije postojala statistički značajna razlika u uspehu VTO u odnosu na sam nalaz histeroskopije. 98,67% pacijenata podržalo je rutinsku upotrebu histeroskopije pred prvi postupak VTO, dok je 83% pacijenata podržavlo rutinsku upotrebu histeroskopije pred svaki postupak VTO. U finalnom predikcionom modelu se uz AUC od 0,748 jedino postojanje visokokvalitetnog embriona uz odnos &scaron;ansi (OR) 7,91 (95% CI 1,80-56,06; p=0,0047), transfer blastociste uz OR 3,80 (95% CI 1,90-7,98; p=0,0001) i izvođenje histeroskopije pred VTO uz OR 2,13 (95% CI 1,14-4,08, p=0,0169) pokazalo statistički značajnim prediktorima trudnoće. Diskusija: Studija je dobila pozitivan uticaj histeroskopije na ishod postupka VTO, iskazan pre svega povećanjem stope kliničkih trudnoća nakon sprovođenja histeroskopije (bilo da je na histeroskopiji nađen uredan ili patolo&scaron;ki nalaz). Dodatna prednost histeroskopije predstavljala je i i detekcija prethodno nepropoznate patologije kavuma. Umeren efekat na ukupno pobolj&scaron;anje stope kliničkih trudnoća prilikom rutinskog sprovođenja histeroskopije pred prvu VTO, koji je statističku značajnost dostigao tek analizom subgrupa u skladu je sa nalazima novijih dobro dizajniranih studija koji donekle limitiraju nekritičku upotrebu histeroskopije. Biolo&scaron;ko obja&scaron;njenje potencijalnog pozitivnog uticaja histeroskopije najverovatnije leži u detekciji i tretmanu prethodno nepropoznate patologije kavuma, olak&scaron;avanju procedure embriotransfera, kao i humoralnim i molekularnim promenama koje nastaju u endometrijumu kao posledica odgovarajuće histeroskopske traume a koji su u dosa&scaron;anjim istraživanjima apostrofirani kao faktori koji mogu povećati receptivnost uterusa. Zaključak: Histeroskopija je efikasna, bezbedna i visoko prihvatljiva procedura koja dovodi do povećanja uspeha VTO u standardnim kliničkim indikacijama (prethodnog neuspelog postupka VTO i sumnje na patolo&scaron;ki nalaz kavuma uterusa) bilo da se na samoj histeroskopiji nađe uredan ili patolo&scaron;ki nalaz. Rutinska primena histeroskopije pred prvi postupak VTO se na osnovu rezultata studije ne može smatrati apsolutno opravdanom usled statistički nedovoljno značajnog povećanja stope kliničke trudnoće. Uzev&scaron;i u obzir visoku prihvatljivost od strane pacijenata i najverovatniji pozitivan efekat na stopu trudnoće primena rutinske histeroskopije pred prvu VTO bila bi opravdana ukoliko se implementira koncept ambulantne histeroskopije.</p> / <p>Introduction: Infertility affects 10-15% of all couples. In vitro fertilisation (IVF) is the most effective method of infertility treatment, but despite a significant improvement, success rate of IVF is still around 30% per cycle. The main reason for the IVF failure is inadequate embryo quality, but in 10-20% of cases the cause of IVF failure lies in impaired uterine receptivity. Based on earlier studies hysteroscopy, gold standard in the diagnosis and treatment of uterine cavity pathology, is often performed to increase IVF success. Despite its wide use, there is lack of high quality evidence regarding real contribution of hysteroscopy on IVF outcome in situations of uterine cavity pathology or routinely prior to first IVF or after recurrent implantation failure. The aim of this dissertation was to determine the influence of performing hysteroscopy on IVF outcome, as well as the incidence of previously unrecognized uterine pathology, and to examine patient&#39;s attitudes about performing routine hysteroscopy prior to IVF. Material and methods: The research was conducted in a prospective manner in two successive stages at Clinical Center of Vojvodina from 01.01.2015. until 01.04.2017. During first stage of the study IVF outcome was compared between patients who did not have a hysteroscopy prior to IVF (group A), patients with normal hysteroscopic finding prior to the IVF (Group B) and patients with abnormal hysteroscopic findings prior to IVF which was treated at the same time (Group C). The second stage of the study was a randomized controlled trial (RCT). After verification of normal ultrasound findings prior to the first IVF, patients were randomized to group A2 in who me hysteroscopy was not performed and group B2 who had routine hysteroscopy prior to first IVF. Statistical analysis was carried out using the appropriate statistical software (JMP Ver. 9). Patient characteristics, course and outcome of IVF cycle were compared between groups. The primary outcome was clinical pregnancy rate (CPR) per embryotransfer. In addition to analyzing the IVF outcomes in primarily defined groups, subgroup analysis was also performed, as well as IVF success pre-diction model based on logistic regression. Results: The study included 253 patients (52 patients in Group A, 50 in Group B, 50 in Group C, 51 in Group A2 and 50 in Group B2). There was no statistically significant difference in patient characteristics, ovarian reserve parameters, number of retrieved oocytes, or other relevant parameters of IVF course between the observed groups. In the first stage of the study there was statistically significant (p = 0.013) higher clinical pregnancy rate in patients who had a hysteroscopy before IVF - 50% for Group B and 42% for group C versus 30,77 % in patients without hysteroscopy before IVF (Group A), without statistically significant difference between hysteroscopic groups. In the second stage of the study, routine hysteroscopy prior to first IVF (Group B2) led to clinical pregnancy rate 46% versus 31.37% in patients without hysteroscopy prior to first IVF (Group A2), although without statistical significance (p = 0.089. Relative risk (RR) for achieving clinical pregnancy after performing hysteroscopy was 1.47 (95% CI 0.88-2.43) (p = 0.13). Subgroup analysis of 100 patients with routinely performed hysteroscopy before IVF and 103 patients without hysteroscopy prior to the IVF showed statistically significant higher rates of clinical pregnancies (48% versus 31.07%, in the same order), with RR of 1.54 (95% CI 1.08-2.20), (p = 0.013), and for ongoing pregnancies RR was 1.49 (95% CI 1.01-2.19) (p = 0.039). Overall effect of performing hysteroscopy prior to IVF resulted in a statistically significant increase in the clinical pregnancy with RR 1.48 (95% CI 1.06-2.07) (p = 0.017). After normal ultrasound finding hysteroscopy revealed 34.65% of pathological finding, 22.7% of major and 11.88% of minor pathology of the cavity). There was no statistically significant difference in IVF outcome based on hysteroscopy findings. 98.67% of patients supported the routine use of hysteroscopy before the first IVF procedure, while 83% of patients supported the routine use of the hysteroscopy before every IVF procedure. In the final prediction model, with the AUC of 0.748, only the presence of high quality embryos with odds ratio (OR) 7,91 (95% CI 1,80-56,06; p=0,0047), blastocyst transfer with OR 3,80 (95% CI 1,90-7,98; p=0,0001) and performing hysteroscopy prior to IVF with OR 2,13 (95% CI 1,14-4,08, p=0,0169) proved to be statistically significant predictors of pregnancy. Discussion: The study shoved a positive influence of hysteroscopy on the IVF outcome by increasing clinical pregnancy rate after performing hysteroscopy (whether hysteroscopy revealed normal or pathological finding). Additional benefit of hysteroscopy was detection of previously unrecognized uterine pathology. A moderate effect on the overall improvement in clinical pregnancy rate with use of routine hysteroscopy, which reached statistical significance only by subgroup analysis, is in line with findings of recent well designed studies that somewhat limit the noncritical use of hysteroscopy. A biological explanation of the potential positive effect of hysteroscopy is most likely due to detection and treatment of the previously unrecognized uterine pathology, facilitating embryotransfer procedure, as well as the humoral and molecular changes that occur in the endometrium as a consequence of the hysteroscopic trauma. Those changes were hypothesized as factors that can increase uterine receptivity by numerous research. Conclusion: Hysteroscopy is an effective, safe and highly acceptable procedure that increases IVF success when performed for accepted clinical indications (previous IVF failures, pathological findings of uterine cavity), whether hysteroscopy reveals normal or pathological finding. The routine use of hysteroscopy prior to first IVF based on this study can not be considered justified since increase in clinical pregnancy rate did not reach statistical significance. Given the high acceptance of this concept by the patients and moderate but probable positive effect on IVF outcome, implementation of routine hysteroscopy prior to first VTO would be justified only in office hysteroscopy setting.</p>