Use Of Gonadotropin-releasing Hormone Research Articles

Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis.

Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility management and assisted reproductive technology (ART) is increasing over time. In this review, we report on data regarding ART in wMS and address safety issues. We also discuss the clinical aspects to consider when planning a course of treatment for infertility, and provide updated recommendations to guide neurologists in the management of wMS undergoing ART, with the goal of reducing the risk of disease activation after this procedure. According to most studies, there is an increase in relapse rate and magnetic resonance imaging activity after ART. Therefore, to reduce the risk of relapse, ART should be considered in wMS with stable disease. In wMS, especially those with high disease activity, fertility issues should be discussed early as the choice of DMT, and fertility preservation strategies might be proposed in selected cases to ensure both disease control and a safe pregnancy. For patients with stable disease taking DMTs compatible with pregnancy, treatment should not be interrupted before ART. If the ongoing therapy is contraindicated in pregnancy, then it should be switched to a compatible therapy. Prior to beginning fertility treatments in wMS, it would be reasonable to assess vitamin D serum levels, thyroid function and its antibody serum levels; start folic acid supplementation; and ensure smoking and alcohol cessation, adequate sleep, and food hygiene. Cervico-vaginal swabs for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis, as well as serology for viral hepatitis, HIV, syphilis, and cytomegalovirus, should be performed. Steroids could be administered under specific indications. Although the available data do not clearly show a definite raised relapse risk associated with a specific ART protocol, it seems reasonably safe to prefer the use of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation. Close clinical and radiological monitoring is reasonably recommended, particularly after hormonal stimulation and in case of pregnancy failure.

Optimization of surgical treatment of uterine myoma in women with obesity and the metabolic syndrome

Objectives: to evaluate the benefits of delayed conservative myomectomy with the aim of reducing body weight and correcting hematological and metabolic parameters against the background of the use of gonadotropin-releasing hormone (GnRH) agonists and a combination of myo-inositol and D-chiro-inositol (Inofolic combi) in obese patients with metabolic syndrome by comparing this technique with immediate surgery.Materials and methods. The study included 72 patients with uterine fibroids and obesity who required conservative myomectomy. Patients were offered to postpone surgical intervention in order to correct body weight, metabolic and hematological indicators. As a preoperative preparation, patients were recommended to use GnRH agonists (goserelin), inositols, and iron preparations for anemia. Patients were divided into 2 groups: the first group (n = 31) followed all these recommendations, the second group (n = 41) refused to follow the recommendations and postponed surgical treatment. Group 1 underwent surgical treatment 3 months after the start of treatment, group 2 – after the initial consultation.Results. Patients of the first group lost an average of 7.3 ± 1.4 kg of body weight during preoperative preparation, their hemoglobin level increased by an average of 21.78%, and the volume of the largest myomatous node decreased by an average of 21.82%. The duration of the operation was significantly shorter in group 1 (75 ± 3.84 min) than in group 2 (118 ± 5.33 min). Laparotomy in the first group was not performed in any patient, in the second group it was performed in 9 patients (21.95%) (p < 0.05). There was a decrease in the severity of postoperative pain in group 1, (3.4 В± 1.25 points on the visual analog scale), which was significantly lower than in group 2 (5.1 В± 3.4 points).Conclusions. Body weight reduction against the background of the use of GnRH agonists (goserelin) and inositols (Inofolic combi) due to the improvement of the technical conditions of the operation, metabolic and hematological indicators allow to reduce the duration of surgical intervention and the frequency of laparotomies in patients with uterine fibroids against the background of obesity and metabolic syndrome.

Hormone use for reproductive diseases and heat induction in relation to herd-level reproductive performance in Dutch dairy farms

This ecological study aimed to associate hormone use for reproductive diseases and heat induction with reproductive performance at herd level. Hormone use, herd characteristics, and test-day recording data were obtained from 754 representative Dutch dairy farms belonging to five large veterinary practices from 2017 to 2019 (1679 observations in total). Hormone use was classified into prostaglandin, gonadotropin-releasing hormone (GnRH), and progesterone, and was expressed at herd level as the annual number of hormone doses per 100 adult dairy cows. Hormone use was categorized into four levels (no usage, low, medium, and high use), following the 33rd and 66th percentiles of herds that applied them. Three herd-level reproductive performance indicators (calving interval, calving-to-1st insemination interval, number of inseminations per cow) were analyzed using multivariable General Estimating Equations models. The median annual total hormone use was 36.1 (mean=43.1; min=0.0; max=248.2) doses per 100 adult dairy cows in all herds while the median was 39.2 (mean=46.8; min=0.4; max=248.2) doses per 100 adult dairy cows among the user-herds. The median annual group-specific hormone use was 21.3 (mean=26.1; min 0.0; max=180.0), 11.0 (mean=15.3; min=0.0; max=127.0) and 0.0 (mean=1.8; min=0.0; max=40.3) doses per 100 adult dairy cows for prostaglandin, GnRH, and progesterone, respectively. The final statistical models identified that herds with a high hormone use had a calving interval and a calving-to-1st insemination interval that was 9.3 ± 2.6 and 16.4 ± 2.1 days shorter than that of non-user herds (424.0 ± 2.7 and 114.0 ± 2.1 days), respectively. Furthermore, high-user herds needed on average 0.3 ± 0.04 inseminations more to get their cows pregnant compared to non-user herds (1.83 ± 0.04 no. of inseminations per cow). Medium-user herds had a 6.5 ± 2.6 days shorter calving interval and a 12.0 ± 2.1 days shorter calving-to-1st insemination interval with 0.2 ± 0.04 additional inseminations per cow compared to non-user herds. Low-user herds had a 6.2 ± 2.7 days shorter calving interval and a 7.9 ± 2.2 days shorter calving-to-1st insemination interval compared to non-user herds. The model produced the same trend for prostaglandin and GnRH use, with the higher use being associated with a shorter calving interval, a shorter calving-to-1st insemination interval, and a higher insemination per cow number. For progesterone use the opposite effect was observed. In conclusion, using a large representative herd-level dataset, hormone use was associated with a better reproductive performance in terms of calving interval and calving-to-1st insemination interval but gave extra average number of inseminations per cow. It should be monitored how reproduction performance changes when striving for a more prudent hormone use.

PMON91 Late Presentation of Pituitary Apoplexy Following Gonadotropin-Releasing Hormone Agonist for Prostate Cancer Treatment

Abstract Background Pituitary apoplexy (PA) is characterized by sudden increase in pituitary gland volume secondary to ischemia and/or necrosis. Certain predisposing factors can result in PA and use of gonadotropin-releasing hormone (GnRH) agonist for prostate cancer (PCa) is one such condition. We present a case of 59-year-old male who had insidious onset of PA following leuprolide administration, resulting in late presentation of PA. Case Presentation A 59-years old male was referred to the endocrinology clinic for evaluation of pituitary enlargement found on MRI brain in June 2021. He complained of fatigue, anorexia, unintentional weight loss, diplopia, and blurry vision, which developed insidiously and gradually worsened over six months. In 2014, he was diagnosed with stage 4 PCa (Gleason Score=8) with metastasis to the lymph nodes, ribs, and pelvic bones and underwent palliative radiation for bone metastasis and androgen deprivation with intramuscular leuprolide 22.5 mg every 3 months between July 2014 till July 2020. On presentation, he was hemodynamically stable and visual field testing was negative. Anterior pituitary hormone evaluation revealed panhypopituitarism with low serum ACTH 5 pg/ml (7.2-63.3 pg/ml), cortisol 2.9 mcg/dl (5-15 mcg/dl), TSH 0.53 mclIU/ml (0.6-4.7 mclIU/ml), Free T4 0.27 ng/dl (0.58-1.76 ng/dl), IGF-1 58 ng/ml (54-258 ng/ml), LH 0.3 mIU/ml (1.5-9.3 mIU/ml), FSH 1 mIU/ml (1.4-18 mIU/ml) and testosterone < 3 ng/dl (1.5-9.3 ng/dl). Pituitary MRI July 2021 demonstrated subacute hemorrhage inside the pituitary gland which was not present in prior MRI in September 2020. Based on laboratory work up showing secondary adrenal insufficiency and central hypothyroidism, as well as pituitary imaging confirming apoplectic event, he was diagnosed with PA secondary to GnRH agonist use. He was initially treated with stress dose of steroids followed by prednisone 5 mg daily and levothyroxine 75 mcg daily. He had significant improvement of symptoms over next few weeks including near complete resolution of visual symptoms. Conclusion Given high prevalence of PCa and increased use of GnRH agonists, more patients will develop PA, which was once thought to be extremely rare. Furthermore, it is critical that patients receiving GnRH agonists should be evaluated for possible PA, even in the absence of acute symptoms, which is classically seen in PA. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Minimal Stimulation Using Gonadotropin-Releasing Hormone Antagonist is Associated with Higher Live Birth Rates: A National Study of 13,050 Cycles.

The optimal protocol for minimal stimulation in vitro fertilization (IVF) has yet to be established. This study aims to determine if the use of gonadotropin-releasing hormone (GnRH) antagonist during minimal stimulation improves outcomes. All cycles designated as minimal stimulation from 2014 to 2016 from the Society for Assisted Reproductive Technology Clinic Online Reporting System were identified. Cycles in which GnRH antagonist was administered (n = 5984) were compared to those that did not receive it (n = 7066). Wilcoxon's rank-sum test and chi-square test were used to analyze continuous and categorical variables. A total of 6750 patients undergoing 13,050 cycles were included. GnRH antagonist use was associated with a significantly higher total gonadotropin dosage (median 975.0 [interquartile range, IQR, 600.0, 1575.0] vs. median 660.0 [IQR 375.0, 975.0], p < 0.001), lower cycle cancelation rate (11.3% vs. 13.6%, p < 0.001; OR 1.24, 95% CI 1.12-1.38, p < 0.001), and higher live birth rate (4.3% vs. 2.1%, p < 0.001; OR 0.47, 95% CI 0.39-0.58, p < 0.001). GnRH antagonist use was associated with a significantly higher live birth rate in women ≥35 years of age (2.7% vs. 0.9%, p < 0.001; OR 0.34, 95% CI 0.25-0.47, p < 0.001) and antimullerian hormone <1 (4.9% vs. 2.6%, p = 0.004; OR 0.52, 95% CI 0.33-0.81, p = 0.004). The use of GnRH antagonist suppression during minimal stimulation IVF is associated with an improved live birth rate, especially in older women and in women with diminished ovarian reserve. Although GnRH antagonist use may increase costs, it significantly decreases cancelation rate, increases number of embryos cryopreserved, and should be encouraged for minimal stimulation IVF.

PMON223 Sellar Meningioma in Association with Fertility Treatment, A Case Report

Abstract Introduction Sex hormones play a crucial role in the development and growth of meningioma. Progesterone receptor is expressed in more than 70% of meningioma, practically in benign (WHO grade1) meningioma. It was observed that meningiomas increase in size and become more symptomatic during pregnancy. Similarly, the use of hormonal therapy, including gonadotropin-releasing hormone (GnRH) agonist, can be associated with an increased risk for meningioma. Moreover, the use of GnRH agonist can be associated with a risk of pituitary adenoma growth, which is difficult to distinguish from sellar meningioma by routine MRI scan. This case report shows a rare association of fertility hormonal treatment with sellar meningioma and the possible differential diagnosis. Case Presentation A 45-year-old obese woman with a past medical history of hypertension, prediabetes, hypothyroidism, and mild hyperprolactinemia presented to us with a 2-week history of persistent and worsening periorbital headache, associated with nausea, vomiting, and left retro-orbital pain with eye movement. She had undergone fertility treatment, intrauterine insemination (IUI), and hormonal therapy, including GnRH agonist, bromocriptine, and levothyroxine. She had a recent IUI 1 week prior to her presentation. She denied weakness, facial paresthesia, blurry/double vision, recent excessive weight gain/loss, or the use of any anticoagulation or antiplatelet medications. Her MRI brain scan without contrast revealed a 2.3×1.5×1.2 cm heterogeneous soft tissue mass involving the sella and left cavernous sinus with a slight impingement of the optic chiasm and left optic nerve. These findings were consistent with meningioma or pituitary macroadenoma. The patient denied any increase in her ring or shoe size, menstrual disturbances, loss of peripheral vision, orthostatic dizziness, or skin pigmentation.Her laboratory workup showed a serum prolactin of 33.3 ng/mL (reference value &amp;lt;25ng/mL), TSH of 2.11 mIU/L (reference value 0.5-5.0 mIU/L), free T4 of 1.3 ng/dL (reference value 0.7-1.9 ng/dL), IGF-1 of 250 ng/mL (reference value 90-360 ng/mL for people ages 40-54), morning ACTH of 6 pmol/L (reference value 10-60 pmol/L), and morning cortisol of &amp;lt;0.2 mcg/dL (reference value 5-25mcg/dL). In addition, she had a subnormal response for the cosyntropin stimulation test, which confirmed the diagnosis of secondary adrenal insufficiency. The patient was treated with replacement glucocorticoid therapy. She underwent an endonasal endoscopic transsphenoidal resection of the tumor, and its histopathological examination revealed meningioma with fibrosis and sclerosis, WHO grade 1.ConclusionGnRH agonist can stimulate the growth of meningioma and pituitary adenoma in women undergoing fertility treatment. Our case shows a rare association of GnRH use with sellar meningioma and how we should consider meningeal and pituitary tumors in the differential diagnosis of any sellar mass in women undergoing fertility treatment. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

COMPARISON OF THE EUPLOIDY RATE AND CLINICAL PREGNANCY RATE OF PGT-A TESTED EMBRYOS BETWEEN LONG GnRH AGONIST AND GnRH ANTAGONIST PROTOCOLS: A RETROSPECTIVE STUDY

Whether an association exists between the use of gonadotropin-releasing hormone (GnRH) analog and blastocyst euploidy rate as well as clinical pregnancy rate in preimplantation genetic testing for aneuploidy (PGT-A) cycles.

Use of gonadotropin-releasing hormone (GnRH) agonist trigger in fertility preservation for patients with inherited genetic disorders.

In patients with varying hematologic disorders (thalassemia, sickle cell anemia, aplastic anemia, etc.), inherited bone marrow failure syndromes, and immune deficiencies due to a single gene disorder, the advent of stem cell transplantation (SCT) as a treatment option has allowed for significant disease improvement, and possibly cure. This specific treatment option often requires exposure to chemotherapeutic agents and sometimes whole body radiation; therefore, primary ovarian insufficiency is often sequelae of the therapy. The optimization of fertility preservation protocols within this patient population is of extreme importance. This review aims to detail the use of GnRH agonist use within this patient population, within the context of fertility preservation cycles.

Qualitative Analysis of Interviews and Focus Groups Exploring Factors Contributing to Adherence to GnRH Agonists in Men with Prostate Cancer.

Side effects from the prolonged use of gonadotropin-releasing hormone (GnRH) agonists may lead to nonadherence to the treatment in men with advanced prostate cancer (PCa). We investigated the reasons contributing to nonadherence to GnRH agonists through interviews with men with PCa and focus groups with their health care professionals. The three stages of the study were validation of themes, interviews with men on GnRH agonists, and focus groups with oncology specialists and clinical nurse specialists. An experienced oncologist validated factors contributing to nonadherence identified from the literature. A total of 10 men with PCa were recruited from a large teaching hospital and were interviewed on a one-to-one basis using a topic guide. In stage three, two separate focus groups were held with oncology specialists and clinical nurse specialists treating men with PCa. The interviews and focus groups were audio recorded and transcribed verbatim. Initial codes identified from stage three were grouped into themes and thematically analyzed. Themes identified from the interviews and focus groups influencing adherence to treatment were side effects of treatment, patient belief system, benefits outweigh harm, quality of life over quantity of life, social support, and patient-clinician relationship. Although side effects such as hot flushes and loss of libido were sometimes overwhelming for many, these men felt that treatment benefits outweighed harm. Reasons leading to nonadherence can be multifactorial and unique to each patient. Employing different strategies by health care professionals may lead to the eventual acceptance of treatment, while also acknowledging their reasons for nonadherence.

Gynecological uses of GnRH antagonists: review article

Aim: to review and analyze the use of gonadotropin-releasing hormone (GnRH) antagonists in endometriosis, adenomyosis, non-menstrual pelvic pain, uterine fibroids, prostate cancer, female infertility, and precocious puberty. Methods: the information used to write this manuscript was obtained during a three-month period, between October and May 2022, from specialized literature, written in English and Spanish, related to the use and potential applications of GnRH antagonists in medicine, mainly published during the last five years, using journals found in the most relevant medical digital archives, including PubMed, SciELO, Google Scholar, Cochrane, and Elsevier. Among the keywords used for obtaining this updated information were gonadotropin-releasing hormone (GnRH) antagonists; GnRH receptors (GnRHR); elagolix; relugolix; cetrorelix; linzagolix; hypothalamic-pituitary-gonadal (HPG) axis; endometriosis; adenomyosis; pelvic pain; uterine fibroids; leiomyomas; infertility; precocious puberty; PP; and central PP. Results: GnRH antagonists induce a rapid onset of clinical effects, without the flare-up effect that is seen with agonists, and have immediate therapeutic effects; once treatment concludes, hormonal suppression rapidly ceases, with normalization of gonadal function within a few days, guaranteeing an increase of GnRH concentration, controlling non-menstrual pelvic pain and heavy menstrual bleeding, and serving as part of the treatment of infertility and precocious puberty. Conclusion: even though the aforementioned gynecological pathologies can be treated with the use of multiple drugs, GnRH antagonists have shown to be potential first lines of treatment, as long as their administration protocols are followed correctly.

GnRH Administration in the Synchronization of Receptors Cows for Fixed-Time Embryo Transfer

The bovine production chain in Brazil is highlighted worldwide; however, researchers are seeking to improve production even further by evaluating the use of reproductive biotechnologies, such as the transfer of embryos at a fixed time. The aim of this study was to analyze the expression of estrus associated or not with the use of gonadotropin releasing hormone (GnRH), on the diameter of the dominant follicle, diameter of the corpus luteum, utilization rate and conception rate of receptors cows. The experiment was carried out in southern Brazil and 400 receptors cows were used, distributed in a 2x2 factorial scheme, considering estrus expression and GnRH administration. All receptors were synchronized and, on Day 10, their ovaries were evaluated and, based on estrus expression, they were distributed into 2 subgroups: with and without GnRH application. On Day 18, they had their ovaries evaluated and they were inovulated, and on Day 41, the pregnancy diagnosis was made. The expression of estrus increased the diameter of the dominant follicle and corpus luteum and the utilization rate of the recipient cows; however, it did not improve the conception rate. The administration of GnRH, with or without the expression of estrus, did not affect any of the studied variables.

Pre-IVF treatment with a GnRH antagonist in women with endometriosis (PREGNANT): study protocol for a prospective, double-blind, placebo-controlled trial

IntroductionInfertility is a common complication of endometriosis. While in vitro fertilisation-embryo transfer (IVF) successfully treats endometriosis-associated infertility, there is some evidence that pregnancy rates may be diminished in women seeing...

Productive and reproductive performance of crossbred dairy heifers with induced lactation and efficacy of antimicrobial therapy associated with internal teat sealants

This study evaluated (a) the efficacy of an association between injectable antibiotic therapy and sealant (ATBS) on milk yield (MY), somatic cell count (SCC), and prevalence of intramammary infections (IMI); and (b) the efficacy of gonadotropin-releasing hormone (GnRH) on follicular cyst (FCs) resolution (cyclicity at the 45th day in milk; DIM) and cumulative pregnancy rate (CPR) in heifers submitted to a lactation induction protocol (LIP). A total of 114 crossbred (Holstein × Jersey) heifers, with 34.7 ± 4.8 months and 439 ± 56.35 kg were submitted to LIP. On the 5th day of the LIP, the heifers were assigned to (i) ATBS (n = 57) with 7 mg/kg of norfloxacin associated with sealant and (ii) Control 1 (n = 57; CONT1) with no treatments. Lactation began on the 21st day of LIP and the 15th DIM, FCs were diagnosed and 106 heifers were randomized into two treatment groups with 53 heifers each: (i) GnRH (5 mL injectable GnRH) and (ii) Control 2 (CONT2; no treatment). Of the 114 heifers initially induced, 83.33% (n = 95) responded to LIP with an average MY of 15.19 kg/milk/day during 22 weeks of lactation. In the first 14 DIM, the IMI prevalence was 18% and 28% for heifers ATBS and CONT1 treated, respectively. Additionally, coagulase-negative Staphylococcus was the most frequently isolated group of pathogens. Mammary quarters that received ATBS treatment had a lower risk of IMI and SCC than CONT1. The cyclicity at 45 DIM was 68% (ATBS) and 35% (CONT1), and 57% and 46% for animals in the GnRH and CONT2. CPR was 60% in the ATBS group and 89% in CONT1, but GnRH treatment did not affect the CPR. In conclusion, LIP was effective in stimulating MY in heifers, and the IMI prevalence decreased with ATBS treatment. Also, the use of GnRH did not affect the FC regression, cyclicity at 45 DIM, and CPR.

MODERN APPROACHES TO CONTRACEPTION IN DOMESTIC AND WILD ANIMALS: A REVIEW

Contraception is the use of practices, methods, or equipment to prevent pregnancy in a sexually active female. Contraception methods, often known as birth control, pregnancy prevention, or fertility control, are intended to prevent the fertilization of an egg or the implantation of an embryo within the uterus. Hormonal contraception is a term that refer to techniques of contraception that work by affecting the endocrine system. To reduce the population of stray animals and wildlife, as well as to control rabies and damage to agricultural commodities, crops, and forest resources, advanced and effective contraceptives are required. Recently, advanced compounds are used as contraceptives like classical use of Gonadotropin releasing hormone (GnRH), GnRH agonist, GnRH antagonist, and GnRH toxin conjugate-PAP in dogs and GnRH vaccines in deer, feral pigs, rabbits, and bisons. The possibility of limiting fertility by antibodies, inactivating important reproductive hormones, as established by active and passive immunization in animals, is a recent advancement in immunological contraception. Contraceptive vaccination (CV) could be a realistic and helpful alternative to currently existing contraception methods. The molecules being studied for CV development either target gamete production [luteinizing hormone-releasing hormone (LHRH)/GnRH, Follicle stimulating hormone (FSH)], gamete function [sperm antigens and oocyte zona pellucida (ZP)], or gamete outcome (hCG). Veterinary candidate molecules are available like zone vaccine for dogs, bovine LH receptor vaccine, and phage peptide sperm protein vaccine. A number of target-based upcoming technologies include gene silencing, Kisspeptin, Gonadotropin inhibiting hormone (GnIH), Retinoic acid receptor antagonist, etc might make perfect and desirable contraception in animals and humans.

Follicle-Stimulating Hormone (FSH) Levels During Androgen Deprivation Therapy Are Not Associated With Survival or Development of Castration-Resistant Prostate Cancer

Background Follicle-stimulating hormone (FSH) dysregulation plays a potential role in prostate cancer progression. The objective of this study was to evaluate whether higher FSH levels during androgen deprivation therapy (ADT) for recurrent prostate cancer could predict the development of castration-resistant prostate cancer (CRPC), prostate cancer-specific survival (CSS), and overall survival (OS). Methods Serum FSH levels were measured in cryopreserved samples of the continuous ADT arm of the PR.7 trial, supplemented with analogous samples from a large contemporaneous biobank. Univariate and multivariate analyses assessed the relationship between FSH tertiles and time to CRPC, as well as CSS, and OS. Results A total of 172 patients were included in our analysis. Of these, 54 patients (31%) developed CRPC during the 9-year follow-up. Median FSH for the tertiles was 4.35, 6.13, and 11.32 mIU/mL. FSH tertiles were not significantly associated with the time to CRPC, or with CSS or OS. FSH levels were not a significant prognostic factor for these oncologic outcomes. Conclusion As previously reported, the use of gonadotropin-releasing hormone (GnRH) antagonists for ADT has significantly more suppression of FSH levels than GnRH agonists. Our results do not suggest that differences in circulating FSH 1 year following ADT initiation influence long-term oncologic outcomes or development of CRPC.

GnRH Analogues as a Co-Treatment to Therapy in Women of Reproductive Age with Cancer and Fertility Preservation.

In this review, we analyzed existing literature regarding the use of Gonadotropin-releasing Hormone (GnRH) analogues (agonists, antagonists) as a co-treatment to chemotherapy and radiotherapy. There is a growing interest in their application as a prophylaxis to gonadotoxicity caused by chemotherapy and/or radiotherapy due to their ovarian suppressive effects, making them a potential option to treat infertility caused by such chemotherapy and/or radiotherapy. They could be used in conjunction with other fertility preservation options to synergistically maximize their effects. GnRH analogues may be a valuable prophylactic agent against chemotherapeutic infertility by inhibiting rapid cellular turnover on growing follicles that contain types of cells unintentionally targeted during anti-cancer treatments. These could create a prepubertal-like effect in adult women, limiting the gonadotoxicity to the lower levels that young girls have. The use of GnRH agonists was found to be effective in hematological and breast cancer treatment whereas for ovarian endometrial and cervical cancers the evidence is still limited. Studies on GnRH antagonists, as well as the combination of both agonists and antagonists, were limited. GnRH antagonists have a similar protective effect to that of agonists as they preserve or at least alleviate the follicle degradation during chemo-radiation treatment. Their use may be preferred in cases where treatment is imminent (as their effects are almost immediate) and whenever the GnRH agonist-induced flare-up effect may be contra-indicated. The combination treatment of agonists and antagonists has primarily been studied in animal models so far, especially rats. Factors that may play a role in determining their efficacy as a chemoprotective agent that limits gonadal damage, include the type and stage of cancer, the use of alkylating agents, age of patient and prior ovarian reserve. The data for the use of GnRH antagonist alone or in combination with GnRH agonist is still very limited. Moreover, studies evaluating the impact of this treatment on the ovarian reserve as measured by Anti-Müllerian Hormone (AMH) levels are still sparse. Further studies with strict criteria regarding ovarian reserve and fertility outcomes are needed to confirm or reject their role as a gonadal protecting agent during chemo-radiation treatments.

Estrus expression and pregnancy rates in heifers primiparous and multiparous Nelore cows subjected to timed artificial insemination with strategic use of gonadotropin-releasing hormone

We evaluated the effects of nulliparous, primiparous, and multiparous conditions on the estrus and pregnancy rates in females that did not show estrus but were treated with gonadotropin-releasing hormone (GnRH) at the time of timed artificial insemination (TAI). Nelore females (n = 531) were allocated according to the following categories: nulliparous (n = 144), primiparous (n = 132), and multiparous (n = 255). The animals received a conventional TAI protocol, and estrus expression was identified by the absence of paint in the sacrococcygeal region on the day of TAI. Females that did not show estrus were treated with 10 μg of GnRH together with insemination. The rates of estrus and pregnancy were analyzed using a logistic regression model (P &lt; 0.05). The estrus expression was lower (P = 0.006) in the primiparous (61.36%) group than in the nulliparous (76.39%) and multiparous (75.69%) groups. Similar pregnancy rates were observed in females that showed estrus (nulliparous 84.54%, primiparous 86.42%, and multiparous 80.31%; P = 0.39) and in females that did not show estrus and received GnRH (nulliparous 41.18%, primiparous 56.86%, and multiparous 58.06%; P = 0.24). The total pregnancy rates were also similar (P = 0.98) among the categories (nulliparous 74.3%, primiparous 75.0%, and multiparous 74.9%). The primiparous females had a lower rate of estrus, and the pregnancy rates were similar among the categories that received GnRH.

A randomized Clinical Trial comparing embryo quality and clinical pregnancy rate in PCOS patients underwent controlled ovarian stimulation using antagonist protocol with freeze all strategy and triggered for final oocyte maturation by gonadotropin agonist versus human chorionic gonadotropin in IVF cycles

Background: The use of Gonadotropin-releasing hormone (GnRH) antagonist protocol rather than the long agonist protocol showed a marked reduction in the incidence of OHSS Aim: To compare the effect of triggering oocytes by agonist versus HCG on reduction of risk of OHSS, embryo quality and clinical pregnancy rate. Patients and methods: A randomized Clinical Trial was conducted at IVF unit in Cairo University Obstetric and Gynecologic hospital. The patients were divided into two groups, the 1st group received GnRH agonist trigger, the 2nd group received hCG trigger; all embryos were frozen at day 5 and frozen embryos were transferred the next cycle. Results: There was an obvious reduction in the risk of OHSS in the GnRH agonist triggered group than in the HCG triggered group but with no statistically significant difference. In the current study, there was no statistically significant difference between the HCG triggered group in comparison to the GnRH agonist triggered group regarding chemical and clinical pregnancy rates. Conclusion: The use of GnRH triggering for women with PCOS undergoing ICSI cycle with antagonist protocol with freeze all and transfer of frozen embryos in a later cycle has a lower risk of OHSS than using HCG triggering method.

ADAPTING THE TREATMENT OF OVARIAN CYSTS ACCORDING TO THEIR TYPE IN DAIRY CATTLE

Ovarian cysts, estimated as the most frequent ovarian disorder in dairy cattle, can impact the economic aspect and trigger serious loss by affecting the reproductive performance. However, treatment strategies for ovarian cysts in dairy cattle are disputed, as some researchers favour the use of gonadotropin-releasing hormone (GnRH) for all cysts, whereas others recommend this treatment only for follicular cysts, with prostaglandin F2α (PGF2α) for luteal cysts, but not all of the dairy cattle responded to these regimes. Other studies mention a spontaneous recovery for some of the dairy cattle that present this disorder. However, the Ovsynch protocol appears to be the most used for treating ovarian follicular cysts, despite low pregnancy rates. Thus, this study’s main purpose is to assess by analogy the reproductive efficiency of multiparous dairy cattle with follicular cysts after treatment with a recommended dose of GnRH or a further Ovsynch protocol, and of cattle with luteal cysts after PGF2α or a further 12-day Presynch protocol, by comparing the reproductive responses between treated and non-treated cattle. It is remarkable that ten of the dairy cattle diagnosed with ovarian cysts recovered spontaneously without any hormonal intervention, but the reproductive performance indicates that treatment should be started as soon as the condition is diagnosed. Compared with other studies, our approach improved the conception (82.4% and 64.3%, respectively) and pregnancy rates (53.8% and 50%, respectively) in both follicular and luteal cysts.

Central Precocious Puberty in Boys and Girls: Similarities and Differences

Central precocious puberty (CPP) is due to the premature activation of the hypothalamic–pituitary–gonadal axis, which is responsible for the appearance of secondary sexual characteristics. It occurs before the age of 8 and 9 in girls and boys, respectively. CPP shows higher incidence in females than in males. Causes of CPP are similar in both sexes, but the idiopathic form is more frequent in girls, while organic forms are more frequent in males. Recent studies demonstrated a role of some genetic variants in the pathogenesis of CPP. The diagnostic evaluation based on accurate physical examination, assessment of the pituitary–gonadal axis, pelvic sonography in girls, and determination of bone age. Magnetic resonance of the central nervous system should be done in all boys and selected girls. Since the 1980s, pharmacologic treatment involves the use of gonadotropin-releasing hormone (GnRH) analogs. These drugs are characterized by few side effects and long-term safety. Many data are available on the outcome of GnRH analog treated female patients, while poor data are reported in boys. Adult height is improved in both sexes.