**4.3 Intrauterine treatment**

Disorders related to reproductive tract infections may be related to RBC syndrome and very often overlooked by clinicians. Prophylactic practices have been used, as the uterine administration of antiseptic solutions (lugol) 24 h. after mating/AI (Tanaka et al., 1994), although fertility results are poor (Huszenicsa et al., 1994).

Clinical Approach to the Repeat Breeder Cow Syndrome 355

day 5 after AI to day 19. The suggested fertility improvement in RBCs is based on the rise of the progesterone level above the minimum threshold necessary to maintain pregnancy and the increment of progesterone receptors. Intravaginal progestagen treatments are effective some days after the insertion, while progesterone injection (200 mg on days 5, 7, 9 and 11 post-IA) fails to increase plasma concentrations of progesterone in RBC (Walton et al., 1990).

The administration of GnRH around the insemination time aims to accelerate and ensure ovulation in cows, acting directly on the pituitary, stimulating the secretion and release of gonadotrophins, such as LH and FSH, and promoting the preovulatory LH peak, which is essential for follicular dehiscence. In many cases, RBC syndrome is associated with ovulatory defects, as anovulation, delayed ovulation or gonadotrophin release failure.

If luteal deficiency is suspected as reproductive failure in cows, GnRH (100 µg) could be used on day 5 post-AI (Gonzalez-Stagnaro, 1993). GnRH induces LH and FSH discharge pituitary, promotes increased levels of progesterone and exerts a luteoprotector (luteotrophic), increasing fertility in RBCs associated with subfunctional CL or ovulation defects. The mentioned treatment has also been combined with intrauterine antibiotic (infusion of 30-50 ml containing 300000 IU penicillin and 0,5 g streptomycin), increasing fertility in RBCs. This treatment could be more appropriate when abnormal vulvar

A comprehensive study carried out in RBCs indicates that the administration of GnRH at the AI time may be beneficial for improving fertility in these cows (Stevenson et al., 1990). These authors do not recommend the use of double insemination in RBCs, in contrast with Singh et al. (2005) who suggest that pregnancy rates can be improved by increasing the

These hormones have been used in RBCs to induce ovulation and exert the luteotrophic

In 1965, Roussel et al. administered intramuscularly pregnant mare serum (PMS) on day 15 or 16 of the estrous cycle, obtaining a conception rate of 73,9% in RBCs compared with

Treatment with hCG on day 5 after insemination can achieve higher levels of progesterone

The luteolytic effect of prostaglandins has been used to treat RBCs. In this case, treatment aims to achieve better heat detection and to increase the number of cows in heat. Numerous protocols are used in cow, e.g. two PGF2alpha injections apart 11 days and insemination 80 hours later. Intravenous PGF2alpha (0,2 ml cloprostenol) has also been reported in RBCs at AI time. However, the most frequent use of this hormone has been combined with other

However, HCG is the most used exogenous gonadotrophin for treating RBC syndrome.

for at least 2 weeks, due to the development of accessory CL (Walton et al., 1990)

**4.5.2 GnRH (gonadotrophin-releasing hormone)** 

conformation is present.

insemination frequency.

effect on the CL.

44,4% of control cows.

**4.5.4 Prostaglandins** 

**4.5.3 Exogenous gonadotrophin** 

Studies on bacteriology and histology of the uterus concluded that the non-specific genital infection is one of the main causes of RBC, and it is suggested that antimicrobial treatments (chloramphenicol, gentamicin, enrofloxacin, tetracycline, or nitrofurantine) could improve the reproductive indexes (Santana et al., 1998a).

#### **4.4 Alternative medicine**

Scientific contributions report the utility of some alternative medicines, such as acupuncture or moxibustion, to reduce the incidence of RBC syndrome.

Moxibustion has been used to reduce reproductive failure in RBCs (Hosaha & Nakama, 2002). Moxas (balls of about 3 cm in diameter) containing 2 g of Artemisia spp. are applied on nine points of the skin and burned for 15 min. The treatments are applied for 3 consecutive days, and then repeated during the heat. Authors describe an increase in blood flow at the uterine arteries, which is considered to improve fertility.

We also find references in the literature about the positive effect of aquapuncture therapy (Lin et al., 2002), i.e. acupuncture combined with injections. A volume of 5-10 ml of glucose 50% was injected at certain points set by traditional acupuncture in cattle. This study reported a good fertility rate, although many gestations failed later.

### **4.5 Hormonal treatments**

Numerous hormonal treatments have been used to improve results in RBCs. The literature about treatments in RBCs is difficult to compile, since criteria to define animals included on this syndrome are variable. It is reported the use of progesterone, alone or combined with other substances, at different times of the estrous cycle to protect the pregnancy and to improve the maternal recognition of pregnancy. Numerous studies describe the influence of GnRH (and analogues) to improve fertility in RBCs. HCG, an exogenous gonadotrophin, has been administered during luteal phase and at AI time. References exist about the use of pregnant mare serum for the RBC therapy. Prostaglandins have also been widely used to improve heat detection.

#### **4.5.1 Progesterone (Pg)**

Progesterone is essential for implantation and maintenance of pregnancy. CL dysfunction decreases Pg concentrations and then negatively affects fertility (Gustafsson et al., 1986; Kimura et al., 1987). In contrast, some authors have not found differences between Pg concentrations in normal or repeat breeder cows (Ayalon, 1984).

It has been noted that the administration of progesterone as of 3 to 5 days after insemination and for 2-3 weeks (or more) improves conception rates in RBCs. Umakanthan (1995) administered 250 mg of retard progesterone on days 4, 14, 24, 34, 44 and 54 after insemination. The pregnancy rate was 96% in RBCs versus 20% in control cows. Kimura et al. (1987) argue that the delayed formation of the CL induces estrus repetition, and then suggest that progesterone therapy should be started on 4-5th day after insemination.

Bulman & Lamming (1978) inserted intravaginal devices (PRID) for 14 days in RBCs, previously removing the estrogen capsule. The treatment improved the ovulation and shortened the calving-conception interval. Villaroel et al. (2004) have used this disposal from

Studies on bacteriology and histology of the uterus concluded that the non-specific genital infection is one of the main causes of RBC, and it is suggested that antimicrobial treatments (chloramphenicol, gentamicin, enrofloxacin, tetracycline, or nitrofurantine) could improve

Scientific contributions report the utility of some alternative medicines, such as acupuncture

Moxibustion has been used to reduce reproductive failure in RBCs (Hosaha & Nakama, 2002). Moxas (balls of about 3 cm in diameter) containing 2 g of Artemisia spp. are applied on nine points of the skin and burned for 15 min. The treatments are applied for 3 consecutive days, and then repeated during the heat. Authors describe an increase in blood

We also find references in the literature about the positive effect of aquapuncture therapy (Lin et al., 2002), i.e. acupuncture combined with injections. A volume of 5-10 ml of glucose 50% was injected at certain points set by traditional acupuncture in cattle. This study

Numerous hormonal treatments have been used to improve results in RBCs. The literature about treatments in RBCs is difficult to compile, since criteria to define animals included on this syndrome are variable. It is reported the use of progesterone, alone or combined with other substances, at different times of the estrous cycle to protect the pregnancy and to improve the maternal recognition of pregnancy. Numerous studies describe the influence of GnRH (and analogues) to improve fertility in RBCs. HCG, an exogenous gonadotrophin, has been administered during luteal phase and at AI time. References exist about the use of pregnant mare serum for the RBC therapy. Prostaglandins have also been widely used to

Progesterone is essential for implantation and maintenance of pregnancy. CL dysfunction decreases Pg concentrations and then negatively affects fertility (Gustafsson et al., 1986; Kimura et al., 1987). In contrast, some authors have not found differences between Pg

It has been noted that the administration of progesterone as of 3 to 5 days after insemination and for 2-3 weeks (or more) improves conception rates in RBCs. Umakanthan (1995) administered 250 mg of retard progesterone on days 4, 14, 24, 34, 44 and 54 after insemination. The pregnancy rate was 96% in RBCs versus 20% in control cows. Kimura et al. (1987) argue that the delayed formation of the CL induces estrus repetition, and then

Bulman & Lamming (1978) inserted intravaginal devices (PRID) for 14 days in RBCs, previously removing the estrogen capsule. The treatment improved the ovulation and shortened the calving-conception interval. Villaroel et al. (2004) have used this disposal from

suggest that progesterone therapy should be started on 4-5th day after insemination.

the reproductive indexes (Santana et al., 1998a).

or moxibustion, to reduce the incidence of RBC syndrome.

flow at the uterine arteries, which is considered to improve fertility.

reported a good fertility rate, although many gestations failed later.

concentrations in normal or repeat breeder cows (Ayalon, 1984).

**4.4 Alternative medicine** 

**4.5 Hormonal treatments** 

improve heat detection.

**4.5.1 Progesterone (Pg)** 

day 5 after AI to day 19. The suggested fertility improvement in RBCs is based on the rise of the progesterone level above the minimum threshold necessary to maintain pregnancy and the increment of progesterone receptors. Intravaginal progestagen treatments are effective some days after the insertion, while progesterone injection (200 mg on days 5, 7, 9 and 11 post-IA) fails to increase plasma concentrations of progesterone in RBC (Walton et al., 1990).
