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Jans V, Dondorp W, Mastenbroek S, Mertes H, Pennings G, Smeets H, de Wert G. Between innovation and precaution: how did offspring safety considerations play a role in strategies of introducing new reproductive techniques? Hum Reprod Open 2020; 2020:hoaa003. [PMID: 32201741 PMCID: PMC7077615 DOI: 10.1093/hropen/hoaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
The field of reproductive medicine has been criticized for introducing ARTs without systematic research on possible safety risks and for failing to meet the standards of evidence-based innovation held elsewhere in medicine. In this paper, firstly, we ask whether ‘responsible innovation’ has been a concern for the field, and if so, how it has understood the practical implications of this idea for the development and introduction of potentially risky new ARTs. Secondly, we consider whether the field has indeed fallen short of its responsibilities in this respect, and if so, how things can be improved. To answer these questions, we present three case studies involving the introduction of a new reproductive technology: ICSI, preimplantation genetic testing and mitochondrial replacement therapy. As a framework for analyzing these cases, we used Per Sandin’s account of the four dimensions of dealing with risks (threat, uncertainty, action, command) that are central to debates about the possible role of the so-called precautionary principle. We conclude that, although offspring safety concerns have been on the agenda of the debate about bringing the relevant technologies to the clinic, systematic safety and effectiveness studies were not always conducted. As professionals in assisted reproduction have a responsibility to take account of the welfare of the children they are creating, we suggest a policy of proceeding with systematic caution. Legal measures may be needed to ensure that professional guidance is followed in practice. Finally, an open question concerns the threshold for acceptable risk in the context of introducing new ARTs. Multiple stakeholders, including professional societies and patient organizations, should have a role in the urgent debate about this.
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Affiliation(s)
- Verna Jans
- Department of Health, Ethics and Society and Research School GROW for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Wybo Dondorp
- Department of Health, Ethics and Society and Research School GROW for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Sebastiaan Mastenbroek
- Amsterdam University Medical Center, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - Heidi Mertes
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Guido Pennings
- Bioethics Institute Ghent (BIG), Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Hubert Smeets
- Department of Clinical Genomics, Research School GROW for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Guido de Wert
- Department of Health, Ethics and Society and Research School GROW for Oncology & Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Campos PD, Oliveira IM, Sena de Souza J, Da Conceição RR, Giannocco G, Chiamolera MI, Silva MRDD, Romano MA, Romano RM. Maternal bisphenol A exposure disrupts spermatogenesis in adult rat offspring. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:163-175. [PMID: 30755151 DOI: 10.1080/15287394.2019.1572557] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Bisphenol A (BPA) is an endocrine-disrupting chemical (EDC) that is widely used in the manufacturing of plastics and inner linings of food cans. Previously, it was reported that BPA disturbed the sexual dimorphic nucleus of the hypothalamus and delaying the onset of puberty attributed to an estrogenic action. In addition, BPA during the perinatal period increased LH serum concentrations in male offspring of dams at doses below the reproductive NOAEL (No Observable Adverse Effect Level) based upon World Health Organization guidelines. Based upon these findings, the objective of this study was to (1) determine the effects of perinatal treatment with low doses of BPA on regulation of spermatogenesis in adult offspring and (2) elucidate molecular mechanisms involved in the pathogenesis of gonadal dysfunction. The expression of genes related to spermatogenesis was disrupted with adverse consequences on sperm production, reserves, and function. Both BPA treated groups exhibited reduction in sperm production and epithelial height of seminiferous tubules, accompanied by diminished integrity of the acrosome and plasma membrane, decreased mitochondrial activity and increased incidence of morphological abnormalities. The sperm transit time was also slower. However, only in the group receiving the higher BPA dose was transcript expression of genes affected (reduced Ar and increased Esr1). It is of interest that serum testosterone levels were elevated in the same group where Ar was decreased. Data suggest that exposure to low BPA doses during hypothalamic sexual differentiation period produces permanent deleterious effects on spermatogenesis in adulthood.
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Affiliation(s)
- Patricia De Campos
- a Laboratory of Reproductive Toxicology, Department of Pharmacy , State University of Centro-Oeste , Parana , Brazil
| | - Isabela M Oliveira
- a Laboratory of Reproductive Toxicology, Department of Pharmacy , State University of Centro-Oeste , Parana , Brazil
| | - Janaina Sena de Souza
- b Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina , Universidade Federal de São Paulo (Unifesp/EPM) , São Paulo , Brazil
| | - Rodrigo Rodrigues Da Conceição
- b Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina , Universidade Federal de São Paulo (Unifesp/EPM) , São Paulo , Brazil
| | - Gisele Giannocco
- b Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina , Universidade Federal de São Paulo (Unifesp/EPM) , São Paulo , Brazil
| | - Maria I Chiamolera
- b Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina , Universidade Federal de São Paulo (Unifesp/EPM) , São Paulo , Brazil
| | - Magnus R Dias-Da Silva
- b Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina , Universidade Federal de São Paulo (Unifesp/EPM) , São Paulo , Brazil
| | - Marco A Romano
- a Laboratory of Reproductive Toxicology, Department of Pharmacy , State University of Centro-Oeste , Parana , Brazil
| | - Renata Marino Romano
- a Laboratory of Reproductive Toxicology, Department of Pharmacy , State University of Centro-Oeste , Parana , Brazil
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Mortimer D, Barratt CLR, Björndahl L, de Jager C, Jequier AM, Muller CH. What should it take to describe a substance or product as 'sperm-safe'. Hum Reprod Update 2013; 19 Suppl 1:i1-45. [PMID: 23552271 DOI: 10.1093/humupd/dmt008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Male reproductive potential continues to be adversely affected by many environmental, industrial and pharmaceutical toxins. Pre-emptive testing for reproductive toxicological (side-)effects remains limited, or even non-existent. Many products that come into direct contact with spermatozoa lack adequate testing for the absence of adverse effects, and numerous products that are intended for exposure to spermatozoa have only a general assumption of safety based on the absence of evidence of actual harm. Such assumptions can have unfortunate adverse impacts on at-risk individuals (e.g. couples who are trying to conceive), illustrating a clear need for appropriate up-front testing to establish actual 'sperm safety'. METHODS After compiling a list of general areas within the review's scope, relevant literature and other information was obtained from the authors' personal professional libraries and archives, and supplemented as necessary using PubMed and Google searches. Review by co-authors identified and eliminated errors of omission or bias. RESULTS This review provides an overview of the broad range of substances, materials and products that can affect male fertility, especially through sperm fertilizing ability, along with a discussion of practical methods and bioassays for their evaluation. It is concluded that products can only be claimed to be 'sperm-safe' after performing objective, properly designed experimental studies; extrapolation from supposed predicate products or other assumptions cannot be trusted. CONCLUSIONS We call for adopting the precautionary principle, especially when exposure to a product might affect not only a couple's fertility potential but also the health of resulting offspring and perhaps future generations.
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Affiliation(s)
- David Mortimer
- Oozoa Biomedical Inc., Caulfeild Village, West Vancouver, BC, Canada.
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Abstract
Micromanipulation technology entered the forum of human conceptionin vitroin the late 1980s. It was erroneously perceived as a new technology – a purely mechanical approach to bypass failures of conceptionin vitro, the aetiology of which were unknown. In fact, it is the modification of technology developed since the beginning of this century, and its logical utilization for conceptionin vitro, preconception (polar body) biopsy and preimplantation (blastomere and trophectoderm) biopsy in the realm of human infertility and genetic disorders.
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Dozortsev D, Neme R, Diamond MP, Abdelmassih S, Abdelmassih V, Oliveira F, Abdelmassih R. Embryos generated using testicular spermatozoa have higher developmental potential than those obtained using epididymal spermatozoa in men with obstructive azoospermia. Fertil Steril 2006; 86:606-11. [PMID: 16952508 DOI: 10.1016/j.fertnstert.2006.01.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Revised: 01/31/2006] [Accepted: 01/31/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether the injection of testicular spermatozoa results in more viable embryos (higher implantation rate) than injection of epididymal spermatozoa in cases of obstructive azoospermia. DESIGN Retrospective analysis of 265 cases of testicular sperm aspiration (TESA) and percutaneous sperm aspiration (PESA), including 185 cases of obstructive azoospermia. SETTING Private Infertility clinic. PATIENT(S) None, charts review. INTERVENTION(S) None, charts review. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate (PR), implantation rate. RESULT(S) Although fertilization rates were higher in the PESA group, implantation rates were significantly better in the TESA group. There was also a trend to higher ongoing PR and lower miscarriage rates in TESA cases. CONCLUSION(S) In cases of obstructive azoospermia, embryos generated using testicular spermatozoa have higher developmental potential than those obtained using epididymal spermatozoa.
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Affiliation(s)
- Dmitri Dozortsev
- Clínica e Centro de Pesquisa em Reprodução Humana Roger Abdelmassih, São Paulo, Brazil.
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New techniques for sperm acquisition in obstructive azoospermia. Fertil Steril 2004; 82 Suppl 1:S186-93. [PMID: 15363724 DOI: 10.1016/j.fertnstert.2004.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sofikitis NV, Toda T, Miyagawa I, Zavos PM, Pasyianos P, Mastelou E. Beneficial effects of electrical stimulation before round spermatid nuclei injections into rabbit oocytes on fertilization and subsequent embryonic development. Fertil Steril 1996; 65:176-85. [PMID: 8557137 DOI: 10.1016/s0015-0282(16)58048-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the effects of electrical stimulation of rabbit oocytes before round spermatid nuclear injection procedure on oocyte activation and fertilization. DESIGN The ratio of activated oocytes to the number of successfully injected oocytes and the proportion of offspring to the number of activated oocytes after round spermatid nuclear injections into oocytes stimulated via mechanical stimulation (group A) or a combination of electrical and mechanical stimulation (group B) was compared. INTERVENTIONS Round spermatid nuclei were isolated from mature male rabbits and microinjected into the oocytes of groups A and B. Injected oocytes were cultured for 24 hours. The embryos developed from groups A and B were transferred to synchronized recipient does. RESULTS Embryos that developed normally through implantation in groups A and B were carried successfully through complete gestation in the recipient does. The ratio of the activated oocytes to the number of successfully injected oocytes and the proportion of offspring to the number of activated oocytes were significantly higher in group B. CONCLUSION Electrical stimulation of oocytes before ooplasmic spermatid nuclear injections and ET procedures has beneficial effects on oocytes activation, fertilization, and subsequent embryonic development.
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Affiliation(s)
- N V Sofikitis
- Tottori University School of Medicine, Yonago, Japan
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Martin-DeLeon PA. Analysis of the chromosome complement in outbred mouse sperm fertilizing in vitro. GAMETE RESEARCH 1989; 22:71-81. [PMID: 2917728 DOI: 10.1002/mrd.1120220108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The chromosome complements in a population of mouse sperm from random-bred ICR donors were analyzed at first-cleavage metaphase after in vitro fertilization (IVF) of oocytes from females of the same strain. The sperm were aged as donations occurred within an average of 31 days, either since last mating or at arrival at the animal facility in the case of virgin males. Of a total of 598 sperm complements studied from 22 sexually mature males aged 10-26 weeks old, there was one diploid complement (0.17%). The frequencies of hyperhaploidy and structural aberrations that were studied in 338 complements were 4.4% and 3.6%, respectively, giving an overall frequency of 8.0%. The hyperhaploid complements consisted of n + 1, n + 2, n + 3, and n + 7 counts, while the structural abnormalities were of the chromosome type and included large and small fragments and a possible translocation. This is the highest frequency of sperm chromosome abnormalities reported for mouse sperm obtained from males under physiological conditions and fertilized in vitro or in vivo. Sperm aging, strain, and/or technique differences are among the factors that may be responsible for this high frequency. Since the 8.0% frequency of hyperhaploidy and structural abnormalities is similar to the frequency reported for human sperm after IVF, the outbred murine in vitro fertilization system may be a useful model to study the origin of human sperm chromosome abnormalities.
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Affiliation(s)
- P A Martin-DeLeon
- School of Life and Health Sciences, University of Delaware, Newark 19716
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Zackowski JL, Martin-DeLeon PA. Segregation products of male mice doubly heterozygous for the RB(6.16) and RB (16.17) translocations: influence of sperm karyotype on fertilizing competence under varying mating frequencies. GAMETE RESEARCH 1989; 22:93-107. [PMID: 2917730 DOI: 10.1002/mrd.1120220110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The meiotic segregants of male mice heterozygous for Rb(6.16)24Lub and Rb(16.17)7Bnr were viewed, for the first time, at first cleavage metaphase. Chromosomes were analyzed after G-banding, C-banding, and karyotyping. To study sperm aging effects, chromosomes of 202 one-cell zygotes derived from males mating at intervals of approximately 3, 14, and 21 days were examined. At least 89.6% of sperm-derived complements were products of 2:2 segregation; at most, a possible 6.4% were 3:1 segregants. The six expected types of 2:2 segregants, both balanced and unbalanced, were equifrequent in the total zygote population derived from sperm of all ages. When the data were analyzed according to mating frequency, the 3-day sperm population considered most likely to be fresh showed a deficiency of the segregant nullisomic for chromosome 6 and disomic for chromosome 17, when compared with the reciprocal segregant (P less than 0.025) as well as to all other 2:2 segregants (P less than 0.05). However, these sperm fertilized in greater numbers (P less than 0.01) than their reciprocal segregant (disomic for 6 and nullisomic for 17) in the 14-day sperm population. While sperm with chromosomal abnormalities are capable of fertilization, the competence of segregants nullisomic for 6 and disomic for 17 apparently depends on the prior storage period in the male. Further, the results suggest that the effect of aneuploidy on sperm function is dependent on the specific chromosome(s) involved.
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Affiliation(s)
- J L Zackowski
- School of Life and Health Sciences, University of Delaware, Newark
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Simpson JL, Gray RH, Queenan JT, Mena P, Perez A, Kambic RT, Tagliabue G, Pardo F, Stevenson WS, Barbato M. Pregnancy outcome associated with natural family planning (NFP): scientific basis and experimental design for an international cohort study. ADVANCES IN CONTRACEPTION : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE ADVANCEMENT OF CONTRACEPTION 1988; 4:247-64. [PMID: 3075423 DOI: 10.1007/bf01849266] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although natural family planning (NFP) is a form of contraception without ostensible maternal risks (other than pregnancy), potential fetal risks could exist if aging gametes are involved in inadvertent fertilization. In the following report, we first review animal studies firmly establishing that aging sperm and aging oocytes (delayed fertilization) cause chromosomal abnormalities in mammals and other species. We next review human studies associating decreased coital frequency with trisomy and studies of NFP populations that generally show no increased frequency of anomalous offspring or spontaneous abortions. Our rationale for initiating an international cohort study is presented, along with the experimental design selected. Preliminary findings indicate that the experimental design chosen will indeed provide information allowing NFP safety to be assessed definitively.
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Martin-DeLeon PA, Williams MB. Sexual behavior and Down syndrome: the biological mechanism. AMERICAN JOURNAL OF MEDICAL GENETICS 1987; 27:693-700. [PMID: 2957914 DOI: 10.1002/ajmg.1320270324] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sufficient evidence of a correlation between infrequent coitus and Down syndrome (DS) has now accumulated to warrant reevaluation of the suggested biological mechanisms. The evidence provides no support for delayed fertilization as the mechanism responsible for this correlation, as was originally proposed by German [Nature 217:516-519, 1968]. A better explanation of this association is provided by the sperm aging hypothesis, which gains its support from both animal studies and chromosomal findings of a paternal contribution to DS. The animal studies supporting this hypothesis show an increased incidence of sperm-derived trisomies resulting from sperm stored for prolonged periods in the male tract. The chromosomal findings show a paternal origin in 20% of DS infants; the sperm aging hypothesis concerns the biological mechanism in this 20%. In addition to explaining the excess of DS for older mothers, the sperm aging hypothesis explains the excess for teenage unwed mothers and indicates that sperm aging from decreased ejaculatory frequency may be a cause of DS in all age groups. Testable directly in humans against German's delayed fertilization hypothesis, the sperm aging hypothesis has immediate clinical implications. It suggests 1) an approach to reduce the incidence of DS and miscarriages and 2) clinical research that will increase knowledge of the circumstances indicating a need for antenatal monitoring.
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Simpson JL. Relationship between congenital anomalies and contraception. ADVANCES IN CONTRACEPTION : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE ADVANCEMENT OF CONTRACEPTION 1985; 1:3-30. [PMID: 3939506 DOI: 10.1007/bf01849140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Martin-DeLeon PA, Boice ML. Sperm aging in the male after sexual rest: Contribution to chromosome anomalies. ACTA ACUST UNITED AC 1985. [DOI: 10.1002/mrd.1120120206] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Martin-DeLeon PA, Boice ML. Sperm aging in the male and cytogenetic anomalies. An animal model. Hum Genet 1982; 62:70-7. [PMID: 6218064 DOI: 10.1007/bf00295606] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Sperm generally appear in the ejaculate within three weeks after vasovasostomy, but may soon disappear because of scarring of the anastomotic site. For this reason attempt at conception early after the operation should be encouraged.
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Shaver EL, Yanagimachi R. The effect of in vitro storage of hamster sperm on fertilization and early development. ACTA ACUST UNITED AC 1978. [DOI: 10.1002/mrd.1120010303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
The change in fertility of bull semen with time in storage at -196 C was examined in data on inseminations by the Michigan Animal Breeders Cooperative over 5 yr. Intervals from collection to use were grouped by 10 days for the 1st yr, 30 days for the 2nd yr, 180 days for the 3rd yr, and a single class for semen stored 4 or 5 yr. There were 97,586 first inseminations from bulls with 10 or more ejaculates and from ejaculates with four or more classes. Nonreturn rates for 50-, 60-, 90-, and 180-day intervals post-breeding were calculated. Heterogeneity of quadratic regressions of nonreturn rates on semen age was unimportant. Both regression and least squares analyses were used. Nonreturn rates increased to about 115 days of storage and remained there through the 4 and 5 yr age group. The lowest and highest nonreturn rates for a return interval differed by approximately 4%. Maximum differences in nonreturn rates for different intervals were at the lowest nonreturn rates.
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