Mobile Health technology in pediatric esophagogastroduodenoscopy quality indicators assessment: results from a national program of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition

BACKGROUND AND AIMS

Upper endoscopy procedures (UEP, esophagogastroduodenoscopy [EGDS] and retrograde endoscopic retrograde cholangiography [ERCP]) are an established standard of care in pediatric gastroenterology. The Pediatric endoscopy quality improvement network (PEnQuIN) recently published its pediatric-specific endoscopy quality guidelines. This study, initiated by the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP), aims to evaluate the adherence of Italian Pediatric Endoscopy Centers to these established quality standards.

METHODS

Conducted between April 2019 and March 2021, this nationwide study utilized a smartphone app-based approach. Data encompassing pediatric endoscopy facilities, patient profiles, endoscopy indications, 17 procedure-related PEnQuIN indicators, and a GHAA-9m patient satisfaction questionnaire were systematically collected.

RESULTS

A comprehensive analysis of 3582 procedures from 24 PECs revealed that 2654 (76%) were UEP. The majority of centers (75%) involved more than one operator, with 9 PEC incorporating adult endoscopists, responsible for 5% of UEPs. Overall, adherence to quality standards was good; however, areas of improvement include sub-optimal reporting of sedation details, adherence to disease-specific guidelines, and patient satisfaction questionnaire completeness (56%). The complication rate aligned with literature standards (1%), and patient satisfaction was generally high. A noteworthy observation was a 30% decrease monthly reporting rate and a shift in disease-specific patterns following the COVID-19 outbreak.

CONCLUSIONS

Pediatric UEP practices in Italy adhere well to established quality standards. Emphasizing the adoption of disease-specific guidelines is crucial for optimizing resources, enhancing diagnostic accuracy, and minimizing unnecessary procedures. Prioritizing patient satisfaction is important for immediate enhancements in practice as well as for future research endeavors.

Antral follicle count, productive and reproductive parameters in Bos indicus and Bos indicus-taurus prepubertal heifers with early puberty induction

ABSTRACT Prepubertal Nelore (G-N = 15) and crossbred Nelore x Aberdeen Angus heifers (G-NA = 15) were used for this study. AFC, live weight, body condition score (BCS), ovary and dominant follicle (DF) diameters were determined in each animal. Puberty induction was performed by insertion of a 4th use progesterone device (D0) which was removed on D12. Also, 1 mg estradiol benzoate was administered, and estrus intensity was classified (D12). At D21, the presence and diameter of the corpus luteum (CL) were registered. AFC was highly repeatable, regardless of hormone induction in both G-N (r=0.79) and G-NA (r=0.90). The mean AFC was greater in G-N compared to G-NA (24.2±8.5 vs. 17.7±9.0 follicles). A variation in BCS throughout the study occurred in G-NA, but not in G-N. The average weight gain (AWG) was greater in G-NA compared to G-N (0.69±0.33 vs. 0.40±0.29kg/day). The G-NA resulted in a larger diameter of DF at D12 than G-N (11.6±2.7 vs. 9.3±1.5mm). In conclusion, AFC was greater in Nelore heifers, although in both breeds this count was highly repeatable during puberty induction. Crossbred heifers had greater BCS and AWG with greater diameter of DF, indicating higher precocity when compared to Nelore heifers.

Follicular dynamics, luteal characteristics, and progesterone concentrations in synchronized lactating Holstein cows with high and low antral follicle counts

We performed two experiments in high milk-producing Holstein cows. First, we evaluated the repeatability of the antral follicle count (AFC) - where all follicles were ≥2 mm in diameter - during the days of the ovulation synchronization protocol for timed artificial insemination (TAI) in dairy cows (n = 20). In the second study we investigated the follicular dynamics and Doppler ultrasonography in cows with low (≤15 follicles, n = 9) and high (≥25 follicles, n = 9) AFC, and measured progesterone (P4) concentrations during CL evaluation. In addition, the diameter of the preovulatory follicle, area of blood flow of the preovulatory follicle, CL area, and CL blood flow were compared between groups with high and low AFC. Ultrasound examinations were performed during the days of the protocol and 10 days after ovulation to assess the CL. The constancy of the AFC was analyzed by calculating the repeatability. Parametric variables were analyzed using the t-test, and nonparametric variables were analyzed using the Mann-Whitney test (P ≤ 0.05). The repeatability of the AFC on different days of the protocol was 0.98. Cows with low AFC showed a greater diameter of the preovulatory follicle (16 ± 0.3 vs. 15 ± 0.4 mm), blood flow area of the preovulatory follicle (17.3 ± 2.3 vs. 8.1 ± 3.2 mm²), CL area (579.1 ± 16.9 vs. 405.8 ± 21.2 mm²), area of CL perfusion (97.1 ± 9.4 vs. 68.3 ± 5.2 mm²), as well as higher P4 levels (3.1 ± 0.2 vs. 2.2 ± 0.2 ng/mL). In high milk-producing Holstein cows, the AFC has high repeatability on different days of the TAI protocol, and cows with a low AFC show larger preovulatory follicles and CLs with greater perfusion, in addition to greater P4 concentrations in comparison to those cows with a high AFC.

Intravenous immunoglobulin for corticosteroid-resistant intestinal Henoch-Schönlein purpura: worth a controlled trial against corticosteroids?

OBJECTIVES

Henoch-Schönlein purpura (HScP) may present in children with severe, occasionally refractory, gastrointestinal (GI) involvement. The use of corticosteroids (CSs) is commonplace in the management of the disease, but to date no standardized protocol is available and, although rare, resistance to CS therapy may be challenging to clinicians. IVIG has been proposed as an effective alternative to CSs, but to date no controlled trial has been conducted to ascertain their real efficacy. We share our personal experience of successful IVIG treatment in two cases of GI HScP, comparing it with similar experiences reported in literature.

METHODS

Retrospective clinical data collection, comparison with available literature.

RESULTS

We describe two children with severe HScP GI vasculitis refractory to high-dose intravenous CSs that responded rapidly to IVIG administration, with complete recovery within a few days. Patient characteristics and response to IVIG administration were comparable to those of other previously reported cases.

CONCLUSION

Our observation confirms that IVIG may be useful in the treatment of CS-resistant HScP-related GI vasculitis in children, and highlights the need for more structured research, including a randomized trial against CSs, in order to ascertain their real effectiveness.

130 Increased antral follicle population at 60 days of gestation in Holstein cows with low antral follicle count

The antral follicle count (AFC) has been pointed out as one of the main factors that influence the efficiency of reproductive biotechniques. Thus, AFC is considered a fertility marker, which has high repeatability in the same animal. The objective of this study was to evaluate AFC in cows at AI (nonpregnant) and at two moments of gestation (30 and 60 days). For this, 35 pregnant cows, aged 23 to 99 months, confined in a freestall system, kept in the same environmental conditions (24°46'28”S, 49°56'42”W) and under the same feeding conditions, were selected for this study. The same technician performed the AI of the females, after detection of natural or induced oestrus, with 25mg of Dinoprost (Lutalyse) intramuscularly (IM). We established AFC (antral follicles ≥3mm diameter) using a convex intravaginal transducer at the time of AI and at 30 and 60 days of pregnancy. Females were distributed in groups of low (≤18 follicles, n=11), intermediate (≥24 and ≤28 follicles, n=11), or high AFC (≥30 follicles, n=13). Data were analysed using a generalized linear mixed model (Minitab version 18.1), with significance declared at P ≤ 0.05. In the low AFC group, there was an increase in the mean number of antral follicles in relation to gestation, presenting 14.82±1.36 at the time of AI and 23.45±2.31 and 35.18±3.17 at 30 and 60 days of pregnancy, respectively (P<0.0001). Similarly, the intermediate group presented an increase in mean AFC, from 24.64±0.76 at the time of AI and 29.27±3.32 at 30 days to 43.36±5.91 at 60 days of gestation (P=0.001). There was no difference in the high AFC group at different moments, as these presented 41.92±3.50 at the time of AI, 38.31±3.96 at 30 days, and 50.92±5.49 at 60 days of pregnancy. Although mean AFCs differed (P<0.0001) between the low, intermediate, and high AFC groups at time of AI and at 30 days of gestation, there were no differences in AFC between the three groups at 60 days of gestation (P=0.329). In conclusion, low AFC females presented an increase in the number of antral follicles at gestation moments 30 and 60 days from AI. This finding reinforces the strategy of using this category more efficiently for ovum pickup at the beginning of gestation.

113 Influence of antral follicles count on conception rate in Holstein cows and antral follicles count variation on insemination day and on pregnancy Day 30 and 60

Several studies have indicated the population of antral follicles or count of antral follicles (AFC) as one of the main factors that influence the efficiency of reproductive biotechniques and its use as a marker of fertility. In this context, knowing the factors that interfere with or are influenced by this parameter is of crucial importance. Thus, the present study aimed (1) to determine the influence, in high-producing Holstein cows, of low, intermediate, and high AFC on the conception rate to AI, and (2) to evaluate if AFC shows variation at AI moment and in relation to 2 different moments of the gestation (30 and 60 days). In the first (n=95) and second (n=54) experiment, high-producing Holstein cows with a body condition score 2.5-4.5, aged 23-99 months, and maintained in a freestall system were inseminated. Using frozen semen from a single bull and performed by a single technician, the insemination was performed after detection of spontaneous estrus or induction with 25mg of dinoprost tromethamine IM. To determine AFC (follicles ≥2mm), the ovaries of each animal were examined by ultrasound at the time of AI at 30 and 60 days of pregnancy. The pregnancy diagnosis was performed by ultrasound 30 days after AI. In the second experiment, 54 females considered pregnant on the 30-day examination had the AFC reassessed 30 days later (60 days of gestation) to determine the variation in the number of follicles. In the first study, cows were divided into low (≤35 follicles, n=30), intermediate (≥40 and ≤55 follicles, n=30), and high (≥60 follicles, n=30 cows) according to the AFC quartiles (Q1, Q2, and Q3). The AFC was analysed by ANOVA followed by the Tukey's test and the conception rate by the Chi-squared test. In the second study, the AFC was compared between day of AI (considered nonpregnant), 30 and 60 days of pregnancy by repeated-measures using the generalized linear model (P ≤ 0.05). In the first study, the number of antral follicles was different (P<0.001) among groups with low (28±7 follicles), intermediate (47±5 follicles), and high AFC (72±11 follicles); however, the conception rate was similar (P=0.270) for the respective groups, at 26.7% (8/30), 36.7% (11/30), and 50% (15/30), respectively. In the second study, there was an increase (P<0.0001) in the number of antral follicles during the pregnancy, from 55.1±3.1 follicles in the AI moment to 82.6±4.2 at 30 days and reaching 115.2±5.1 follicles at 60 days of pregnancy. In conclusion, these data demonstrated that the conception rate was not influenced by the different AFC groups; however, the AFC increased as pregnancy progressed. In addition, we can suggest that the initial third of gestation (when it is still possible to manipulate the ovaries) is a strategic moment for oocyte retrieval in bovine females for the in vitro embryo production.

Antral follicle population in prepubertal and pubertal heifers

The antral follicle count (AFC) is an important tool in the selection of bovine females destined for biotechnology. However, little is known about AFC in prepubertal and pubertal heifers. Some challenges inherent to the physiology of young females must be considered to achieve efficient rates with different procedures, such as ovum pick-up and IVF. This paper covers some important topics about ovarian physiology related to the population of antral follicles and reproductive efficiency in young female cattle.

7 Ovarian Follicular Dynamics and Conception Rate in Bos indicus Cows with Different Antral Follicle Counts Subjected to Timed Artificial Insemination

Two experiments in Nelore cows subjected to conventional protocol for timed AI (TAI) were designed to compare the influence of antral follicle count (AFC; 1) on the ovarian follicular dynamics and (2) conception rates. First, multiparous cows with high (G-high, ≥45 follicles; n = 43) and low AFC (G-low, ≤15 follicles; n = 32) were selected to receive a conventional oestradiol/progesterone-based TAI protocol for monitoring ovarian follicular dynamics. Second, AFC from 962 multiparous suckling cows (40 ± 15 days postpartum) subjected to a conventional protocol for TAI were classified as G-high (≥45 follicles; n = 194), G-intermediate (≥20 and ≤40 follicles, n = 397), and G-low AFC (≤ 15 follicles; n = 243). Pregnancy status was evaluated 30 to 35 days later. Data were analysed using ANOVA followed by the Tukey test and model of logistic regression (P ≤ 0.05). In the first study, the AFC were greater (P ≤ 0.05) in G-high than in G-low, but remained stable in both groups during the evaluations. The ovarian diameter, perimeter, and area were greater (P ≤ 0.05) in G-high than in G-low (28.3 ± 3.9 v. 20.5 ± 3.2 mm, 100.9 ± 13.2 v. 73.8 ± 13.9 mm, and 67.5 ± 16.4 v. 37.7 ± 11.7 mm2; respectively). Follicular growth rate, time of ovulation, corpus luteum diameter, and progesterone concentration were similar (P > 0.05) for cows with low or high AFC. Dominant follicles showed greater (P ≤ 0.05) diameter in G-low than G-high at D4 (7.3 ± 2.2 v. 6.2 ± 1.4 mm; P = 0.069, tendency), D8 (11.2 ± 1.8v. 9.5 ± 1.8 mm), D9 (12.3 ± 1.7 v. 10.6 ± 1.7 mm), and D10 (13.4 ± 1.3 v. 12.2 ± 1.8 mm), and the estimated diameter of the ovulatory follicle tended (P = 0.08) to be higher in G-low than in G-high (14.4 ± 1.5 v. 13.4 ± 2.1 mm). In the second study, AFC of G-low cows showed higher (P ≤ 0.05) conception rate (61.7%) than those of G-intermediate (52.9%) and G-high (49.5%) cows. In Nelore cows subjected to ovulation synchronization protocol, cows with high AFC showed higher ovarian measurements, but those with low AFC had large follicular diameters. Additionally, the cows with low AFC showed higher conception rate than groups with intermediate and high counts.

Improvement of bovine in vitro embryo production by ovarian follicular wave synchronization prior to ovum pick-up

This study evaluated the effects of the synchronization of ovarian follicular wave emergence on the efficiency of in vitro embryo production. Bos indicus cows (n = 20) were divided into two groups (control vs. synchronization) and subjected to repeated ovum pick-up (OPU) sessions (8 replicates each, with an interval of 21 days in a 2 × 2 crossover design) and subsequent in vitro embryo production. Cows in the control group (n = 10) were submitted to OPU procedures without any stimulation every 21 days. Animals in the synchronization group received a protocol-based progesterone implant, estradiol benzoate and prostaglandin on a random day of the estrus cycle (Day 0) and the OPU was performed on Day 5. After in vitro production, embryos were transferred to recipients synchronized at a fixed time and the diagnosis was performed 60 days later. An evaluation of the parameters for each OPU session revealed that donors that received the synchronization protocol pre-OPU showed a greater number of embryos (5.9 ± 0.5 vs. 4.5 ± 0.4; P = 0.037), higher rate of embryo production (45.8% vs. 38.5%; P = 0.001) and higher mean number of conceptions per group (2.2 ± 0.2 vs. 1.6 ± 0.2; P = 0.07) in relation to the group that did not receive hormonal treatment. We concluded that synchronization of the follicular wave prior to OPU showed positive effects on in vitro embryo production as well as on pregnancy rates.

Regional distribution and integrity of equine ovarian pre-antral follicles

The goal of this study was to determine the distribution of pre-antral follicles in the ovarian parenchyma of mares. For Experiment 1, each ovary was cut longitudinally at the greater curvature, performing two hemiovaries. After that, six fragments from each hemiovary were obtained, resulting in 12 fragments, which were divided into the innermost region of the parenchyma, the middle region and the outermost region. All the three obtained sections were cut transversally to obtain two fragments from each one. For Experiment 2, each ovary also submitted to a longitudinal cut on the greater curvature, forming two hemiovaries. Each hemiovary was sectioned into four symmetrical fragments, resulting in eight fragments per ovary. The fragments were related as being near to or far from the ovulatory fossa. The fragments of both experiments were immediately fixed in Carnoy for 12 hr and kept in 70% ethanol for 24 hr. Follicles were classified according to the stages of development and for morphological integrity according to oocyte morphology and granulosa cells. After the histological assessment, a total of 1,130 follicles were visualized from Experiment 1, being 1,054 (93.3%) primordial follicles and 76 (4.7%) follicles in development. The innermost region had the highest percentage of pre-antral follicles compared to the other regions (p < .05). The middle and outermost regions showed higher percentages of intact primordial and developing follicles than the innermost region (p < .05). Considering Experiment 2, 938 follicles were found, being 894 (95.3%) primordial and 44 (4.7%) follicles in development. The region near the ovulatory fossa presented higher (58.7%; 551 of 938) follicular concentration compared to the region far from the ovulatory fossa (41.3%; 387 of 938; p < .05). As a conclusion, distribution of pre-antral follicles in the equine ovary has a specific pattern through the parenchyma. Also, the follicular integrity differed in the studied ovarian areas.

The development and integrity of equine pre-antral follicles cultured in vitro with follicle-stimulating hormone (FSH) supplementation

This study investigated the effects of different concentrations of FSH (10, 50, 100 and 200 ng/ml) in supplemented MEM+ on the development of equine pre-antral follicles that were cultured in vitro for 2 or 6 days. The ovaries (n = 5) from mares in seasonal anoestrus were collected from a local abattoir. Ten ovarian tissue fragments of approximately 3 × 3 × 1 mm were obtained from each animal. The fragments were cultured in situ for 2 days (D2) or 6 days (D6) in MEM+ or MEM+ supplemented with FSH at four different concentrations, establishing the following 11 groups: control (D0); MEM + (D2); MEM + (D6); MEM + 10 ng/ml of FSH (D2); MEM + 10 ng/ml of FSH (D6); MEM + 50 ng/ml of FSH (D2); MEM + 50 ng/ml of FSH (D6); MEM + 100 ng/ml of FSH (D2); MEM + 100 ng/ml of FSH (D6); MEM + 200 ng/ml of FSH (D2); and MEM + 200 ng/ml of FSH (D6). Follicles were observed in only 9.65% (388 of 4,018) of the histological sections. Of the 861 follicles evaluated, 488 were in the primordial stage, and 373 were in various developmental stages; 59.7% were morphologically normal. Regarding the integrity of the pre-antral follicles, the groups with 100 ng/ml FSH of 2-days culture as well as 50, 100 and 200 ng/ml FSH of 6-days culture provided the best results. In conclusion, the in vitro culture of abattoir-derived equine ovarian fragments presented better morphological integrity when supplemented with FSH for 6 days, in comparison with the MEM culture group. However, no clear effects were observed with FSH regarding the promotion of activation from a primordial to a developing follicle.

Use of sexed sorted semen for fixed-time artificial insemination or fixed-time embryo transfer of in vitro-produced embryos in cattle

Artificial insemination and in vitro embryo production are powerful tools for disseminating superior genetic qualities and improving the reproductive performance of dairy and beef cattle. In conjunction with these biotechnologies, sexed-sorted semen has been used to obtain offspring of a predetermined sex. This study compared the pregnancy rates obtained using in vitro fertilization/timed embryo transfer (IVF/TET) and timed artificial insemination (TAI), both performed using sexed-sorted (Y-chromosome-bearing) semen obtained from the same bull. For the in vitro embryo production, the ovaries of 250 Nelore cows with known histories were collected in the slaughterhouse and used for IVF. After evaluation of the recipients (IVF/TET group; n = 974), the resultant embryos were transferred to the females with corpus luteum (n = 822). The pregnancy-related data for this group were compared with those for the TAI group (n = 974). Ultrasonography was performed at 60 days to determine the pregnancy status and confirm the sex of the fetus. A total of 2008 oocytes produced 1050 embryos, with 52% of them reaching the blastocyst stage. The pregnancy rate and the accuracy in determining the fetal sex were 35.4% (345/974) and 95.07% (328/345), respectively, for the IVF/TET group and 30% (293/974; P < 0.05) and 94.88% (278/293), respectively, for the TAI group. In the present study, we concluded that male calves could be better obtained using IVF/TET rather than TAI; therefore, this strategy can be considered to increase the pregnancy rate of beef cattle.

233 HIGH NUMBERS OF ANTRAL FOLLICLES INFLUENCE THE IN VITRO EMBRYO PRODUCTION, BUT NOT THE CONCEPTION RATE OF FIXED-TIME ARTIFICIAL INSEMINATION IN NELORE CATTLE

The aim of this study was to compare the conception rates to fixed-time artificial insemination (FTAI) and in vitro embryo production between Nelore cows with high or low antral follicle counts (AFC). First, multiparous Nelore cows (Bos indicus, n = 547, 40–60 days postpartum) were subjected to synchronization of ovulation. Randomly during their oestrous cycle (Day 0), cows received an intravaginal device containing 1.9 g of P4 (CIDR®) and 2 mg of oestradiol benzoate (Estrogin®), intramuscularly. At device removal (Day 8), cows received 500 µg of PGF2α (Ciosin®), 300 IU of eCG (Novormon®), and 1 mg of oestradiol cipionate (ECP®), intramusculary. All cows were inseminated 48 h after P4 device removal. Antral follicles = 3 mm were counted using an intravaginal microconvex transducer (Day 0), and cows were assigned to groups of high (G-High, = 25 follicles, n = 183), intermediate (G-Intermediate, 16–20 follicles, n = 183), or low AFC (G-Low, = 10 follicles, n = 181). In another study to compared the in vitro embryo production, Nelore cows (n = 66, 72–96 months) were subjected to ultrasound-guided follicular aspiration using an intravaginal microconvex array transducer (7.5 MHz). The COC were selected and cows were assigned to groups according to the oocyte production: G-High (n = 22, = 40 oocytes), G-Intermediate (n = 25, 18–25 oocytes), or G-Low (n = 19, = 7 oocytes). Previously tested semen from a single bull was used for IVF using a previously described protocol (Silva-Santos et al. 2014 Reprod. Domest. Anim. 49, 228–232). The oocyte and embryo production (viable embryo: grade I, II, III; vitrifiable embryo: grade I, II) were evaluated. The number of follicles was evaluated by Kruskal-Wallis, and the chi-square test was used for data on oocyte and embryo production (P = 0.05). The average follicular population was 30.7 ± 5.7 (G-High), 18.6 ± 1.64 (G-Intermediate), and 7.8 ± 2.4 follicles (G-Low; P < 0.05), but there were no differences in the conception rates among groups (51.9 v. 48.6 v. 58.6%, respectively; P > 0.05). The total number of oocytes recovered were 1109 (G-High), 534 (G-Intermediate), and 101 (G-Low; P < 0.05). The mean number of viable oocytes was 40.4 ± 10.6 (G-High), 14.8 ± 3.0 (G-Intermediate), and 3.8 ± 1.1 (G-Low; P < 0.05) and the percentage of viable oocytes was 80% (G-High), 69% (371/534, G-Intermediate), and 71% (G-Low; P < 0.05). Cleavage rate was 79% (G-High), 74% (348/472, G-Intermediate), and 71% (G-Low; P < 0.05), and blastocyst rate was 42% (G-High), 32% (153/472, G-Intermediate), and 13% (G-Low; P < 0.05). The number of viable embryos was 18.4 ± 6.7 (G-High), 6.1 ± 3.6 (G-Intermediate), and 0.6 ± 0.7 (G-Low; P < 0.05) and the percentage of vitrifiable embryos was 81% (G-High), 77% (118/153, G-Intermediate), and 58% (G-Low; P < 0.05). Therefore, Nelore cows with high oocyte production had ~10-fold higher oocyte production and produced ~30-fold more embryos compared with the low AFC group. In conclusion, AFC had no influence on the conception rates to FTAI; however, Nelore cows with high oocyte production exhibited higher in vitro embryo production.

Pregnancy rate and birth rate of calves from a large-scale IVF program using reverse-sorted semen in Bos indicus, Bos indicus-taurus, and Bos taurus cattle

Obtaining sexed sperm from previously frozen doses (reverse-sorted semen [RSS]) provides an important advantage because of the possibility of using the semen of bulls with desired genetic attributes that have died or have become infertile but from whom frozen semen is available. We report the efficiency of RSS on the pregnancy rate and birth rate of calves in a large-scale program using ovum pick-up and in vitro embryo production (IVEP) from Bos indicus, Bos indicus-taurus, and Bos taurus cattle. From 645 ovum pick-up procedures (Holstein, Gir, and Nelore), 9438 viable oocytes were recovered. A dose of frozen semen (Holstein, Nelore, Brahman, Gir, and Braford) was thawed, and the sperm were sex-sorted and cooled for use in IVF. Additionally, IVF with sperm from three Holstein bulls with freeze-thawed, sex-sorted (RSS) or sex-sorted, freeze-thawed (control) was tested. A total of 2729 embryos were produced, exhibiting a mean blastocyst rate of 29%. Heifers and cows selected for adequate body condition, estrus, and health received 2404 embryos, and 60 days later, a 41% average pregnancy rate was observed. A total of 966 calves were born, and 910 were of a predetermined sex, with an average of 94% accuracy in determining the sex. Despite the lower blastocyst rate with freeze-thawed, sex-sorted semen compared with sex-sorted semen, (P < 0.05), the pregnancy rate (bull I, 45% vs. 40%; II, 35% vs. 50%; and III, 47% vs. 48% for RSS and control, respectively; P > 0.05) and sex-sorted efficiency (bull I, 93% vs. 98%; II, 96% vs. 94%; and III, 96% vs. 97% for RSS and control, respectively; P > 0.05) were similar for each of the three bulls regardless of the sperm type used in the IVF. The sexing of previously frozen semen, associated with IVEP, produces viable embryos with a pregnancy rate of up to 40%, and calves of the desired sex are born even if the paternal bull has acquired some infertility, died, or is located a long distance from the sexing laboratory. Furthermore, these data show the feasibility of the process even when used in a large-scale IVEP program.