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Six hundred and nine Holstein cows from 19 commercial dairy herds were used to evaluate pregnancy rates obtained following two systematic breeding protocols. Cows were assigned randomly at each location to either timed AI TAI ; consisting of 25 mg of PGF2 d -23 ; followed by 100 g GnRH d -9 ; then 25 mg of PGF2 d -2 ; and 100 g GnRH d 0 ; with AI 6 to later or Modified Targeted Breeding MTB ; that eliminated the second GnRH administration on d 0 and included periodic visual observation and AI following the detection of estrus or timed AI at 72 estrus was not detected. Initial PGF2 administration occurred at approximately 45 DIM. If a cow was determined not to be pregnant during bi-monthly uterine palpation the initial protocol was repeated eliminating the first PGF2 administration. There was no detectable difference in days to first AI for TAI 71.9 d ; and MTB 73 d ; . First service pregnancy rates for TAI and MTB protocols differed across herds with a mean of 25.9% for MTB and 30.8% for TAI with a herd X protocol interaction P 0.05 ; . Pregnancy rates for the MTB protocol increased if cows were detected in estrus 50% ; versus cows bred on appointment 15.5% ; . Second service pregnancy rates improved for both protocols to 34.6% for MTB and 38.7% for TAI. Month of AI did influence pregnancy rates for both first and second service P 0.01 ; . Pregnancy rates were highest for MTB in herds that had excellent estrus detection. However, TAI had an overall higher pregnancy rate with the elimination of estrus detection, for example, drug information. Steve Liles stated that the Committee asked Provider Synergies to go back to all the manufacturers and work with them for better rebates on the Bladder Relaxant Agents. The Committee expressed interest in having the product with the most utilization and Detroo LA in this class on the Preferred Drug List PDL ; . 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Description Records the type of immunotherapy administered as first course treatment at this facility. If immunotherapy was not administered, then this item records the reason it was not administered to the patient. Immunotherapy consists of biological or chemical agents that alter the immune system or change the host's response to tumor cells. Rationale Systemic therapy may involve the administration of one or a combination of agents. This data item allows for the evaluation of the administration of immunotherapeutic agents as part of the first course of therapy. In addition, when evaluating the quality of care, it is useful to know the reason if immunotherapy was not administered. Instructions for Coding Record only immunotherapy received at this facility. Do not record agents administered at other facilities. Code 00 if immunotherapy was not administered to the patient, and it is known that it is not usually administered for this type and stage of cancer. 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