SARS-COV-2 and Male Reproductive Health.

Critical challenges for the public and private health, research, and medical communities have been posed by the COVID-19 outbreak. Some of these challenges are related to the possible adverse effects of SARS-CoV-2 on male reproductive health, and whether other potential modes of transmission may occur, such as sexual transmission. Moreover, concerns have been raised in terms of whether the COVID-19 outbreak may have an impact on fertility worldwide. In this study, we will discuss the origins of SARS-CoV-2. We will further describe its mechanism of action, diagnosis, symptoms, and potential effects on the male reproductive system.

ANDROGEN RECEPTOR EXPRESSION IN TRIPLE NEGATIVE BREAST CANCER AND ITS RELATIONSHIP TO PROGNOSTIC FACTORS / Expressão de receptor de androgênio em câncer de mama triplo negativo e sua relação com fatores prognósticos

Objective: Triple negative breast cancer (TNBC) is a subset of tumors with an aggressive intrinsic biology, resulting in poor prognosis. Androgen receptor (AR) is currently one of the most studied biomarkers in TNBC, playing a role in the genesis and development of breast cancer. Methods: In this cross-sectional study, we retrospectively reviewed the medical records of all patients with TNBC who received care from 2012 to 2014 at a single health center in southern Brazil. Histological material from breast tumors was analyzed by immunohistochemistry for AR expression and related to age, histological grade, tumor-infiltrating lymphocytes (TILs), and Ki-67. Results: Of 34 TNBC cases identified, 23 (67.6%) were AR negative and 11 (32.4%) were AR positive. The average age of the patients was 51.9 years (range: 30­82 years). Among positive cases, AR was weakly expressed in 6 and strongly expressed in 5 cases. Most patients (n=28; 82.0%) had poorly differentiated tumors. Mean Ki-67 expression was 65.0% in AR-negative and 43.6% in AR-positive cases (p<0.05). There was a significant association between age and AR expression (p<0.005), which was associated with mean age 70.8 years in the strongly AR-positive group and 42.3 years in the weakly AR-positive group. The mean percentage of TILs was 38.6% in AR-positive and 39.1% in AR-negative cases (p=0.391). Conclusion: There was no significant association between AR expression and histological grade or TILs. AR positivity in TNBC was associated with older age and tumors with lower Ki-67 expression, indicating two subgroups with distinct phenotypes in patients with TNBC.

Objetivo: O câncer de mama negativo triplo (triple negative breast cancer ­ TNBC) é um subtipo de tumores com biologia intrínseca agressiva, resultando em pior prognóstico. O receptor de andrógeno (androgen receptor ­ AR) é atualmente um dos biomarcadores mais estudados em TNBC, desempenhando papel na gênese e no desenvolvimento do câncer de mama. Métodos: Neste estudo transversal, revisamos retrospectivamente os registros médicos de todos os pacientes com TNBC que receberam atendimento de 2012 a 2014 em um único centro no sul do Brasil. O material histológico dos tumores de mama foi analisado por imuno-histoquímica para a expressão de AR e relacionado a idade, grau histológico, linfócitos infiltrantes de tumores (TILs) e Ki-67. Resultados: Dos 34 casos identificados de TNBC, 23 (67,6%) eram AR negativos e 11 (32,4%), AR positivos. A idade média foi de 51,9 anos (30­82 anos). Entre os casos positivos, AR foi fracamente expresso em 6 e fortemente expresso em 5 casos. A maioria dos pacientes (n=28, 82,0%) apresentou tumores pouco diferenciados. A expressão média de Ki-67 foi de 65,0% em AR-negativo e 43,6% em AR-positivo (p<0,05). Houve associação significativa entre a idade e a expressão de AR (p<0,005), associada à idade média de 70,8 anos no grupo com AR fortemente positivo e de 42,3 anos no grupo com AR fracamente positivo. A porcentagem média de TILs foi de 38,6% em AR-positivo e de 39,1% em AR-negativo (p=0,391). Não houve associação significativa entre expressão AR e grau histológico ou TILs. Conclusão: A positividade de AR em TNBC foi associada com idade mais avançada e tumores com menor expressão de Ki-67, indicando dois subgrupos com fenótipos distintos em pacientes com TNBC.

Expression analysis of transglutaminase 2 in premalignant lesions of the cervix

Background: The medical management of low-grade squamous intraepithelial lesions (LSIL) is variable, thus a biomarker could assist with the clinical conduct. Type 2 transglutaminase (TG2) has been proposed as a cellular-interfering factor in HPV infection and carcinogenesis. Therefore, this study has the objective of evaluating TG2 expression in LSIL and highgrade squamous intraepithelial lesions (HSIL) and of relating it to the different HPV viral types. Methods: This study included 146 patients with suspected LSIL or HSIL detected in routine conventional Papanicolaou tests. The presence of HPV DNA and viral typing was defined by the polymerase chain reaction method (PCR). TG2 Immunohistochemistry (IHC) was conducted according to the manufacturer's instructions; IHC was carried out in an Autosteiner-Link 48 Dako equipment. IHC quantitation was performed by relative expression and by using the software Image J. Qualitative variables, such as frequencies and proportions, were compared by using the χ2 test for independent samples. For comparison of the qualitative to the quantitative data, nonparametric Mann-Whitney test was used. Results: The association between histopathological examination and TG2 was statistically significant (p <0.05). Results showed that patients with normal cervical histopathology and LSIL are locally associated with TG2 expression levels >50% (p <0.05), and patients with HSIL are associated with no TG2 expression (p <0.05). The analysis of the samples with the Image J software shows a significant (p <0,001) decrease in TG2 immunostaining in HSIL if compared to normal and to LSIL samples. This demonstrates a correlation between the relative quantification and the results provided by Image J. Analysis of HPV types showed a significant association with HPV11 (p = 0.031). This indicates that patients with HPV type 11 had higher TG2 values than patients with different types. Image J analysis showed no significant association between TG2 and HPV viral types. Conclusion: The present data suggest that TG 2 has a high expression in LSIL and normal tissues, and decreased in HSIL. We also observed that its expression is associated with HPV11 (AU)

Spinal cord injury and male infertility: a review / Traumatismo raquimedular e infertilidade masculina: revisão / Lesión de la médula espinal e infertilidad masculina: una revision

Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.

O trauma raquimedular (TRM) é uma importante causa de morbimortalidade na sociedade atual, principalmente por acometer adultos jovens. Dentre as diversas sequelas decorrentes da lesão medular encontram-se as alterações na qualidade de vida sexual e na paternidade. A infertilidade decorre de diversas alterações como: disfunção erétil, anejaculação, alterações bioquímicas no sêmen e estruturais nos espermatozoides. As terapias para a infertilidade pós-TRM, em geral, objetivam o estímulo à ejaculação e posterior inseminação, sendo a baixa qualidade do sêmen o fator determinante para infertilidade. A terapia hiperbárica representa uma possibilidade de atuar diretamente no tecido lesado, seja ele medular ou testicular, diminuindo o dano.

La lesión de la médula espinal sigue siendo una causa importante de morbilidad y mortalidad en la sociedad actual, que afecta principalmente a hombres en la adolescencia a la edad adulta. Entre las varias secuelas resultantes de lesiones de la médula espinal, el deterioro del sistema sexual es de gran relevancia una vez que afectan la calidad de la vida sexual y la paternidad. La infertilidad es secundaria a varios eventos, tales como la disfunción eréctil, aneyaculación, modificación bioquímica seminal y la morfología de los espermatozoides. Los tratamientos para la infertilidad post-TRM, en general, tienen por objeto estimular la eyaculación seguida de inseminación in vitro, siendo la baja calidad seminal el factor determinante de la infertilidad de estos pacientes. En este escenario, la terapia con oxigenación hiperbárica, aún en estudio, representa un tratamiento alternativo ya que actúa sobre el sistema nervioso central lesionado por el trauma y sobre el tejido testicular para reducir el daño espinal y preservar la regulación fisiológica del sistema genital como una forma de evitar la infertilidad.

Sintomas depressivos e suas características em pacientes submetidos a hemodiálise / Depressive symptoms and their characteristics in patients undergoing hemodialysis

A depressão é uma condição presente em 20% dos portadores de doenças crônicas, estando associada à incapacitação funcional e comprometimento da saúde física. A doença renal crônica faz parte desse escopo, com prevalência de 405 pacientes por milhão de habitantes submetidos a hemodiálise no Brasil. Objetiva-se avaliar prevalência de sintomatologia depressiva e suas características em pacientes sob tratamento dialítico. Métodos: Estudo transversal, realizado entre junho e agosto de 2010, incluindo os pacientes submetidos a hemodiálise no Hospital Geral de Caxias do Sul, que preencheram os critérios de inclusão. Procedeu-se a aplicação de instrumentos de coleta de dados. O ponto de corte para depressão foi de 16 pontos no Inventário de Depressão de Beck. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: A amostra foi constituída por 64 pacientes. A média de idade foi de 53,66 ± 15,82 anos; 51,7% eram do sexo feminino. A prevalência de depressão foi de 44,8%. Os pacientes com IDB < 16 apresentaram escore médio de 7,23 ± 3,5; já aqueles com IDB > 16 apresentaram média de 26,43 ± 9,35 (p < 0,001). Os pacientes que necessitavam cuidador apresentaram maiores índices de depressão (p< 0,001). Nos pacientes com IDB > 16 os fatores mais influentes foram sono, cansaço e incapacidade de tomar decisões. Conclusão: A prevalência de depressão nos pacientes em hemodiálise é alta. Os pacientes que necessitam de cuidadores apresentam maior escore no IDB. Alterações do sono, cansaço e incapacidade de tomar decisões são os principais fatores para o humor depressivo.

Depression is a condition present in 20% of patients with chronic diseases and is associated with functional disability and impaired physical health. Chronic kidney disease is part of this scope, with an estimated prevalence of 405 patients per million undergoing hemodialysis in Brazil. The objective of this study was to evaluate the prevalence of depressive symptoms and their characteristics in patients on dialysis. Methods: A cross-sectional study conducted between June and August 2010, including patients undergoing hemodialysis at the General Hospital of Caxias do Sul, who met the inclusion criteria. The data collection instruments (questionnaire, Mini Mental State Examination and the Beck Depression Inventory–BDI) were administered individually during a hemodialysis session. The cut-off point for depression was 16 points in the BDI. Results: We studied 64 patients. The mean age was 53.66 ± 15.82 years, 51.7% were females. The prevalence of depression was 44.8. Patients with BDI<16 had a mean score of 7.23 ± 3.5, whereas those with BDI>16 had an average of 26.43 ± 9.35 (p <0.001). Patients who needed caregivers had higher levels of depression (p <0.001). In patients with BDI>16, the most influent factors were sleep, fatigue and inability to make decisions. Conclusion: The prevalence of depression in hemodialysis patients is high. Patients who need caregivers had higher scores on the BDI. Sleep disorders, fatigue and inability to make decisions are the main factors for depressed mood.

Contribution of in-vitro maturation in ovarian stimulation cycles of poor-responder patients.

This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method to increase the number of embryos available for transfer and whether transfers with RSM-derived embryos would contribute to clinical outcomes of poor-responder patients in ovarian stimulation cycles. The study included 440 patients undergoing intracytoplasmic sperm injection cycles in which fewer than five metaphase II (MII) oocytes and at least one immature oocyte were retrieved after follicle aspiration. Patients were allocated into two groups based on the injected oocytes' nuclear maturation status: MII group (n=330), in which only embryos derived from MII oocytes were transferred, and RSM group (n=110), in which at least one embryo derived from an RSM oocyte was transferred. No differences between the MII and RSM groups were observed for pregnancy (16.7% versus 16.5%) or miscarriage (25.5% versus 29.4%) rates, respectively. The RSM group had a higher number of transferred embryos (1.87+/-1.24 versus 2.35+/-1.22; P<0.001), a lower embryo transfer cancellation rate (14.5% versus 6.36%; P=0.025) and lower implantation rate (15.4+/-31.5% versus 10.5+/-22.3%; not significant). These findings suggest that RSM did not contribute to the outcomes in poor-responder cycles.

Assisted reproductive technology outcomes in azoospermic men: 10 years of experience with surgical sperm retrieval.

An azoospermic man suffers from an absence of sperm in the ejaculate and this condition is present in about 10% of infertile men. Obstructive azoospermia (OA) is characterized by an occlusion or partial absence of the reproductive tract with the presence of normal spermatogenesis. On the other hand, non-obstructive azoospermia (NOA) is characterized by impaired spermatogenesis. In these cases, spermatozoa can be obtained by percutaneous epididymal or testicular sperm aspiration (PESA and TESA, respectively) and used for intracytoplasmic injection (ICSI). To compare ICSI outcomes using spermatozoa that were surgically retrieved by PESA and TESA, azoospermic patients were divided into the following categories: (i) TESA-NOA (n = 102), (ii) TESA-OA (n = 103), and (iii) PESA-OA (n = 171). Fertilization, pregnancy, and implantation rates were compared between the groups. We noted a lower normal fertilization rate (p = 0.0017) and a higher abortion rate (p = 0.0387) among men in the TESA group who had OA when compared with men in the PESA group who had OA. On the other hand, a lower normal fertilization rate (p = 0.05) and a lower rate of non-cleaved embryos (p = 0.034) was found in the TESA group of NOA patients as compared to the TESA group of OA patients. No statistically significant differences were detected between the TESA and PESA groups and the OA and NOA groups, respectively. The clinical outcomes of embryos arising from ICSI cycles using spermatozoa harvested via PESA and TESA were similar, regardless of whether the patient had obstructive or non-obstructive azoospermia.

Negative influence of paternal age on clinical intracytoplasmic sperm injection cycle outcomes in oligozoospermic patients.

OBJECTIVE: To evaluate the effect of male age on clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles, according to sperm concentration. DESIGN: Retrospective, observational study. SETTING: Assisted reproduction center. PATIENT(S): The study included 1,024 couples undergoing ICSI cycles with fresh spermatozoa. INTERVENTION(S): The influence of paternal age on ICSI outcomes of oligozoospermic and normozoospermic patients was evaluated. MAIN OUTCOME MEASURE(S): Rates of high-quality embryos, pregnancy, implantation, and miscarriage were evaluated through linear logistic regression analyses. RESULT(S): When the sperm concentration was abnormal, paternal age influenced implantation (regression coefficient value = -0.7009) and pregnancy rates (odds ratio = 0.95, 95% confidence interval 0.91-0.99). However, in normozoospermic patients, no influence of paternal age was observed on implantation (regression coefficient value = 0.0566) or pregnancy rates (odds ratio = 1.00, 95% confidence interval 0.97-1.03). CONCLUSION(S): For couples in which the men are oligozoospermic, the implantation rate could be impaired by increased paternal age. In these couples, the chance of pregnancy decreased 5% for each year of paternal age. When men are normozoospermic, this effect is not observed.

Criopreservação de oócitos / Oocytes cryopreservation

criopreservação de oócitos atualmente representa uma grande evolução em Reprodução Humana Assistida. Essa técnica consiste na conservação de células ou tecidos a temperaturas inferiores a -196¨¬C. A criopreservação de oócitos é um dos principais destaques, que surgiu com o objetivo de preservar a fertilidade feminina e, ainda, contornar as questões éticas e legais associadas ao congelamento de embriões. As técnicas de criopreservação vêm sendo aprimoradas, tendo sido observado um avanço notável nas taxas de fertilização obtidas a partir de oócitos congelados. Com base nisto, este estudo teve como objetivo realizar uma revisão bibliográfica sobre dois métodos de criopreservação (congelamento lento e vitrificação). Para isso, realizaram-se leitura e seleção de informações trabalhadas por outros autores em revistas científicas, sites de busca e livros específicos de reprodução humana assistida. Foram analisados: histórico da criopreservação de oócitos; indicações; crioprotetores; métodos de criopreservação e resultados das taxas de fertilização, gravidez e aborto segundo pesquisas já realizadas tanto com congelamento lento quanto com vitrificação de oócitos. Apesar dos resultados favoráveis à criopreservação oocitária, são necessárias mais pesquisas para que haja estabilização dos resultados e estabelecimento de uma técnica de criopreservação de oócitos humanos que seja universal e padronizada, podendo ser aplicada com sucesso nas clínicas de Reprodução Humana Assistida.

Cryopreservation of oocytes currently represents a major evolution in the human assisted reproduction. This technique consists of the conservation of cells or tissues in temperatures less than -196 ¢ªC. In view of the controversy in several cultures on legal and ethical issues associated with the freezing of embryos, the development of techniques that could solve this problem became necessary. The cryopreservation of oocytes is one of the highlights, aiming to preserve the fertility of women. The techniques of cryopreservation have been improving in search of quality and good results. Nowadays, we observe a progress in fertilization rates obtained from frozen oocytes. Our objective was to carry out a bibliographic review of two methods of cryopreservation (slow freezing and vitrification). In order to do that, we read and checked information provided by other authors in scientific journals, search engines and books on human assisted reproduction. We analyzed: history of oocytes cryopreservation; indications; cryoprotectors; methods and results of cryopreservation of fertilization, pregnancy and abortion rates, according to other surveys on slow freezing and oocyte vitrification. Despite the favorable results of oocytes cryopreservation, further studies are necessary to stabilize the results and to establish a technique which be universal for cryopreservation of human oocytes and can be successfully applied in human assisted reproduction clinics.

The role of enzymatic antioxidants detected in the follicular fluid and semen of infertile couples undergoing assisted reproduction.

The follicular fluid environment surrounding the oocytes may play a critical role in fertilization and subsequent embryo development. The goal of our study was to evaluate the oxidative stress markers in the semen, blood serum, and follicular fluid of couples undergoing Intracytoplasmic Sperm Injection (ICSI). Two hundred and eight infertile couples underwent ICSI and the levels of superoxide dismutase (SOD) and catalase and lipid peroxidation (LPO) were evaluated. Semen Catalase was highly correlated with fertilization and cleavage rates, but not with pregnancy rates. Fertilization and cleavage rates were correlated with the levels of SOD and Catalase in the follicular fluid. After adjusting for age, a negative correlation was detected between LPO levels in follicular fluid and pregnancy rates. Follicular fluid LPO levels may be a marker as a metabolic activity within the follicle need for establishing a pregnancy.

Congelamento de espermatozoides para pacientes com câncer e a reprodução assistida: [revisão] / Cryopreservation of sperm before the initiation of cancer therapy and assisted reproductive technics: [review]

Um crescente número de pessoas com câncer é tratado com sucesso e para aqueles com expectativa de sobrevida por longo tempo os efeitos tardios do tratamento são preocupantes. Em muitos pacientes com câncer a qualidade seminal já está reduzida antes mesmo de serem submetidos a qualquer forma de tratamento e deterioração posterior é observada após o tratamento do câncer. Infelizmente, é impossível prever quem irá ter espermatogênese normal ou ficará com azoospermia. Debates têm acontecido à respeito da necessidade de ginecologistas, urologistas, hematologistas, generalistas e oncologistas recomendarem criopreservação de espermatozoides, se o tempo permitir, antes de iniciar a terapia para o câncer. Hoje, criopreservação de sêmen associado a técnicas de reprodução assistida pode fornecer à maioria dos pacientes inférteis com câncer, após a terapia, oportunidade de ter um filho, com excelentes chances de consegui-lo.

Current concepts and future trends in male germ cell cryobanking.

While the idea of freezing human male gametes has been experimented since the late 1700's, it was not until 50 years ago that human sperm were frozen, and later thawed in such a way that they could fertilize an egg and initiate development. In the past several decades the technology of cryopreservation, or maintaining life in a frozen state, has advanced considerably. With the use of modern techniques, cryopreservation of sperm to preserve an individual's ability to reproduce has become successful, safe, and widely available. In the past several decades the technology of cryopreservation, or maintaining life in a frozen state, has advanced considerably preserving the ability of sperm to maintain its fertilizing potential.

A comparison of post-thaw results between embryos arising from intracytoplasmic sperm injection using surgically retrieved or ejaculated spermatozoa.

OBJECTIVE: To study the effect of freeze-thaw on embryos derived from intracytoplasmic sperm injection (ICSI) using surgically retrieved and ejaculated spermatozoa. DESIGN: Retrospective study. SETTING: Private IVF center. PATIENT(S): Three hundred eighty-three patients undergoing frozen-thawed ET cycles. INTERVENTION(S): Testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) were the sperm surgical retrieval methods used for ICSI. Embryos resulting from ICSI using surgically retrieved and ejaculated spermatozoa were frozen, thawed, and transferred. MAIN OUTCOME MEASURE(S): Post-thaw survival, implantation, and pregnancy rates. RESULT(S): No differences were found between the ejaculated sperm and TESA/PESA groups in terms of post-thaw survival rate (68.4% vs. 66.1%, respectively), pregnancy rate (20.1% vs. 16.1%), and implantation rate (10.6% vs. 12.7%). Similar results were found for those variables when comparing TESA and PESA groups. CONCLUSION(S): Cleavage embryos arising from ICSI cycles using testicular and epididymal spermatozoa can be frozen with survival, pregnancy, and implantation rates comparable to those obtained with ejaculated spermatozoa.

The male biological clock is ticking: a review of the literature.

The term biological clock is usually used by physicians and psychologists to refer to the declining fertility, increasing risk of fetal birth defects and alterations to hormone levels experienced by women as they age. Female fecundity declines slowly after the age of 30 years and more rapidly after 40 and is considered the main limiting factor in treating infertility. However, there are several scientific reports, chapters in books and review articles suggesting that men may also have a biological clock. The aim of our study was to conduct a review of the literature, based on the Medical Literature Analysis and Retrieval System Online (Medline), to evaluate the male biological clock. After adjustments for other factors, the data demonstrate that the likelihood that a fertile couple will take more than 12 months to conceive nearly doubles from 8% when the man is < 25 years old to 15% when he is > 35 years old. Thus, paternal age is a further factor to be taken into account when deciding on the prognosis for infertile couples. Also, increasing male age is associated with a significant decline in fertility (five times longer to achieve pregnancy at the age of 45 years). Patients and their physicians therefore need to understand the effects of the male biological clock on sexual and reproductive health, in that it leads to erectile dysfunction and male infertility, as well as its potential implications for important medical conditions such as diabetes and cardiovascular diseases.

Azoospermia after treatment with clomiphene citrate in patients with oligospermia.

OBJECTIVE: To describe three cases of azoospermia in patients with oligospermia after clomiphene citrate (CC) intake. DESIGN: Case report. SETTING(S): Academic medical center. PATIENT(S): Three patients with oligospermia. INTERVENTION(S): Three oligospermic men used CC, resulting in azoospermia. MAIN OUTCOME MEASURE(S): Semen analysis after CC use and after discontinuation of CC. RESULT(S): Three patients were sent to our clinic for investigation of their azoospermia after use of CC. They had severe oligozoospermia (sperm concentrations of 3.4, 2.8, and 4.1 x 10(6)/mL, respectively) before treatment with CC. These patients were re-evaluated with two new semen analyses, showing azoospermia. After 3 months without use of the drug, the mean sperm concentration was 2.5 +/- 1.1 x 10(6)/mL. CONCLUSION(S): The benefits of empiric treatment with CC must be balanced with the possible undesirable effects, such as azoospermia.

Effect of cigarette smoking on antioxidant levels and presence of leukocytospermia in infertile men: a prospective study.

OBJECTIVE: To evaluate the effect of cigarette smoking on antioxidant levels and the presence of leukocytospermia in infertile men. DESIGN: Prospective study. SETTING: Academic medical center. PATIENT(S): Ten fertile donors and 112 infertile patients were included in the study. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Semen analysis was performed according to the World Health Organization guideline. The activity of the superoxide dismutase was based on the adrenochrome concentration, and the catalase activity was determined by the velocity of hydrogen peroxide consumption. RESULT(S): Lower levels of superoxide dismutase and catalase were seen in infertile patients compared with fertile donors. Superoxide dismutase was significantly correlated with sperm concentration and negatively correlated with leukocytospermia. In addition, leukocytospermia was inversely correlated with sperm motility. Superoxide dismutase levels were negatively related to cigarette smoking. CONCLUSION(S): Cigarette smoking may impair sperm motility and decrease the antioxidant activity (negative correlation with superoxide dismutase) in the seminal plasma.

The male biological clock is ticking: a review of the literature / O relógio biológico masculino está batendo: revisão da literatura

The term biological clock is usually used by physicians and psychologists to refer to the declining fertility, increasing risk of fetal birth defects and alterations to hormone levels experienced by women as they age. Female fecundity declines slowly after the age of 30 years and more rapidly after 40 and is considered the main limiting factor in treating infertility. However, there are several scientific reports, chapters in books and review articles suggesting that men may also have a biological clock. The aim of our study was to conduct a review of the literature, based on the Medical Literature Analysis and Retrieval System Online (Medline), to evaluate the male biological clock. After adjustments for other factors, the data demonstrate that the likelihood that a fertile couple will take more than 12 months to conceive nearly doubles from 8 percent when the man is < 25 years old to 15 percent when he is > 35 years old. Thus, paternal age is a further factor to be taken into account when deciding on the prognosis for infertile couples. Also, increasing male age is associated with a significant decline in fertility (five times longer to achieve pregnancy at the age of 45 years). Patients and their physicians therefore need to understand the effects of the male biological clock on sexual and reproductive health, in that it leads to erectile dysfunction and male infertility, as well as its potential implications for important medical conditions such as diabetes and cardiovascular diseases.

O termo relógio biológico é geralmente usado por médicos e psicólogos para se referir ao declínio da fertilidade, aumento no risco de defeitos congênitos, e níveis hormonais alterados que a mulher com o passar dos anos apresenta. A fecundidade feminina declina paulatinamente após os 30 anos e mais rapidamente após os 40 anos e é considerada como o principal fator limitante nos tratamentos da infertilidade. Entretanto, existem vários artigos científicos capítulos de livros e artigos de revisão sugerindo que o homem também apresente um relógio biológico. O objetivo do nosso estudo foi realizar uma revisão no Medline (Medical Literature Analysis and Retrieval System Online) para avaliar o relógio biológico masculino. Após ajustar para outros fatores, foi demonstrado que a probabilidade de um casal apresentar uma demora superior a 12 meses para engravidar praticamente duplica de 8 por cento quando o homem possui idade inferior a 25 para 15 por cento quando possui idade superior a 35 anos; desta forma, a idade paterna é um fator a ser levado em consideração quando se decidir sobre o prognóstico de um casal infértil. Além disso, a idade avançada está associada com um declínio significante na fertilidade (tempo para engravidar superior a cinco vezes aos 45 anos de idade), sendo independente de idade da parceira, freqüência de relação sexual e estilo de vida, assim como os efeitos de outros fatores de risco para subfertilidade. Os pacientes e seus médicos devem entender os efeitos do relógio biológico na saúde sexual e reprodutiva, levado à disfunção erétil e infertilidade, assim como às potenciais contribuições para condições médicas como diabetes e doenças cardiovasculares.

Obtenção de gametas seguros por meio de associação de técnicas de processamento seminal para casais sorodiscordantes para HIV / Safe gametes acquisition through association of seminal processing techniques with HIV serodiscordant couples

OBJETIVO: o objetivo deste estudo foi avaliar os parâmetros laboratoriais e clínicos de pacientes submetidos à reprodução humana assistida, associando técnicas de processamento seminal para eliminação de partículas virais da amostra de sêmen em casais nos quais o homem é infectado pelo vírus da imunodeficiência humana adquirida (HIV). MÉTODOS: foram avaliados 11 ciclos de injeção intracitoplasmática de espermatozóide (ICSI) realizados em casais nos quais os homens eram infectados pelo HIV (Grupo HIV), e 35 ciclos de ICSI nos quais se utilizaram espermatozóides doados (Grupo Controle). As amostras de sêmen dos doadores foram submetidas à análise seminal completa, processamento seminal (lavagem) e criopreservação. Os homens do Grupo HIV receberam antibioticoterapia prévia e realizou-se análise seminal, lavagem e gradiente descontínuo de densidade antes da criopreservação. As amostras foram avaliadas para carga viral e a ICSI foi realizada quando não houve detecção do HIV. RESULTADOS: quanto aos resultados da análise seminal, os grupos se mostraram comparáveis em relação à concentração e motilidade progressiva dos espermatozóides. Entretanto, a porcentagem de espermatozóides morfologicamente normais foi maior no Grupo Controle (14,3 por cento) comparado ao HIV (5,8 por cento; p=0,002). Na avaliação dos parâmetros embrionários, as taxas de fertilização normal (Controle: 74,7 por cento e HIV: 71,7; p=0,838) e de bons embriões (Controle: 42,4 por cento e HIV: 65,1 por cento; p=0,312) foram semelhantes. Por outro lado, o Grupo Controle apresentou melhores resultados clínicos que o HIV (gestação continuada: 52,9 e 12,5 por cento; p=0,054; implantação: 42,6 e 10,4 por cento; p=0,059, respectivamente), apesar de as diferenças não serem estatisticamente significantes. Após o nascimento, não houve soroconversão das mães e das crianças nascidas. CONCLUSÕES: a associação de técnicas de processamento seminal para eliminação do HIV de amostras...

PURPOSE: the propose of this study was to analyze the clinical and laboratorial parameters of patients submitted to human assisted reproduction techniques with association of sperm processing techniques, in order to remove virus particles from semen samples of couples in which men was infected by human immunodeficiency virus (HIV). METHODS: it was assessed 11 intracytoplasmatic sperm injection (ICSI) cycles from couples whose men were HIV seropositive (HIV Group), and 35 cycles in which semen donors' samples were used in ICSI procedures (Control Group). Semen samples from Control Group were submitted to routine semen analysis, sperm wash and cryopreservation. The man from HIV Group received previous antibiotic therapy; the semen samples were analyzed routinely and prepared by sperm wash and density gradient method before cryopreservation. Those samples were evaluated to viral load and ICSI was performed when no HIV was detected. RESULTS: regards to semen analysis the groups were similar to sperm concentration and progressive motility. Nevertheless, the percentage of sperm with normal morphology were higher on Control Group (14.3 percent) than HIV (5.8 percent; p=0.002). On embryo parameters assessment, the normal fertilization (CT: 74.7 percent and HIV: 71.7; p=0.838, respectively) and good embryos rate (CT: 42.4 percent and HIV: 65.1 percent; p=0.312, respectively) were comparable. On the other hand, the Control Group presented better clinic results than HIV Group (ongoing pregnancy rate: 52.9 percent versus 12.5 percent; p=0.054, and implantation rate: 42.6 versus 10.4 percent; p=0.059, respectively), however the differences were not statistically significant. After delivery, no seroconversion was observed on mother and child. CONCLUSIONS: the association of sperm processing techniques in order to remove HIV from semen samples does not influence in laboratorial parameters of assisted reproduction techniques cycles. On the other hand, ...

Endometriose e infertilidade: Videolaparascopia e/ou fertilização in vitro / Endometriosis and infertility: Videolaparoscopy and/or in vitro fertilization

A endometriose é caracterizada por implante e crescimento de tecido endometrial fora da cavidade uterina. Afeta mulheres em idade reprodutiva e tem sido observada em 5% à 10% das pacientes submetidas a laparotomias ginecológicas. Podemos encontrar desde pacientes assintomáticas, até quadros de dor pélvica crônica, dismenorréia, dispareunia e infertilidade. Tendo em vista que pacientes com endometriose tem cerca de vinte vezes mais chances de serem inférteis se comparadas às que não tem a doença, direcionamos nosso estudo para a revisão da literatura na escolha do melhor tratamento para a endometriose quando a única manifestação é a infertilidade. Após descartar o fator masculino, devemos avaliar a gravidade da doença, a idade da paciente e a duração da infertilidade. O diagnóstico definitivo só pode ser realizado por meio de visão direta e biópsia dos focos de endometriose, portanto devemos considerar o tratamento cirúrgico laparoscópico como primeiro passo na terapêutica. Em pacientes com endometriose mínima ou leve a ablação das lesões associadas à adesiólise é o tratamento de escolha. A fertilização in vitro (FIV) parece ser abordagem adequada nos casos de coexistência de outros fatores de infertilidade e/ou falha de outras abordagens terapêuticas, além dos casos de endometriose grave com distorção da cavidade pélvica. No tratamento das pacientes com endometriose e infertilidade devemos levar em consideração a presença ou não de fator masculino ou outro fator concominante, gravidade da doença, idade da paciente e duração da infertilidade.