Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

Abstract Objective: Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Methods: Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Results: Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Conclusion: Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

Significados atribuídos por mulheres com câncer de mama ao grupo de apoio / Meanings attributed by women with breast cancer to a support group / Significados atribuidos por las mujeres con cáncer de mama al grupo de apoyo

A sobrevivência ao câncer de mama é um problema de saúde pública que demanda serviços especializados com foco na reabilitação psicossocial. Entre as necessidades identificadas nesse contexto está o incentivo à adoção de estratégias de promoção de autocuidados pelas mulheres. Uma das estratégias adotadas consiste no grupo de apoio psicológico, que auxilia as pacientes a enfrentar a longa jornada do tratamento. Assim, o objetivo deste estudo é compreender os significados produzidos por mulheres com câncer de mama sobre sua participação em um grupo de apoio. Trata-se de um estudo qualitativo, descritivo e exploratório realizado com dez mulheres com câncer de mama usuárias de um serviço de reabilitação para mastectomizadas. Como referencial metodológico foi utilizada a Teoria Fundamentada nos Dados. A coleta de dados foi realizada por meio de entrevista aberta em profundidade e os conteúdos foram transcritos e codificados. A análise indutiva e o método de comparação constante foram aplicados nos processos de codificação aberta, axial e seletiva, que permitiram identificar três categorias nucleares: percepção das atividades realizadas no grupo, identificação de benefícios e barreiras do convívio no grupo e transformações decorrentes da participação. As participantes significaram sua presença no grupo como fonte de acolhimento, apoio, desenvolvimento de recursos pessoais e amizades, contribuindo para promover sua qualidade de sobrevida. Além dos potenciais benefícios, também foram identificadas barreiras que podem dificultar a adesão e continuidade da participação no grupo, o que sugere a necessidade de incorporar no cuidado um olhar para as dimensões subjetivas da saúde da mulher.(AU)

Surviving breast cancer is a public health problem and depends on services focused on psychosocial rehabilitation. Healthcare providers must encourage women to adopt strategies to promote their self-care. The psychological support group is a resource that helps women to face the long journey of treatment. This study aimed to understand the meanings women with breast cancer produced about their participation in a support group. This exploratory cross-sectional study was carried out with 10 women with breast cancer who use a rehabilitation service for mastectomized patients. Grounded Theory was used as a methodological reference. An open in-depth interview was applied for data collection. The contents were transcribed and coded. Inductive analysis and the constant comparison method were applied in the open, axial, and selective coding processes, which enabled the identification of three core categories: perception of the activities carried out in the group, identification of benefits and barriers of living in the group, and transformations resulting from participation. Participants denote their involvement with the group as a source of shelter, support, development of personal resources and friendships that helps promoting quality of life. Besides these potential benefits, participants also evinced barriers that can hinder adherence and continuity of participation in the group, suggesting the importance of incorporating a look at the subjective dimensions of women's health into care.(AU)

Sobrevivir al cáncer de mama es un problema de salud pública que depende de los servicios centrados en la rehabilitación psicosocial. Entre las necesidades identificadas en esta materia se encuentra el uso de estrategias para promover el autocuidado. Uno de los recursos que ayuda a afrontar el largo camino del tratamiento es el grupo de apoyo psicológico. El objetivo de este estudio es conocer los significados que producen las mujeres con cáncer de mama sobre su participación en un grupo de apoyo. Se trata de un estudio cualitativo, descriptivo y exploratorio, realizado con diez mujeres con cáncer de mama usuarias de un servicio de rehabilitación para mastectomizadas. Como referencia metodológica se utilizó la teoría fundamentada en los datos. Se aplicó una entrevista abierta en profundidad para la recogida de datos, cuyos contenidos fueron transcritos y codificados. El análisis inductivo y el método de comparación constante se aplicaron en los procesos de codificación abierta, axial y selectiva, lo que permitió identificar tres categorías centrales: percepción de las actividades realizadas en el grupo, identificación de los beneficios y las barreras de vivir en el grupo y transformaciones resultantes de la participación. Las mujeres denotan su participación en el grupo como una fuente de acogida, apoyo, desarrollo de recursos personales y amistades, que ayuda a promover la calidad de vida. Además de los beneficios potenciales, también se identificaron barreras que pueden dificultar la adherencia y continuidad de la participación en el grupo, lo que sugiere la necesidad de incorporar en la atención una mirada centrada en las dimensiones subjetivas de la salud de las mujeres.(AU)

O hormônio antimulleriano e a reserva ovariana: uma revisão integrativa da literatura / The anti-mullerian hormone and the ovarian reserve: an integrative literature review

O hormônio antimulleriano é secretado pelas células da granulosa dos folículos que estão em desenvolvimento no ovário. Por meio da sua dosagem, é possível avaliar a reserva ovariana. A mulher tem seu número máximo de oócitos no perío- do fetal, mas, conforme o tempo passa, existe uma queda do número de células germinativas. Desse modo, para mulheres que têm o desejo de engravidar, a dosa- gem de hormônios e a avaliação da reserva ovariana podem ajudar no processo. O objetivo do estudo foi encontrar evidências na literatura que comprovem que o hormônio antimulleriano é o melhor marcador da reserva ovariana. Para isso, foi realizada uma revisão integrativa, classificada como qualitativa; a busca de da- dos foi realizada no PubMed, utilizando a seguinte palavra-chave: "hormônio anti- mulleriano (HAM)". Foram encontrados oito artigos que abordavam diretamente o tema, e há evidências que corroboram a hipótese de que o hormônio antimulleria- no é um bom marcador da reserva ovariana, sendo necessários mais estudos para determinar a sua superioridade.

The anti-mullerian hormone is secreted by the granulosa cells of follicles that are developing in the ovary. Though its dosage is possible to evaluate the ovarian re- serve. Women have their maximum number of oocytes in the fetal period, but there is a decrease in the number of germinative cells as time goes by. Thus, women that desire to get pregnant can have hormones dosed and the ovarian reserve evalua- ted to help them with this process. The objective of this study was to find evidence in the literature that proves that the anti-mullerian hormone is the best marker of ovarian reserve. For this purpose, an integrative review was conducted, using the key word: "anti-mullerian hormone (AMH)". Eight articles were found on the subject and there is evidence that proves the hypothesis of the anti-mullerian hormone as a good marker, however more studies are needed to determine its superiority.

Comparación de hallazgos histeroscópicos vs. histerosalpingográficos en pacientes sometidas a tratamiento de fertilidad / Comparison of hysteroscopic vs. hysterosalpingographic findings in patients subjected fertilization treatment

Objetivo: Comparar los hallazgos histeroscópicos vs histerosalpingográficos en pacientes sometidas a tratamiento de fertilidad. Métodos: Estudio observacional, descriptivo, retrospectivo para determinar las causas de infertilidad, y analítico para evaluar la correspondencia de los hallazgos entre la histerosalpingografía y la histeroscopía de mujeres que asistieron a la consulta de fertilidad de la Clínica Leopoldo Aguerrevere, entre enero de 2018 y mayo de 2022. Resultados: Las causas de infertilidad más frecuentes fueron la edad (52,6 %), el factor tubárico (12,4 %) y la falla ovárica precoz (11,7 %); 47,4 % presentaban dos causas de infertilidad, 44,5 % solo una y 8,1 % tres causas. La fertilización in vitro (50,4 %) fue el tratamiento más utilizado para lograr el embarazo. En la histerosalpingografía se reportaron 67,9 % pacientes normales, del total de pólipos reportados, 5,1 % presentaron un pólipo y 4,4 % dos pólipos. En la histeroscopía se reportaron 46 % pacientes normales, del total de pólipos, 30,7 % presentó un pólipo, 4,4 % dos y 0,7 % tres pólipos. Entre los hallazgos más comunes hubo discordancia entre la histerosalpingografía e histeroscopía, siendo las coincidencias menores al 50 %. El índice Kappa, indicó que la correspondencia entre ambos estudios fue baja. Conclusiones: La histeroscopía es una técnica necesaria para el estudio de los trastornos endouterinos en mujeres infértiles, aportando información sobre lesiones endocavitarias uterinas, que pueden no ser apreciados con la histerosalpingografía, esta última puede emplearse para diagnóstico presuntivo de patología endometrial y evaluación de la permeabilidad de las trompas de Falopio(AU)

Objective: To compare hysteroscopic vs. hysterosalpingographic findings in female patients subject fertility treatment. Methods: Observational, descriptive, retrospective study to determine the causes of infertility, and analytical to evaluate the correspondence of the findings between hysterosalpingography and hysteroscopy of women who attended the fertility clinic of the Leopoldo Aguerrevere Clinic between January 2018 and May of 2022. Results: The most frequent causes of infertility were age (52.6%), tubal factor (12.4%) and early ovarian failure (11.7%); 47.4% had two causes of infertility, 44.5% only one and 8.1% three causes. In vitro fertilization (50.4%) was the most commonly used treatment to achieve pregnancy. In hysterosalpingography, 67.9 % normal patients were reported, of the total polyps reported, 5.1 % had one polyp and 4.4 % two polyps. In hysteroscopy, 46 % normal patients were reported, of the total polyps, 30.7 % presented one polyp, 4.4 % two and 0.7 % three polyps. Among the most common findings there was discordance between hysterosalpingography and hysteroscopy, with coincidences being less than 50%. The Kappa index indicated that the correspondence between the two studies was low. Conclusions: hysteroscopy is a necessary technique for the study of endouterine disorders in infertile women, providing information on uterine endocavitary lesions, which may not be appreciated with hysterosalpingography, the latter can be used for presumptive diagnosis of endometrial pathology and evaluation of permeability of the fallopian tubes(AU)

A survey on the current status of cognition of birth safety among married HIV-infected people aged 18-45 years / 中华流行病学杂志

Objective: To understand the current status of fertility safety cognition among married HIV-infected people aged 18-45 years and to provide evidence for fertility safety intervention in HIV-infected families. Methods: Six districts in Chongqing and Zigong City in Sichuan Province were selected. A questionnaire survey was conducted among married HIV-infected people aged 18-45 years who were followed up from November 2021 to April 2022 to collect their general demographic characteristics, histories of sex experience, fertility intention, and knowledge of birth safety. Unconditional logistic regression and Poisson regression were used to analyze the factors affecting the cognition of birth safety. Results: A total of 266 HIV-infected people were included in the study; 58.3% (155/266) were women, and 48.9% (130/266) had fertility desire. The cognition rate of knowledge of birth safety was 59.4% (158/266). The cognition rate of women's knowledge of birth safety was 2.14 (95%CI: 1.25-3.66) times that of men's. The cognition rate of knowledge of birth safety among HIV-infected persons with a high school education level or above was 1.88 (95%CI: 1.08-3.27) times that of those with a low education level. The cognition rate of knowledge of reproductive safety among HIV-infected people with fertility intention was 1.88 (95%CI: 1.10-3.22) times that of those without fertility intention. The cognition rate of knowledge of birth safety among HIV-infected persons who received AIDS knowledge promotion and education was 9.06 (95%CI: 2.46-33.32) times that of those who did not. The cognition rate of measures of birth safety was 5.3% (14/266). The Poisson regression analysis showed no significant difference in the cognition rate of specific measures among gender, age, education and other factors. Conclusions: HIV-infected people aged 18-45 years and married with a spouse have a low awareness of birth safety, and there are risks of HIV transmission between couples and mother-to-child in the family. Targeted birth safety education and intervention should be strengthened to reduce HIV transmission.

Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China / 北京大学学报(医学版)

OBJECTIVE@#To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province.@*METHODS@#Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression.@*RESULTS@#The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66).@*CONCLUSION@#The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.

A pre-conception cohort study of fertility and its related factors among couples with the intention of conception / 中华预防医学杂志

Objective: To describe fertility and explore factors associated with it among pre-conception couples of childbearing age. Methods: Based on the pre-conceptional offspring trajectory study of the School of Public Health of Fudan University, couples of childbearing age who participated in the pre-conception physical examination in Shanghai Jiading District from 2016 to 2021 were recruited and followed up. Couples' time to pregnancy (TTP) was analyzed and Cox proportional hazards regression model was used to explore the factors associated with TTP. Kaplan-Meier was used to calculate each menstrual cycle's cumulative pregnancy rate. Results: A total of 1 095 preconception couples were included in the analysis, the M(Q1,Q3)of TTP was 4.33 (2.41, 9.78) menstrual cycles. Age of women (FR=0.90, 95%CI: 0.85-0.95, P<0.001), women who were overweight or obese before pregnancy (FR=0.36, 95%CI: 0.24-0.55, P<0.001), women who were exposed to second-hand smoking (FR=0.63, 95%CI: 0.44-0.92, P=0.016), women whose home or office had been renovated in the past 2 years and had a particular smell (FR=0.46, 95%CI: 0.26-0.81, P=0.008) were risk factors for impaired fertility. Regular menstrual cycles (FR=1.64, 95%CI: 1.16-2.31, P=0.005), females who often drank tea/coffee (FR=1.55, 95%CI: 1.11-2.17, P=0.011) and males who took folic acid before conception (FR=2.35, 95%CI: 1.38-4.23, P=0.002) were associated with better fertility. The cumulative pregnancy rate of 3, 6, and 12 menstrual cycles was 37.6%, 64.4%, and 78.4%, respectively. Conclusion: Older couples, overweight or obesity before pregnancy, irregular menstruation, exposure to secondhand smoke and decoration pollutants in females are associated with impaired fertility. Frequent tea/coffee drinking before pregnancy in females and taking folic acid before pregnancy in males are associated with shortened conception time.

Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage / 法医学杂志

OBJECTIVES@#To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases.@*METHODS@#Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency.@*RESULTS@#All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment.@*CONCLUSIONS@#Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.

Fertility-preserving treatment outcomes in endometrial cancer and atypical hyperplasia patients with different molecular profiles / 中华妇产科杂志

Objective: To investigate the impact of molecular classification and key oncogenes on the oncologic outcomes in patients with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) receiving fertility-preserving treatment. Methods: Patients with EC and AEH undergoing progestin-based fertility-preserving treatment and receiving molecular classification as well as key oncogenes test at Obstetrics and Gynecology Hospital, Fudan University from January 2021 to March 2023 were reviewed. Hysteroscopic lesion resection and endometrial biopsy were performed before initiating hormone therapy and every 3 months during the treatment to evaluate the efficacy. The risk factors which had impact on the treatment outcomes in EC and AEH patients were further analyzed. Results: Of the 171 patients analyzed, the median age was 32 years, including 86 patients with EC and 85 patients with AEH. The distribution of molecular classification was as follows: 157 cases (91.8%) were classified as having no specific molecular profile (NSMP); 9 cases (5.3%), mismatch repair deficient (MMR-d); 3 cases (1.8%), POLE-mutated; 2 cases (1.2%), p53 abnormal. No difference was found in the cumulative 40-week complete response (CR) rate between the patients having NSMP or MMR-d (61.6% vs 60.0%; P=0.593), while the patients having MMR-d had increased risk than those having NSMP to have recurrence after CR (50.0% vs 14.4%; P=0.005). Multi-variant analysis showed PTEN gene multi-loci mutation (HR=0.413, 95%CI: 0.259-0.658; P<0.001) and PIK3CA gene mutation (HR=0.499, 95%CI: 0.310-0.804; P=0.004) were associated with a lower cumulative 40-week CR rate, and progestin-insensitivity (HR=3.825, 95%CI: 1.570-9.317; P=0.003) and MMR-d (HR=9.014, 95%CI: 1.734-46.873; P=0.009) were independent risk factors of recurrence in EC and AEH patients. Conclusions: No difference in cumulative 40-week CR rate is found in the patients having NSMP or MMR-d who received progestin-based fertility-preserving treatment, where the use of hysteroscopy during the treatment might be the reason, while those having MMR-d have a higher risk of recurrence after CR. Oncogene mutation of PTEN or PIK3CA gene might be associated with a lower response to progestin treatment. The molecular profiles help predict the fertility-preserving treatment outcomes in EC and AEH patients.

Mortalidade de mulheres em idade fértil no Brasil de 2006 a 2019: causas e tendências / Mortality of women of fertile age between 2006 and 2019: causes and trends / Mortalidad de mujeres en edad fértil entre 2006 y 2019: causas y tendencias

Resumo O objetivo deste estudo é analisar a tendência das principais causas de óbito de mulheres em idade fértil (MIF) no Brasil, por faixa etária, no período de 2006 a 2019. Utilizaram-se dados do Sistema de Informações sobre Mortalidade (SIM) e do Instituto Brasileiro de Geografia e Estatística (IBGE). As principais causas de morte de MIF (10 a 49 anos) foram classificadas por capítulos da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10). Posteriormente realizou-se análise de tendência temporal por meio de modelos de regressão polinomial das principais causas de morte de MIF segundo faixa etária. No Brasil, as maiores taxas de mortalidade por causas p/100 mil MIF deveram-se a neoplasias (25,34), doenças do aparelho circulatório (20,15), causas externas (18,69), doenças infecciosas e parasitárias (8,79) e doenças do aparelho respiratório (6,37). Para o período analisado, após padronização, as taxas de mortalidade por doenças do aparelho circulatório, do aparelho respiratório e infecciosas e parasitárias apresentaram tendência decrescente, com uma queda expressiva de 26,6% para as doenças do aparelho circulatório; já as taxas de mortalidade por causas externas e neoplasias registraram tendência crescente de 2006 a 2012 e decrescente de 2013 em diante. As causas externas e as neoplasias foram as principais causas de óbito, especialmente entre as mulheres mais jovens e com tendência crescente. Sendo este um importante problema de saúde pública, faz-se necessário planejar ações que otimizem os recursos e melhorem a qualidade de vida e saúde das mulheres.

Abstract The aim of this study is to analyze the trend of the main causes of death of women of reproductive age (WRA) in Brazil by age group from 2006 to 2019. Data used are from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE) of Brazil. The main causes of death of WRA (10 to 49 years) were divided by chapters as per the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Subsequently, a temporal trend analysis was performed using polynomial regression models for the main causes of death in WRA. In Brazil, the highest mortality rates by cause by 100,000 WRA occurred due to: neoplasms (25.34), diseases of the circulatory system (20.15), external causes (18.69), infectious and parasitic diseases (8.79) and respiratory system diseases (6.37). For the analyzed period, after standardization, the mortality rate due to diseases of the circulatory and respiratory systems, and infectious and parasitic conditions showed a decreasing trend, with a significant drop of 26.6% for diseases of the circulatory system; while external causes and neoplasms showed an increasing trend from 2006 to 2012 and decreasing from 2013 onwards. Identifying the main causes of death of WRA in each age group is required to guide the planning of actions to optimize resources and obtain better results in women's health.

Resumen El objetivo de este estudio es analizar la tendencia de las principales causas de muerte de mujeres en edad fértil (MEF) en Brasil por grupo de edad desde 2006 hasta 2019. Con datos del Sistema de Información de Mortalidad (SIM) y del Instituto Brasileiro de Geografía y Estadísticas (IBGE) de Brasil, las principales causas de muerte de MEF (10 a 49 años) fueron divididas por capítulos de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud (CIE-10). Luego se hizo un análisis de tendencia temporal mediante modelos de regresión polinomial de las principales causas de muerte en MEF. En Brasil, las mayores tasas de mortalidad por causa en MEF/100.000 mujeres ocurrieron por neoplasias (25,34), enfermedades del aparato circulatorio (20,15), causas externas (18,69), enfermedades infecciosas y parasitarias (8,79) y enfermedades del sistema respiratorio (6,37). Para el período analizado, después de la estandarización, la tasa de mortalidad por neoplasias y por enfermedades de los sistemas circulatorio, respiratorio e infeccioso y parasitario mostró una tendencia decreciente, con una caída significativa del 26,6 % para enfermedades del sistema circulatorio, mientras que las causas externas y neoplasias mostraron una tendencia creciente entre 2006 y 2012 y decreciente desde 2013 en adelante. Identificar las principales causas de muerte en MEF en cada grupo de edad orienta la planificación de acciones para optimizar recursos y obtener mejores resultados en la salud de la mujer.

Intenções de fecundidade: uma revisão da literatura acerca da variável em países de renda alta e no Brasil / Fertility intentions: a literature review on high-income countries and Brazil / Intenciones de fecundidad: una revisión de la literatura sobre la variable en países de ingresos altos y en Brasil

Resumo A literatura sobre intenções de fecundidade tem ganhado crescente relevância em estudos demográficos porque, sendo um determinante próximo da fecundidade, auxilia o entendimento do comportamento reprodutivo de diferentes populações. Contudo, esta literatura não foi ainda organizada segundo os principais e mais recorrentes aspectos dispersos na literatura. Estudos geralmente utilizam uma única característica acerca das intenções de fecundidade, seja por meio dos seus conceitos, das principais teorias ou de principais indicadores. Este trabalho possui, portanto, o objetivo de organizar e articular os principais e mais recorrentes aspectos presentes nos estudos sobre intenções de fecundidade. Ao longo da discussão, aprofunda-se na relação existente entre intenções de fecundidade e fecundidade observada. A princípio, foca-se nos países de renda alta, sobre e para os quais a literatura referente ao tema foi desenvolvida. Contudo, também são abordados países de renda média e fecundidade baixa, com ênfase no Brasil, para os quais a produção, especialmente a partir de uma abordagem teórica, ainda é incipiente.

Abstract The literature on fertility intentions has gained increasing relevance in demographic studies because, as a close determinant of fertility, it helps understand the reproductive behavior of different populations. However, this literature has not yet been organized according to the main and most recurrent aspects covered. Studies generally use one single aspect of fertility intentions, whether through its concepts, main theories or main indicators. Therefore, the goal of this work is to organize and articulate the main and most recurrent aspects present in studies on fertility intentions. It begins by presenting the main concepts. Then, it discusses important theoretical approaches on the formation of fertility intentions, as well as its main determinants. Finally, it contextualizes fertility intentions (and their levels) in different scenarios. Throughout the discussion, for each topic presented, the paper delves deeper into the relationship between fertility intentions and observed fertility. Its first focus is on high-income countries covered in the literature on the subject. However, it also discusses middle-income countries with low fertility, focusing on Brazil, for which academic production, especially from a theoretical approach, is still incipient.

Resumen La literatura sobre las intenciones de fecundidad ha ganado relevancia en los estudios demográficos porque, al ser estas determinantes próximos de la fecundidad, ayudan a entender el comportamiento reproductivo de diferentes poblaciones. Sin embargo, esta literatura no se ha organizado según sus aspectos principales y más recurrentes. Así, los estudios trabaja en general sobre un solo aspecto de las intenciones de fecundidad, sea a través de sus conceptos, de sus principales teorías o de sus principales indicadores. El objetivo de este artículo es, por lo tanto, organizar y articular los principales y más recurrentes aspectos presentes en los estudios sobre intenciones reproductivas. Así, comienza presentando sus conceptos principales. Luego, discute importantes corrientes teóricas sobre la formación de intenciones de fecundidad y también analiza sus principales determinantes. Finalmente, contextualiza las intenciones de fecundidad (y sus niveles) en diferentes escenarios. A través de cada tema presentado, se profundiza en la relación entre las intenciones de fecundidad y la fecundidad observada en las poblaciones. Es para ello que se centra, en un primer momento, en los países de ingresos altos, sobre y para los cuales se elaboró la literatura sobre el tema. Sin embargo, también se analizan los países de ingresos medios y de baja fecundidad, con énfasis en Brasil, cuya producción, especialmente desde un enfoque teórico, es aún incipiente.

Preservação de fertilidade: cultivo de folículos ovarianos e novo dispositivo para criopreservação seminal / Fertility preservation: ovarian follicle culture and a new device for seminal cryopreservation

INTRODUÇÃO: A oncofertilidade tem o desafio de buscar estratégias para preservar a função reprodutiva. Este estudo explorou duas possibilidades como implementação para as técnicas de preservação da fertilidade feminina e masculina. OBJETIVO: Analisar a eficiência do cultivo de folículos pré-antrais de camundongos suplementado com lisado de plaquetas humanas e desenvolver um protótipo para criopreservação de sêmen humano. MATERIAIS E MÉTODOS: Os folículos pré-antrais foram isolados mecanicamente de ovários de fêmeas de camundongos e foram cultivados individualmente em sistema entre camadas de óleo mineral. Os folículos foram cultivados divididos em 4 grupos, sendo um controle, sem o uso do lisado de plaquetas e três grupos com diferentes concentrações de lisado de plaquetas humanas (PLTMax®). Foram avaliadas a sobrevivência celular, desenvolvimento folicular e características oocitárias. Para o segundo estudo foi desenvolvido e impresso em 3D com filamentos de acrilonitrilo butadieno-estireno (ABS) um protótipo que suporte 10 palhetas com amostras seminais no vapor de nitrogênio líquido (N2L), etapa essencial para criopreservação de sêmen humano. Para os testes foram utilizadas 40 amostras seminais. A temperatura ambiente e no interior das palhetas de envase das amostras foram medidas e estabelecida a curva de resfriamento. Os parâmetros de motilidade, vitalidade e fragmentação do DNA espermático foram avaliados antes do congelamento e após o descongelamento. Foram realizados dois testes, um de posicionamento das palhetas e outro comparativo entre o protótipo e um dispositivo com suporte em poliestireno expandido (EPS). RESULTADOS: O cultivo de 11 dias induziu um aumento no tamanho folicular em todas as condições, sendo maior no grupo controle, seguido do grupo com 10% de PLTMax®, mas com diferença significativa (p<0,001). O grupo controle apresentou maior número de oócitos intactos (>50%) em relação aos demais (<35%). Todos os 4 grupos apresentaram taxas de vitalidade celular acima de 70%. Quanto aos testes com o protótipo em ABS foi verificado que as curvas de refrigeração foram notavelmente reproduzíveis. O material do protótipo resistiu a inúmeros mergulhos (>300) no N2L, sem demonstrar danos ao material. Diferenças significativas (p<0,001) foram observadas para a taxa de recuperação média da motilidade e vitalidade espermática em relação aos dados da amostra 2 fresca em ambos os testes. A motilidade, a vitalidade e a fragmentação do DNA espermático antes do congelamento e após o descongelamento não mostraram diferenças em relação a posição das palhetas. Também não houve diferença quanto ao índice de fragmentação verificada das amostras criopreservadas com uso do protótipo em ABS e o suporte em EPS, mesmo após o cultivo, após 24 horas de cultivo. Contudo, houve diferença em relação a amostra fresca (p<00,1). Quanto a recuperação das taxas de motilidade e vitalidade não houve diferença entre o ABS e EPS após o descongelamento e 24 horas de cultivo. CONCLUSÃO: O PLTMax®, embora tenha apresentado menor desempenho que o HSA, é um candidato de suplementação para o cultivo de folículos pré-antrais que merece ser mais explorado. O protótipo em ABS demonstrou resistência, praticidade e segurança para criopreservação seminal de forma reprodutível e eficiente.

INTRODUCTION: Oncofertility has the challenge of seeking strategies to preserve reproductive function. This study explored two possibilities as implementations for female and male fertility preservation techniques. PURPOSE: To analyze the efficiency of mouse preantral follicle culture supplemented with human platelet lysate and to develop a prototype for human semen cryopreservation. MATERIAL AND METHODS: Preantral follicles were mechanically isolated from female mouse ovaries and were individually cultured using a mineral oil interlayer system. The follicles were cultured divided into 4 groups, one control, without the use of platelet lysate and three groups with different concentrations of human platelet lysate (PLTMax®). Cell survival, follicular development and oocyte characteristics were evaluated. For the second study, a prototype was developed and printed in 3D with acrylonitrile butadiene styrene (ABS) filaments to support 10 straws with seminal samples in liquid nitrogen (N2L) vapor, an essential step for human semen cryopreservation. For the tests 40 seminal samples were used. Ambient and internal temperatures inside the sample straws were measured and the cooling curve was established. The parameters of motility, vitality and sperm DNA fragmentation were evaluated before freezing and after thawing. Two tests were performed, one for positioning the straws and the other comparing the prototype and a device with expanded polystyrene (EPS) support. RESULTS: The 11-day culture induced an increase in follicular size in all conditions, being higher in the control group followed by the group with 10% PLTMax®, but with significant difference (p<0.001). The control group presented a higher number of intact oocytes (>50%) compared to the others (<35%). All 4 groups presented cell vitality rates above 70%. As for the ABS prototype tests, it was verified that the cooling curves were remarkably reproducible. The prototype withstood numerous dips (>300) in N2L without showing damage to the material. Significant differences (p<0.001) were observed for the mean recovery rate of sperm motility and vitality compared to the fresh sample data in both tests. Motility, vitality and sperm DNA fragmentation before freezing and after thawing showed no differences with respect to the position of the straws. There was also no difference in the fragmentation index verified for samples cryopreserved using the ABS prototype and the EPS support, even after 24 hours of culture. However, there was a difference compared to the fresh 4 sample (p<00.1). As for the recovery of motility and vitality rates there was no difference between ABS and EPS after thawing and 24 hours of culture. CONCLUSION: PLTMax®, although it showed lower performance than HSA, is a supplementation candidate for preantral follicle culture that deserves further exploration. The ABS prototype demonstrated strength, practicality and safety for seminal cryopreservation in a reproducible and efficient manner.

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

El rol del pediatra en la prevención de la fecundidad adolescente / The role of the pediatrician in the prevention of adolescent fertility

La fecundidad adolescente en Cuba es elevada y muestra resistencia a su reducción en los últimos años a pesar de las acciones realizadas. Para promover una sexualidad responsable en los adolescentes, se requiere de un diferente y particular accionar de los pediatras. El objetivo de esta colaboración es aportar elementos que sensibilicen e involucren a los pediatras cubanos para que ofrezcan orientación a los adolescentes sobre el ejercicio de una sexualidad plena, libre y responsable, que contribuya a la reducción de la fecundidad y al cuidado integral de la salud sexual y reproductiva. El método utilizado fue la revisión de las legislaciones vigentes y las recomendaciones de varias sociedades internacionales de pediatría, respecto a la función e importancia de la especialidad en la prevención del embarazo adolescente. Se destacan las ventajas del pediatra para la prevención de la fecundidad adolescente, se explican las habilidades que deben adquirir para informar y orientar a los adolescentes, se analizan las barreras que debe favorecer el acceso del adolescente a la prevención de la fecundidad y se exponen las recomendaciones específicas para su actuación Se concluye que los pediatras cubanos pueden contribuir a la reducción de la fecundidad y mejorar el cuidado integral de la salud sexual y reproductiva de los adolescentes(AU)

Adolescent fertility in Cuba is high and shows resistance to its reduction in recent years despite the actions taken. To promote responsible sexuality in adolescents, a different and particular action of pediatricians is required. The objective of this collaboration is to provide elements that sensitize and involve Cuban pediatricians to offer guidance to adolescents on the exercise of a full, free and responsible sexuality, which contributes to the reduction of fertility and comprehensive care of sexual and reproductive health. The method used was the review of current legislation and the recommendations of several international pediatric societies, regarding the role and importance of the specialty in the prevention of adolescent pregnancy. The advantages of the pediatrician for the prevention of adolescent fertility are highlighted, the skills they must acquire to inform and guide adolescents are explained, the barriers that the pediatrician must face to favor the access of adolescents to prevent fertility are analyzed, and the specific recommendations for the action of the pediatrician in the prevention of adolescent fertility are exposed. It is concluded that Cuban pediatricians can contribute to the reduction of fertility and improve the comprehensive care of sexual and reproductive health of adolescents(AU)

Complicaciones endocrinológicas del síndrome de down en pediatría: revisión de la literatura / Endocrine complications of Down syndrome in pediatrics: a review of the literature

El síndrome de Down constituye la cromosopatía más frecuente a nivel mundial y afecta 6,03 a 7,86 de cada 10.000 nacidos vivos en Colombia. Los pacientes pediátricos de este grupo poblacional presentan una mayor incidencia de complicaciones endocrinológicas comparados con la población general. El objetivo de este artículo es revisar las complicaciones endocrinológicas prevalentes en el paciente pediátrico con síndrome de Down, relacionadas con el hipocrecimiento, desarrollo puberal, patología tiroidea, diabetes mellitus, dislipidemias y obesidad; así como describir su seguimiento y tratamiento. Se realizó una búsqueda en la literatura desde agosto de 2020 hasta diciembre de 2021, en las bases de datos PubMed y Google Scholar; incluyendo un total de 44 publicaciones para la presente revisión. Se concluye que el paciente pediátrico con síndrome de Down evidencia un patrón de hipocrecimiento junto a un mayor riesgo de obesidad y sobrepeso. Adicionalmente, presenta con mayor frecuencia patología tiroidea y diabetes mellitus.

Down syndrome is the most common chromosomal disorder worldwide, affecting 6,03 to 7,86 per 10.000 live births in Colombia. Pediatric patients with Down syndrome have a higher incidence of endocrine disorders compared to the general population. The aim of this paper was to review the endocrinological manifestations prevalent in pediatric patients with Down syndrome related to small stature, pubertal development, thyroid dysfunction, diabetes mellitus, dyslipidemia, and obesity. Additionally, their follow-up and adequate treatment are described. A literature search was carried out from August 2020 to December 2021 in the PubMed and Google Scholar databases. A total of 44 publications were included for this review. It is concluded that pediatric patients with Down syndrome are more likely to have short stature and have a higher risk of obesity and overweight. In addition, thyroid dysfunction and diabetes mellitus are frequent complications.

Low versus high antral follicle count on the fertility of timed AI Nelore heifers / Baixa versus alta contagem de folículos antrais na fertilidade de novilhas Nelore inseminadas em tempo-fixo

This study aimed to determine the effect of antral follicle count (AFC), and pubertal status on the fertility of beef heifers. In this study, 230 Nelore heifers, 20±2 months of age, were subjected to an estradiol progesterone-based timed artificial insemination (TAI) program. On Day 0 of the TAI protocol, the heifers were examined by transrectal ultrasound to record videos of the ovaries. Later, in the darkroom of the laboratory of images, the videos were analyzed for AFC (≥ 3 mm) of each ovary. Females who failed the first TAI were resynchronized with the same hormonal protocol. The pregnancy status was evaluated by ultrasonography 30 days after each FTAI. The general mean of the AFC was 22.0 follicles. Thus, the heifers were divided into 2 groups according to AFC: Low AFC (˂ 22 follicles, n = 114), and High AFC (≥ 22 follicles, n = 116). No differences (P > 0.05) in the pregnancy per AI (P/AI) were observed between the Low and High AFC groups, and between pubertal and prepubertal categories. The P/AI was not different between heifers that displayed or did not estrus (P = 0.2). However, considering the estrus response of each AFC group, High AFC heifers that displayed estrus had greater P/AI (P = 0.01) than High AFC heifers that did not display estrus. In summary, AFC and pubertal status did not affect the fertility of Nelore heifers. In contrast, the P/AI of heifers that did not display estrus was lower than heifers observed in estrus only in the High AFC group.(AU)

Esse estudo teve como objetivo determinar o efeito da contagem de folículos antrais (CFA) e da maturidade sexual na fertilidade de novilhas de corte. Neste estudo, 230 novilhas Nelore, com 20 ± 2 meses de idade, foram submetidas a um protocolo de inseminação em tempo-fixo (IATF) a base de estradiol e progesterona. No Dia 0 do protocolo de IATF as novilhas foram examinadas por ultrassonografia transretal e vídeos dos ovários foram gravados para posterior CFA (≥ 3 mm) realizada na sala escura do laboratório de imagens. Trinta dias após a ultrassonografia, as fêmeas que falharam na primeira IATF foram ressincronizadas com o mesmo protocolo hormonal. A prenhez foi avaliada por ultrassonografia 30 dias após cada IATF. A média geral da CFA foi de 22 folículos; assim, as novilhas foram divididas em 2 grupos de acordo com a CFA: CFA baixa (˂ 22 folículos, n=114) e CFA alta (≥ 22 folículos, n=116). A prenhez por IA (P/IA) foi semelhante (P > 0,05) entre os grupos CFA baixa e alta e entre novilhas púberes e pré-púberes. A P/IA não foi diferente entre as novilhas que apresentaram ou não cio (P = 0,2). No entanto, novilhas com CFA alta que apresentaram cio tiveram maior P/IA (P = 0,01) do que novilhas com CFA alta que não apresentaram cio. Em conclusão, a CFA e a maturidade sexual não afetaram a fertilidade de novilhas. Por outro lado, a P/IA das novilhas que apresentaram cio foi maior do que das novilhas não observadas em cio apenas no grupo CFA alta.(AU)

CRISPR/Cas9-mediated genome editing reveals 12 testis-enriched genes dispensable for male fertility in mice / 亚洲男科学杂志(英文版)

Gene expression analyses suggest that more than 1000-2000 genes are expressed predominantly in mouse and human testes. Although functional analyses of hundreds of these genes have been performed, there are still many testis-enriched genes whose functions remain unexplored. Analyzing gene function using knockout (KO) mice is a powerful tool to discern if the gene of interest is essential for sperm formation, function, and male fertility in vivo. In this study, we generated KO mice for 12 testis-enriched genes, 1700057G04Rik, 4921539E11Rik, 4930558C23Rik, Cby2, Ldhal6b, Rasef, Slc25a2, Slc25a41, Smim8, Smim9, Tmem210, and Tomm20l, using the clustered regularly interspaced short palindromic repeats /CRISPR-associated protein 9 (CRISPR/Cas9) system. We designed two gRNAs for each gene to excise almost all the protein-coding regions to ensure that the deletions in these genes result in a null mutation. Mating tests of KO mice reveal that these 12 genes are not essential for male fertility, at least when individually ablated, and not together with other potentially compensatory paralogous genes. Our results could prevent other laboratories from expending duplicative effort generating KO mice, for which no apparent phenotype exists.

Clinical outcomes analysis of fertility-preserving therapy for atypical endometrial hyperplasia and early endometrial carcinoma / 中华肿瘤杂志

Objective: To analyze the clinical efficacy of fertility-preserving therapy in patients with atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EC). Methods: The general condition, pathological type, treatment plan, tumor outcomes and pregnancy outcomes of 110 patients with AEH and EC treated with fertility-preserving therapy in Peking University People's Hospital from December 2005 to September 2019 were retrospectively analyzed. Kaplan-Meier and Log rank tests were used for survival analysis. Results: The response rate of 110 cases of AEH (62 cases) and EC (48 cases) was 94.5% (104/110) after fertility-preserving therapy. There were 93 cases (84.5%) achieved complete response and 11 cases (10.0%) achieved partial response, and the recurrence rate was 29.0% (27/93). The complete response rates of AEH and EC were 90.3% (56/62) and 77.1% (37/48), respectively, without significant difference (P=0.057). The recurrence rates of EC were significantly higher than that of AEH (40.5% vs 21.4%; P=0.022). Forty-one patients with complete response had pregnancy intention, the pregnancy rate was 70.7% (29/41), and the live birth rate was 56.1% (23/41). The live birth rate of AEH was 68.2% (15/22) and that of EC was 42.1% (8/19), the difference was statistically significant (P=0.032). The pathological type was related with the recurrence (P=0.044). Conclusions: Patients with AEH and EC can obtain high complete response rate and pregnancy rate after fertility-preserving therapy. The recurrence rate of EC is higher than that of AEH, while the live birth rate of AEH is higher than that of EC.