A call to action: unified clinical practice guidelines for oncofertility care.

By 2030, WHO estimates that 1.4 million reproductive-aged women will be diagnosed with cancer annually. Fortunately, cancer is no longer considered an incurable disease in many cases. From 2008-2014, 85% of women under the age of 45 years diagnosed with cancer survived. This increase in survival rate has shifted attention from focusing exclusively on preserving life to focusing on preserving quality of life after treatment. One aspect of this is preserving the ability to have a biological family. Oncofertility, the field that bridges oncology and reproductive endocrinology with the goal of preserving fertility, offers these patients hope. Though it is clear that ASCO and ASRM recognize the importance of fertility preservation as an aspect of comprehensive oncology care, there are not yet unified guidelines for oncologists and fertility specialists for treating oncofertility patients. First, we identify the need for reproductive counseling prior to cancer treatment, as many patients report that their fertility preservation concerns are not addressed adequately. We then delineate multi-modal fertility preservation options that are available and appropriate for different patients with corresponding outcomes using different treatments. We discuss the unique challenges and considerations, including ethical dilemmas, for delivering timely and comprehensive care specifically for oncofertility patients. Finally, we address the multidisciplinary team that includes oncologists, reproductive endocrinologists, surgeons as well as their staff, nurses, genetic counselors, mental health professionals, and more. Since oncofertility patient care requires the coordination of both physician teams, one set of unified guidelines will greatly improve quality of care.

Engagement in Nonbiomedical Practices for Fertility Enhancement: A Scoping Review.

Objectives: This scoping review aims to (1) describe the scope and coverage of the body of literature on nonbiomedical practices used for enhancing fertility, (2) summarize and map the existing evidence on the extent and types of nonbiomedical practices used, and (3) examine how the research on this topic has been conducted with particular attention paid to how participants are asked about their use of nonbiomedical practices for fertility enhancement. Design: We conducted a scoping review by which four databases were searched (PubMed, Psychinfo, Socindex, and CINHAL). Articles were screened for inclusion by two researchers through a title and abstract screening followed by a full-text screening. Data were extracted from included articles and results summarized and compared across studies and regions. Results: A total of 32 studies were identified from 16 countries in five regions of the world. The majority of studies were clinic-based, primarily recruiting participants from fertility clinics in urban and suburban areas. More than half of the studies included only women, a few studies included only men, and the remainder of studies included both men and women. Most quantitative studies reported the prevalence of nonbiomedical practice use, which ranged from 8% to 83%; however, there was variation across studies regarding the time frame for which these percentages were derived. Few studies reported on other measures of the extent of use such as duration or frequency. A variety of nonbiomedical practices were identified with biologically based treatments, particularly herbal medicine use, being the most common followed by religious and spiritual interventions. Regional differences were identified. Variation in the wording and format of the question(s) used in survey instruments asking participants about their use of nonbiomedical practices exists and may impact participants' reporting of use. Conclusions: Infertility affects millions of individuals worldwide often with severe social, emotional, and financial consequences. To enhance fertility and, in some cases, overcome infertility, many individuals and couples are engaging in a variety of nonbiomedical practices. This scoping review describes the scope and nature of the existing literature on the use of nonbiomedical practices for fertility enhancement and highlights important gaps and limitations in the conduct of this research. A more comprehensive and inclusive investigation of nonbiomedical practices for enhancing fertility is needed to improve our understanding of how individuals and couples are managing infertility, identify educational and counseling needs, and to improve research related to effectiveness and safety of nonbiomedical practices.

Exploring the facilitators and barriers to using an online infertility risk prediction tool (FoRECAsT) for young women with breast cancer: a qualitative study protocol.

INTRODUCTION: As cancer treatments may impact on fertility, a high priority for young patients with breast cancer is access to evidence-based, personalised information for them and their healthcare providers to guide treatment and fertility-related decisions prior to cancer treatment. Current tools to predict fertility outcomes after breast cancer treatments are imprecise and do not offer individualised prediction. To address the gap, we are developing a novel personalised infertility risk prediction tool (FoRECAsT) for premenopausal patients with breast cancer that considers current reproductive status, planned chemotherapy and adjuvant endocrine therapy to determine likely post-treatment infertility. The aim of this study is to explore the feasibility of implementing this FoRECAsT tool into clinical practice by exploring the barriers and facilitators of its use among patients and healthcare providers. METHODS AND ANALYSIS: A cross-sectional exploratory study is being conducted using semistructured in-depth telephone interviews with 15-20 participants each from the following groups: (1) premenopausal patients with breast cancer younger than 40, diagnosed within last 5 years, (2) breast surgeons, (3) breast medical oncologists, (4) breast care nurses (5) fertility specialists and (6) fertility preservation nurses. Patients with breast cancer are being recruited from the joint Breast Service of three affiliated institutions of Victorian Comprehensive Cancer Centre in Melbourne, Australia-Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Royal Women's Hospital, and clinicians are being recruited from across Australia. Interviews are being audio recorded, transcribed verbatim and imported into qualitative data analysis software to facilitate data management and analyses. ETHICS AND DISSEMINATION: The study protocol has been approved by Melbourne Health Human Research Ethics Committee, Australia (HREC number: 2017.163). Confidentiality and privacy are maintained at every stage of the study. Findings will be disseminated through peer-reviewed scholarly and scientific journals, national and international conference presentations, social media, broadcast media, print media, internet and various community/stakeholder engagement activities.

Protective effect of Liuwei Dihuang Pill on cisplatin-induced reproductive toxicity and genotoxicity in male mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Cisplatin (CP) is the classical chemotherapeutic drug for various cancer, but it also accompanies reproductive toxicity and genotoxicity. Liuwei Dihuang Pill (LW) is the traditional Chinese medicine prescription for treating Kidney-Yin deficiency syndrome, which has been reported to prevent and treat various diseases. However, the protective effect of LW on CP-induced reproductive toxicity and genotoxicity has not been reported. AIM OF THE STUDY: To investigate the potential protective effect and mechanism of LW on CP-induced reproductive toxicity and genotoxicity in male mice. MATERIALS AND METHODS: Mice were given LW (0.4, 1.2 and 3.6 g/kg) or Vitamin C (0.1 g/kg) once daily by oral gavage for thirteen consecutive days. Then, CP (3.00 mg/kg) was given intraperitoneal injection once daily for five consecutive days starting on the ninth day. The protective effects of LW against CP-induced reproductive toxicity and genotoxicity were evaluated by body weight, testis ratio, sperm count, sperm viability, sperm abnormal morphology type, micronuclei test, testicular histopathology, serum malondialdehyde (MDA), total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) level. RESULTS: The results demonstrated that LW could significantly increase CP-induced the reduction of sperm count and sperm viability, then decrease abnormal sperm type rate and micronucleus rate. Moreover, LW also could improve testicular abnormal histopathologic morphology induced by CP exposure. Meanwhile, LW decreased serum MDA level and increased T-SOD, GSH-Px and CAT level compared to CP group. CONCLUSION: our findings show that LW has protective effects on CP-induced reproductive toxicity and genotoxicity. LW decreases serum MDA level and increases T-SOD, GSH-Px and CAT level, which indicates that antioxidant activity may be the potential mechanism of LW to resist reproductive toxicity and genotoxicity.

Myrciaria dubia "camu camu" flour as a magnetoprotector in male mouse infertility.

Possible adverse effects of extremely low frequency magnetic fields (ELF-MF) are linked to a decrease of antioxidant defenses and the production of free radicals. The increase of free radicals affects the mitochondrial functionality inducing apoptosis, which affects the phosphorylation and generation of key ATP in fertilization. Myrciaria dubia, known as "camu camu," is a fruit with high levels of ascorbic acid, which exerts an important antioxidant function in the prevention of premature cell damage. In this study, the effect of Myrciaria dubia flour on oxidative damage produced by ELF-MF (610 µT) was evaluated by detecting the activity of endogenous mitochondrial oxidoreductase enzymes in a complete sperm cycle of mice. We found that the MF caused a significant (P < 0.05) decrease in sperm quality, whereas the groups supplied with Myrciaria dubia flour (50 and 75 mg/kg of body mass) in ELF-MF exposure showed a significant recovery (P < 0.05) in parameters of viability, percentage of plasma membrane integrity and mitochondrial activity, and index of epidymal sperm. This suggests that Myrciaria dubia flour would have an antioxidant activity that counteracts the damaging effects of ELF-MF in spermatogenesis and could be used as a natural ELF-MF protector. Bioelectromagnetics. 40:91-103, 2019. © 2019 Bioelectromagnetics Society.

The protective effect of Costus afer Ker Gawl aqueous leaf extract on lead-induced reproductive changes in male albino Wistar rats.

INTRODUCTION: Lead is a multiple organ toxicant and an oxidative-stress inducer. The effect of Costus afer on metal- induced male reprotoxicity has not been previously carried out, hence this study. The present study investigates the protective effect of Costus afer aqueous leave extract on lead- induced reproductive damages in male albino Wistar rats. METHODS: Adult male albino Wistar rats were weighed and separated into five groups of five rats each. Groups 1 & 2 served as normal and toxic controls receiving deionized and leaded (CH3COO)2Pb.3H2O and water respectively. Groups 3, 4 and 5 were given 750, 1500 and 2250mg/kg of Costus afer orally, respectively while receiving Pb2+ water ad libitum for 28 days. RESULTS: The reproductive and antioxidant parameters obtained from the result served as scientific evidence in the study. The result showed non-significant changes in the absolute and relative weights of epididymis and testes in the Pb Group versus the control. Significant increases were recorded in the sperm analysis, blood lead (7.9±1.02; 1.1±0.01) level (BLL), luteinizing hormone (LH) (8.5±1.4:5.5±0.4), and a decrease in follicle stimulating hormone (FSH) (4.5±2.6:6.5±1.65), with non-significant changes in testosterone (TET) (1.3±0.00:1.6±0.2) in the Pb group compared to the control. CONCLUSION: The treatment with Costus afer exhibited dose-dependent significant changes in testicular oxidative stress, hormonal, sperm analysis and histopathological changes induced by lead. Aqueous leaves extract of Costus afer may be protective against lead induced testicular damage.

Alleviation of Fertility Disorders Based on Probiotics Induced Immune System Improvement: A Review.

Infertility is a worldwide problem affecting a large percentage of the population. Several products and techniques have been adopted to alleviate infertility condition, but the most recent and promising result was obtained through supplementation of probiotics. Continuous research on probiotics opened up a previously unknown area of its role as a modern medicine in improving fertility. New research findings suggest a profertility effect of several probiotics strains through alleviation of various fertility based disorders and modulation of the immune system. The goal of this review is to cover all the major fertility based disorders, particularly highlighting the role of probiotics in improving fertility through alleviation of such fertility based disorders.

Walnut leaf extract acts as a fertility agent in male Wistar albino rats - A search for herbal male fertility enhancer.

Background Walnut leaf is one of the many medicinal plants used in folklore as male fertility enhancers. The present work was therefore undertaken with an aim to scientifically validate this claim. As such, we evaluated the effect of the aqueous extract from walnut leaves on biomolecules related to fertility in adult male rats and its mode of action as fertility-enhancing agent. Methods Twenty-five rats were randomly divided into five groups of five animals each; Group 1 served as control and received normal (0.9%) saline only; Groups II, III, IV received 50, 500, 1,000 mg/kg body weight (BW) of T. conophorum leaf extract orally, while Group V served as standard and was given suspension of clomiphene citrate orally at the dose of 1.04 mg/kg/ml BW. The extract and drug were given daily and the experiment lasted for 21 consecutive days. Results The testicular biochemical parameters in treated groups showed significant (p<0.05) increase in lactate dehydrogenase activity activity, Glucose-6-phosphate dehydrogenase (G-6PDH) activity, glycogen content, 3ß and 17ß hydroxysteroid dehydrogenase activities and testicular and epididymal Zn and Se contents with a significant decrease in cholesterol content. A significant increase in testis weight and epididymis weight were also observed. Also, a significant (p<0.05) increase in the level of serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone, sperm count, motility, viability and a decrease in sperm abnormality were observed in the various treated groups when compared with the control group. This increment was concentration dependent, while the extract at the highest concentration showed a more pronounced effect than the standard drug. Also, no sperm DNA fragmentation index was found in all the treatment groups. Photomicrographs from light and scanning electron microscopy showed large fenestrae of interstitial tissue, large fluid space and intact seminiferous epithelium layers fully packed with spermatogenic cells in treated groups than the control group. Conclusions The present study has demonstrated that Tetracarpidium conophorum leaf possesses fertility-enhancing property and have useful effects on spermatogenesis and sperm parameters in rats.

The effect of celery (Apium graveolens L.) on fertility: A systematic review.

Background Fertility and infertility problems are among the complex issues in medicine. The use of herbal products in the treatment of fertility has been considered as an alternative to synthetic drugs. Celery containing known compounds can have an impact on the fertility rate. The aim of this study was to do a systematic review on conducted studies in conjunction with the celery and reproduction. Methods Required papers were searched from databases like Science direct, PubMed, Scopus, and Springer. Keywords used in this study were "Apium graveolens L.", "fertility", "reproductive system", "sperm", "testis", "delivery", "sexual hormone", "LH", "FSH", "testosterone", "semen", "male", and "female". Out of 238 collected articles (published in the period 1995 to 2015), 222 were excluded due to non-relevance and lack of access to the original article. Results The notable points were the different results seen by different researchers during different treatment periods or at different doses. Of the 16 studies reviewed in this study, 13 studies have mentioned the positive effect of celery on fertility, while three studies reported the inhibitory effects of this plant. Conclusions Celery can have protective effects against substances such as sodium valproate, propylene glycol, and diethyl phthalate causing damages to the testicular structure and spermatogenesis. In this regard, the doses used and the treatment time while using the plant must be accurately investigated. Since there are compounds such as apigenin, the celery can induce inhibitory effects on fertility in case of chronic use or high concentration.

Vitamin D in Reproductive Health and Pregnancy.

Vitamin D has been primarily known for its role in maintaining calcium and phosphorus homeostasis and promoting healthy bone mineralization. Emerging evidence suggests that vitamin D may have a plethora of other functions including cardiometabolic and immunological effects and a role in modulating human reproductive processes. Despite this, vitamin D deficiency (VDD) remains highly prevalent worldwide due to the limited availability of foods that are naturally high or fortified with vitamin D, increased sun avoidance behaviors and use of sunscreen due to fear of skin cancer, and increased sedentary indoor lifestyles, especially among those of reproductive age. This review examines current and emerging evidence for the role of vitamin D in reproductive health including in fertility, conception, and pregnancy outcomes, and outlines areas for future research. We found that existing evidence is based primarily on animal models and in vitro studies with some recent support from observational studies in humans. While these studies indicate that VDD may be a risk factor for adverse fertility and pregnancy outcomes, there is insufficient evidence to establish causality. Future efforts to clarify the benefits of vitamin D in reproductive health may bring about practical, simple, and cost-effective means of improving fertility and pregnancy outcomes.

The Assessment of Diet Quality and Its Effects on Health Outcomes Pre-pregnancy and during Pregnancy.

Overweight and obesity pre pregnancy or during pregnancy is associated with an increased risk for maternal obstetric and fetal complications. Diet is one modifiable risk factor that women may be motivated to improve. General healthy eating guidelines, micronutrient sufficiency and macronutrient quantity and quality are important nutrition considerations pre and during pregnancy. With regards to specific nutrients, health authorities have recommendations for folate and/or iodine supplementation; but not consistently for iron and omega-3 despite evidence for their association with health outcomes. There are modest additional requirements for energy and protein, but not fat or carbohydrate, in mid-late pregnancy. Diet indices and dietary pattern analysis are additional tools or methodologies used to assess diet quality. These tools have been used to determine dietary intakes and patterns and their association with pregnancy complications and birth outcomes pre or during pregnancy. Women who may unnecessarily resist foods due to fear of food contamination from listeriosis and methylmercury may limit their diet quality and a balanced approached is required. Dietary intake may also vary according to certain population characteristics. Additional support for women who are younger, less educated, overweight and obese, from socially disadvantaged areas, smokers and those who unnecessarily avoid healthy foods, is required to achieve a higher quality diet and optimal lifestyle peri conception.

Complementary Therapies and Medicines and Reproductive Medicine.

Complementary therapies and medicines are a broad and diverse range of treatments, and are frequently used by women and their partners during the preconception period to assist with infertility, and to address pregnancy-related conditions. Despite frequent use, the evidence examining the efficacy, effectiveness, and safety for many modalities is lacking, with variable study quality. In this article, we provide an overview of research evidence with the aim of examining the evidence to inform clinical practice. During the preconception period, there is mixed evidence for acupuncture to improve ovulation, or increase pregnancy rates. Acupuncture may improve sperm quality, but there is insufficient evidence to determine whether this results in improved pregnancy and live birth rates. Acupuncture can be described as a low-risk intervention. Chinese and Western herbal medicines may increase pregnancy rates; however, study quality is low. The evaluation of efficacy, effectiveness, and safety during the first trimester of pregnancy has most commonly reported on herbs, supplements, and practices such as acupuncture. There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy. The benefit from ginger to manage symptoms of nausea in early pregnancy is incorporated in national clinical guidelines, and vitamin B6 is recommended as a first-line treatment for nausea and vomiting in pregnancy. The safety of ginger and vitamin B6 is considered to be well established, and is based on epidemiological studies. Acupuncture has been shown to reduce back pain and improve function for women in early pregnancy. There is little evidence to support the use of cranberries in pregnancy for prevention of urinary tract infections, and chiropractic treatment for back pain. Overall the numbers of studies are small and of low quality, although the modalities appear to be low risk of harm.

Antioxidant and androgenic effects of dietary ginger on reproductive function of male diabetic rats.

This study evaluated the antioxidant and androgenic properties of ginger roots on the reproductive function of male diabetic rats. Animals were divided into three groups; the control (Control), diabetic (Diab) and diabetic fed with dietary ginger for 30 d (Diab + Z). Thereafter, blood samples were collected and reproductive organs (testis, epididymis, prostate and seminal vesicle) were removed for determination of sperm parameters, malondialdehyde (MDA) level, glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP) and aspartate and lactate aminotransferase (AST and ALT) activities. Dietary ginger decreased blood glucose and MDA level, increased reproductive organ weights and testosterone level, improved semen quantity and motility, and ameliorated the SOD, CAT and GPx activities as well as testis AST, ALT, LDH and ALP activities. Intake of ginger roots improves the antioxidant and androgenic reproductive function of male diabetic rats in addition to its antidiabetic property.

Molecular mapping of vernalization requirement and fertility restoration genes in carrot.

Carrot (Daucus carota L.) is a cool-season vegetable normally classified as a biennial species, requiring vernalization to induce flowering. Nevertheless, some cultivars adapted to warmer climates require less vernalization and can be classified as annual. Most modern carrot cultivars are hybrids which rely upon cytoplasmic male-sterility for commercial production. One major gene controlling floral initiation and several genes restoring male fertility have been reported but none have been mapped. The objective of the present work was to develop the first linkage map of carrot locating the genomic regions that control vernalization response and fertility restoration. Using an F(2) progeny, derived from the intercross between the annual cultivar 'Criolla INTA' and a petaloid male sterile biennial carrot evaluated over 2 years, both early flowering habit, which we name Vrn1, and restoration of petaloid cytoplasmic male sterility, which we name Rf1, were found to be dominant traits conditioned by single genes. On a map of 355 markers covering all 9 chromosomes with a total map length of 669 cM and an average marker-to-marker distance of 1.88 cM, Vrn1 mapped to chromosome 2 with flanking markers at 0.70 and 0.46 cM, and Rf1 mapped to chromosome 9 with flanking markers at 4.38 and 1.12 cM. These are the first two reproductive traits mapped in the carrot genome, and their map location and flanking markers provide valuable tools for studying traits important for carrot domestication and reproductive biology, as well as facilitating carrot breeding.

[Nutrition and fertility]. / Sposob zywienia a plodnosc.

There is a growing body of evidence that nutritional habits may have a significant effect on both male and female fertility. Maintenance of normal body mass may be effective in the prevention of infertility resulting from ovulatory disorders. Underweight and, to a larger degree, overweight and/or obesity, are related to the enhanced risk of infertility. Insulin resistance is an important pathogenic mechanism that may impair ovulation. Adequate intake of monounsaturated fatty acids, derived mainly from vegetable fats, as well as avoidance of trans isomers of unsaturated fatty acids which are present in industrially produced cakes and sweets, crisps, fast-foods, powdered soups and hard margarines, may be effective in the prevention of infertility in females. Choice of plant rather than animal sources of proteins, decrease in glycemic load of the diet, use of dietary supplements containing iron and folic acid, could also be beneficial. Avoidance of vitamin B12 deficiency and its supplementation seem to be important in the prevention of early miscarriages. Sufficient intake of antioxidants also promotes female reproductive functions. Free radical processes play an important role in the development of male factor infertility. It was shown that proper intake or supplementation with antioxidants may be effective in its prevention and treatment. Such nutrients as zinc, selenium and folic acid act beneficially on sperm quality. A well-balanced diet seems to play an important role in the prevention of infertility in both sexes.

[Acupuncture--propagated indications beyond pain-relief therapy]. / Akupunktur--propagierte Indikationen ausserhalb der Schmerztherapie. Eine quantitative Analyse.

Acupuncture originates from China and has developed out of Traditional Chinese Medicine (TCM). Since the 1970s acupuncture has been carried out more and more in Germany - especially within the context of pain-relief therapy. Acupuncture is more or less considered to be a medically necessary measure in the case of chronic knee or back pains and of chronic headaches, even if the German Acupuncture Trials (GERAC) leave some issues regarding its effectiveness unresolved. Less known is the fact that acupuncture is not only used for pain-relief therapy, but that a lot more indications have emerged over the last 20 years. Acupuncture is increasingly used for the treatment of allergies, asthma bronchial, addictions, tinnitus, but also to stimulate pregnancy and against adipositas, neurodermitis and a lot of other diseases. The available statistics state that acupuncture is used in appr. 20% of all cases for indications apart from pain-relief therapy. There are about 150 indications for which acupuncture is used as a therapy. However, for the majority of the apparent indications no proof is available in the sense of medical studies of an acceptable scientific level. Very often acupuncture has mild side-effects and rather rarely serious side-effects or health hazards. Patients are fequently not informed about them sufficiently.

The ameriorating effects of grapefruit seed extract on testicular morphology and function of varicocelized rats

Varicoceles are abnormal tortuosity and dilatation of the veins of the pampiniform plexus that drain the testis. The pathophysiology of testicular damage in varicocele has not been completely understood. However there is an increasing body of evidence pointing towards the role of reactive oxygen species and oxidative stress in the pathogenesis of varicocele related subfertility. In the present study we examined the role of proanthocynidin-rich ethanol extract of grapefruit seed as an antioxidant in protecting the testis against damage in experimental varicocele. Three groups of rats were constructed as the first group had intact rats; experimental bilateral varicoceles were established by complete ligation of the left and right main spermatic veins in the later two groups. The third group had in addition daily gavage administration of 1 Omg/ kg body weight ethanol extract of grapefruit seed. Eight weeks after varicocele induction, bilateral testicular weights, bilateral testicular volumes, bilateral caudal epididymal sperm characteristics, and bilateral testicular histology and serum hormone levels were tested. It was found that the testes of grapefruit seed extract treated animals had better functional and histological profiles compared to the untreated varicocelized animals. These results indicated the effectiveness of grapefruit seed extract for preservation of testes function morphology in varicocelized subjects.

Los varicoceles son tortuosidades anormales y dilataciones de las venas del plexo pampiniforme que drenan el testículo. La fisiopatología del daño testicular en el varicocele no se ha entendido completamente. Sin embargo, existe un creciente cúmulo de evidencias que apunta hacia el papel de especies reactivas al oxígeno y al estrés oxidativo, en la patogénesis del varicocele relacionados con subfertilidad. En el presente estudio, se examinó el papel de proantocianidina en el extracto etanólico de semilla del pomelo, como un antioxidante en la protección contra el daño testicular experimental en el varicocele. Tres grupos de ratas fueron seleccionados, un grupo de ratas control y dos grupos experimentales. En estos dos últimos grupos, se provocó varicocele bilateral a través de la ligadura completa de las venas testiculares principales izquierda y derecha. El tercer grupo tuvo además una sonda de administración diaria de 10 mg /kg de peso corporal, de extracto etanólico de semilla de pomelo. Ocho semanas después de la inducción de varicocele, se determinó el peso testicular bilateral, volúmenes testiculares bilaterales, características de los espermatozoides de la cola del epidídimo bilateral, la histología testicular bilateral y los niveles séricos de hormona. Se determinó que los testículos de los animales tratados con extracto de semilla de pomelo presentaban una mayor funcionalidad y mejores perfiles histológicos, en comparación con los animales varicocelizados no tratados. Estos resultados indican la eficacia de extracto de semilla de pomelo para la conservación de la morfología funcional testicular, en sujetos varicocelizados.

Therapy Insight: preserving fertility in cyclophosphamide-treated patients with rheumatic disease.

Cyclophosphamide remains a necessary treatment for severe rheumatic diseases, despite the continued search for alternative therapies with less gonadal toxicity. The risk of premature gonadal failure and sterility might lead young patients to delay treatment with cyclophosphamide. The patient's age at treatment and the cumulative dose received remain important risk factors for cyclophosphamide-induced gonadal failure in both males and females. Estrogen-containing oral contraceptives for females and testosterone for males are suggested to reduce the gonadal toxicity of cyclophosphamide, although few studies support these interventions. Owing to increased side effects, hormonal therapy is often avoided in patients with edema, hypertension, nephrotic syndrome or antiphospholipid antibodies. Agonists and antagonists of gonadotropin receptors are under study. Gonadotropin-receptor agonists might have beneficial effects in addition to suppression of sex-hormone production. The outcome of attempted cryopreservation of eggs, embryos or ovaries remains uncertain for women seeking to preserve their reproductive potential. Storing male gametes before chemotherapy is widely practiced and technically successful. As recovery of menses or production of testosterone does not predict individual fertility, identification of biomarkers of gonadal function and reserve, including serum levels of several hormones, ultrasonographic measurements of ovarian volume and antral follicle count, are necessary.