Fertility preservation counseling for women of reproductive age diagnosed with cancer: an integrative review.

This integrative review synthesizes the scientific evidence on fertility preservation counseling prior to oncological treatment for women of reproductive age diagnosed with cancer. Bibliographic research was conducted on databases PubMed, CINAHL, LILACS, EMBASE, Scopus, and Web of Science. The structured search strategy for the review question was "counseling AND antineoplastic agents AND fertility preservation". The use of controlled descriptors and keywords was adapted for each database. Study selection through the Rayyan platform was independent and blinded. The final sample comprised seven studies emphasizing the importance of clarifying factors related to the risk of infertility due to oncological treatment and fertility preservation techniques, such as success rate, pregnancy rate, cost, available options, and side-effects, as well as discussing the possibilities of adoption and surrogacy. This review provided evidence reinforcing the importance of counseling for fertility preservation, promoting motherhood for women who face oncological treatment. Organized networks linking oncology and reproductive medicine units are crucial to facilitate patient referral between these services and interprofessional communication.

Pathomorphological lesions in the ovaries of water buffaloes

Background: Buffalo breeding is common in many countries. Buffalo's milk is used in the production of mozzarella, yoghurt, ice cream, and various dairy desserts; meat is preferred in sausage production. The female buffaloes are bred to benefit from their milk and to obtain offspring. These animals, which are not suitable for feeding in barns, generally live in pastures, especially on wet land, and are very difficult to follow. Therefore, diseases occur randomly in slaughterhouses. Studies on genital system problems are very limited. Water buffaloes (Bubalus bubalis) are animals with economic value as many buffalo products are provided. In this respect, inspection and control of female genital disorders is fundamental to ensure good reproductive performance of female buffaloes. The aim of the study was to investigate pathomorphological lesions occurring in the ovaries of water buffaloes which were sent to slaughterhouses. Materials, Methods & Results: A total of 198 ovaries of water buffaloes were collected from various slaughterhouses located in Adapazari, Istanbul, Kocaeli, Samsun and Trabzon cities of Turkey. After macroscopic examination; tissue samples were fixed in 10 % buffered formalin, processed routinely and were stained with hematoxylin-eosin (HE). As a histochemical staining, Masson's trichrome staining was applied to characterize the lesions. Immunohistochemistry (IHC) was performed on 10 % neutral formalin fixed, paraffin-embedded, 4-6-µm-thick sections from ovaries using progesterone receptor (PR) with streptavidin-biotin complex peroxidase (StrepABC-P) method. Histopathologically, follicular cysts (n:147) and luteal cysts (n:22) were seen. While the cyst lumens were sometimes surrounded by granulosa and/or luteal cells, most of them were limited by the connective tissue capsule structure. This capsule structure was shown in blue by Masson's trichrome staining. Hemorrhage was observed in some cystic corpus luteum, diagnosed as corpus hemorrhagicum. In addition, cysts giving papillary extension into the lumen and inflammation of some ovaries were observed. Immunohistochemically, the staining with PR antibody in ovarian cysts showed no immunolabelling around the follicular cyst, while the nuclei of some of the luteal cells forming the luteal cyst had strongly nuclear positivity and slightly cytoplasmic positivity. In the biochemical examination of the fluids obtained from cystic ovaries (n: 37), the average of estradiol was 2.84 ng/mL (min: 0.01 ng/mL, max: 4.30 ng/mL) and progesterone average is 49.09 ng/mL (min: 1.88 ng/mL, max: 254.2 ng/mL). Discussion: Ovarian cysts in buffaloes seem to be among the serious fertility problems as in cattle. Although the exact cause of ovarian cyts has not been determined yet, it is known that the hypothalamic-pituitary-gonadal (HPG) axis is disrupted in cyst formation in general. In this study, the mean estradiol value was within the standard range but close to the lower limit; progesterone value was above the limit. The increase in progesterone level was compatible with the pathogenesis of cyst genesis. Beside this result, staining with PR was positive in the luteal cells that formed the luteal cyst immunohistochemically. In addition, although the hemorrhages observed in the corpus luteum are considered physiological, it should not be forgotten that they can be vital if they rupture. All these results show us the animals sent for slaughtering mostly have serious genital problems threatening their fertility.

Infertilidade feminina e conjugalidade: revisão integrativa da literatura / Female infertility and conjugality: integrative literature review / Infertilidad femenina y conjugalidad: revisión integrativa de la literatura

A infertilidade repercute como uma problemática em diferentes âmbitos. No tocante à esfera do casal, trata-se de uma situação que pode afetar ambos os cônjuges e opera na satisfação conjugal. Portanto, o objetivo do presente estudo foi conhecer de que modo a conjugalidade é afetada pela infertilidade feminina a partir da produção científica nacional e internacional. Trata-se de uma revisão integrativa da literatura científica indexada nas bases/bibliotecas PUBMED, PsycINFO e LILACS entre 2008 e 2018, nos idiomas português, espanhol e inglês, que recuperou 34 publicações, as quais foram submetidas à análise crítica. Trata-se de uma produção predominantemente internacional, de abordagem quantitativa. A pergunta norteadora que conduziu a presente revisão foi respondida, de modo que se constatou que a infertilidade transforma a relação conjugal, na maioria das vezes negativamente, o que não tem influência direta do fator feminino enquanto causa. Em contrapartida, a busca por tratamento se mostra como um aspecto de coesão entre o casal, que se fortalece ao buscar um objetivo comum. Por isto, faz-se necessário o desenvolvimento de ações que almejem a melhoria na qualidade de vida conjugal e sexual dos casais que estão passando pelo diagnóstico e tratamento para infertilidade.

Infertility has repercussions as a problem in different areas. Regarding the sphere of the couple, this is a situation that can affect both spouses and operates in marital satisfaction. Therefore, the objective of the present study was to know how the conjugality is affected by the female infertility from the national and international scientific production. It is an integrative review of the scientific literature indexed in the databases/libraries PUBMED, PsycINFO and LILACS published between 2008 and 2018, in the Portuguese, Spanish and English languages, which recovered 34 publications, which were submitted to critical analysis. It is a predominantly international production, with a quantitative approach. The guiding question that led to the present revision was answered, so that it was found that infertility transforms the conjugal relationship, most often negatively, which has no direct influence of the female factor as cause. In contrast, the search for treatment is shown as an aspect of cohesion between the couple, which strengthens itself in pursuit of a common goal. Therefore, it is necessary to develop actions that aim at improving the marital and sexual quality of life of couples who are undergoing diagnosis and treatment for infertility.

La infertilidad repercute como una problemática en diferentes ámbitos. En cuanto a la esfera de la pareja, se trata de una situación que puede afectar a ambos cónyuges y opera en la satisfacción conyugal. Por lo tanto, el objetivo del presente estudio fue conocer de qué modo la conyugalidad es afectada por la infertilidad femenina a partir de la producción científica nacional e internacional. Se trata de una revisión integradora de la literatura científica indexada en PubMed, PsycINFO y LILACS entre 2008 y 2018, en portugués, español e Inglés, que se recuperó 34 publicaciones, que se sometieron a un análisis crítico. Se trata de una producción predominantemente internacional, de abordaje cuantitativo. La pregunta orientadora que condujo la presente revisión fue respondida, de modo que se constató que la infertilidad transforma la relación conyugal, en la mayoría de las veces negativamente, lo que no tiene influencia directa del factor femenino en cuanto causa. En contrapartida, la búsqueda por tratamiento se muestra como un aspecto de cohesión entre la pareja, que se fortalece al buscar un objetivo común. Por eso, se hace necesario el desarrollo de acciones que anhelan la mejora en la calidad de vida conyugal y sexual de las parejas que están pasando por el diagnóstico y tratamiento para la infertilidad.

Gonadotropin-releasing hormone agonists for ovarian protection during cancer chemotherapy: systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of gonadotropin-releasing hormone agonist (GnRHa) administration before and/or during cancer chemotherapy for the protection of ovarian reserve in premenopausal women without prior diagnosis of infertility. METHODS: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing administration of GnRHa before and/or during chemotherapy vs chemotherapy alone. Eligible participants were premenopausal women at any stage of cancer, without previous diagnosis of infertility. An electronic database search in MEDLINE, CENTRAL, LILACS and ClinicalTrials.gov was performed. After selecting eligible studies, the relative risk (RR) was assessed for primary ovarian insufficiency (POI)/amenorrhea and for spontaneous pregnancy after completion of treatment. RESULTS: Thirteen RCTs comparing concurrent use of GnRHa and chemotherapy (609 participants) with chemotherapy alone (599 participants) were eligible for meta-analysis. All trials were open-label and patients had been treated for breast cancer (n = 1099) or lymphoma (n = 109). GnRHa had a significant benefit on the risk of POI/amenorrhea (RR, 0.60; 95% CI, 0.45-0.79), which persisted in subgroup analysis for breast cancer (RR, 0.57; 95% CI, 0.43-0.77) but not for lymphoma patients (RR, 0.70; 95% CI, 0.20-2.47). The rate of spontaneous pregnancy after completion of treatment was higher in women receiving GnRHa plus chemotherapy compared with those receiving chemotherapy alone (RR, 1.43; 95% CI, 1.01-2.02). Overall, the quality of evidence was low due to the unclear risk of bias, short follow-up and lack of objective assessment of ovarian function and reserve. CONCLUSIONS: Evidence, albeit of low quality, supports the use of GnRHa before and/or during chemotherapy to reduce the risk of POI and increase the probability of spontaneous pregnancy in the short term. Further high quality RCTs with more accurate assessment of ovarian reserve are needed to support definitive recommendations for clinical practice. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Viable Options for Fertility Preservation in Breast Cancer Patients: A Focus on Latin America.

Thanks to the improved survival outcomes observed in recent years, a growing attention has been given to the quality of life issues faced by young women with breast cancer such as fertility preservation and concerns related to future pregnancies. However, several challenges remain for young women with breast cancer considering undergoing fertility preservation strategies. Further specific issues on this regard should be taken into account in Latin America, where patients and physicians face particular barriers that hinder the routine adoption of this practice. Hence, further efforts are needed to overcome these deficiencies and improve the correct referral of breast cancer patients to fertility preservation strategies. The aim of the present review is to focus on the risk of anticancer treatment-related premature ovarian failure and infertility in young breast cancer patients, to summarize the current knowledge on the available options for fertility preservation, and to discuss the safety issues of pregnancy in breast cancer survivors. Furthermore, this review aims to highlight the specific clinical challenges in this field encountered by healthcare providers and young breast cancer patients from Latin American countries.

Gonadotropin-Releasing Hormone Agonists for Ovarian Function Preservation in Premenopausal Women Undergoing Chemotherapy for Early-Stage Breast Cancer: A Systematic Review and Meta-analysis.

IMPORTANCE: Chemotherapy may result in a detrimental effect on ovarian function and fertility in premenopausal women undergoing treatment for early-stage breast cancer (EBC). To minimize risk of harm to ovarian function and fertility for patients in this setting, careful considerations should be made. Gonadotropin-releasing hormone agonists (GnRHa) have been suggested as an alternative to prevent the loss of ovarian function due to exposure to cytotoxic agents, but GnRHa use for ovarian protection in EBC patients is not fully resolved. OBJECTIVE: To determine the effectiveness of GnRHa administered concurrently with chemotherapy for ovarian function preservation. DATA SOURCES: PubMed, SCOPUS, and Cochrane databases were searched for studies published between January 1975 and March 2015. The abstracts of the American Society of Clinical Oncology Annual Meeting between 1995 and 2014 and the San Antonio Breast Cancer Symposium between 2009 and 2014 were searched as well. STUDY SELECTION: Prospective, randomized, clinical trials addressing the role of ovarian suppression with GnRHa in preventing early ovarian dysfunction in premenopausal women undergoing treatment for EBC were selected. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed independently by 2 authors. The methodology and the risk of bias were assessment based on the description of randomization method, withdrawals, and blinding process. MAIN OUTCOMES AND MEASURES: Rate of resumption of regular menses after a minimal follow-up period of 6 months following chemotherapy was used as a surrogate to assess the incidence of ovarian dysfunction. Additional secondary outcomes included hormone levels and number of pregnancies. Risk ratio estimates were calculated based on the number of evaluable patients. Analyses were conducted using a random effect model. RESULTS: Seven studies were included in this analysis, totaling 1047 randomized patients and 856 evaluable patients. The use of GnRHa was associated with a higher rate of recovery of regular menses after 6 months (odds ratio [OR], 2.41; 95% CI, 1.40-4.15; P = .002) and at least 12 months (OR, 1.85; 95% CI, 1.33-2.59; P < .001) following the last chemotherapy cycle. The use of GnRHa was also associated with a higher number of pregnancies (OR, 1.85; 95% CI, 1.02-3.36; P = .04), although this outcome was not uniformly reported and fertility or rate of pregnancy was not the primary outcome in any of the trials. CONCLUSIONS AND RELEVANCE: Gonadotropin-releasing hormone agonists given with chemotherapy was associated with increased rates of recovery of regular menses in this meta-analysis. Evidence was insufficient to assess outcomes related to GnRHa and ovarian function and fertility and needs further investigation.

N-Acetyl-Cysteine and l-Carnitine Prevent Meiotic Oocyte Damage Induced by Follicular Fluid From Infertile Women With Mild Endometriosis.

This study evaluated the potential protective effect of the antioxidants, l-carnitine (LC) and N-acetyl-cysteine (NAC), in preventing meiotic oocyte damage induced by follicular fluid (FF) from infertile women with mild endometriosis (ME). We performed an experimental study. The FF samples were obtained from 22 infertile women undergoing stimulated cycles for intracytoplasmic sperm injection (11 with ME and 11 without endometriosis). Immature bovine oocytes were submitted to in vitro maturation (IVM) divided into 9 groups: no-FF (No-FF); with FF from control (CFF) or ME (EFF) groups; and with LC (C + LC and E + LC), NAC (C + NAC and E + NAC), or both antioxidants (C + 2Ao and E + 2Ao). After IVM, oocytes were immunostained for visualization of microtubules and chromatin by confocal microscopy. The percentage of meiotically normal metaphase II (MII) oocytes was significantly lower in the EFF group (51.35%) compared to No-FF (86.36%) and CFF (83.52%) groups. The E + NAC (62.22%), E + LC (80.61%), and E + 2Ao (61.40%) groups showed higher percentage of normal MII than EFF group. The E + LC group showed higher percentage of normal MII than E + NAC and E + 2Ao groups and a similar percentage to No-FF and CFF groups. Therefore, FF from infertile women with ME causes meiotic abnormalities in bovine oocytes, and, for the first time, we demonstrated that the use of NAC and LC prevents these damages. Our findings elucidate part of the pathogenic mechanisms involved in infertility associated with ME and open perspectives for further studies investigating whether the use of LC could improve the natural fertility and/or the results of in vitro fertilization of women with ME.

Short-term effects of a hypocaloric diet with low glycemic index and low glycemic load on body adiposity, metabolic variables, ghrelin, leptin, and pregnancy rate in overweight and obese infertile women: a randomized controlled trial.

BACKGROUND: Obesity is related to hormonal disorders that affect the reproductive system. Low-glycemic index (LGI) diets seem to exert a positive effect on weight loss and on metabolic changes that result from obesity. OBJECTIVE: We investigated the effects of a hypocaloric diet with an LGI and low glycemic load on anthropometric and metabolic variables, ghrelin and leptin concentrations, and the pregnancy rate in overweight and obese infertile women who were undergoing in vitro fertilization (IVF). DESIGN: The study was a randomized block-design controlled trial in which we analyzed 26 overweight or obese infertile women. Patients were assigned to a hypocaloric LGI-diet group or a control group and followed the protocol for 12 wk. Body weight, body mass index (BMI), percentage of body fat, glucose, insulin, homeostasis model assessment of insulin resistance, serum lipids, reproductive hormones, leptin, acylated ghrelin, number of oocytes retrieved in the IVF cycle, and pregnancy rate were determined. RESULTS: There were greater reductions in body mass, BMI, percentage of body fat, waist:hip ratio, and leptin in the LGI-diet group than in the control group (P < 0.05). Despite a change of 18% in mean values, there was no significant increase in acylated ghrelin concentrations in the LGI group compared with the control group (P = 0.215). The LGI-diet group had 85.4% more oocytes retrieved than did the control group (7.75 ± 1.44 and 4.18 ± 0.87, respectively; P = 0.039) in the IVF cycle. Three patients (21.4%) in the LGI group experienced a spontaneous pregnancy during the follow-up, which generated 3 live births. CONCLUSIONS: The hypocaloric LGI diet promoted a decrease in BMI, percentage of body fat, and leptin concentrations, which improved oocyte development and pregnancy rate. These results support the clinical recommendation to advise overweight and obese women to lose weight through a balanced diet before being submitted for treatment with assisted reproduction technologies. A hypocaloric diet combined with LGI foods seems to be beneficial for these patients, but additional studies are required before this treatment is recommended. This trial was registered at clinicaltrials.gov as NCT02416960.

Infertilidade em gatas: abordagem diagnóstica e terapêutica / Infertility in queen: diagnostic and therapeutic approach

A investigação de casos de infertilidade na fêmea felina requer o conhecimento pelo Médico Veterinário da fisiologia reprodutiva da espécie, a correta interpretação dos exames colpocitológicos e a realização de exames ultrassográficos apropriados do aparelho genital da gata. Ademais, o Médico Veterinário não deve se furtar do conhecimento da duração das fases do ciclo estral, dos eventos que ocorrem em cada uma das fases, bem como, dos aspectos hormonais que as caracterizam, que são de suma importância para a resolução de casos de infertilidade na espécie. Tanto Médico Veterinário quanto proprietário devem estar cientes de que a investigação dos casos de infertilidade, muitas vezes, demanda tempo e investimento e que, em alguns casos, não se chega a um diagnóstico conclusivo. Vale a pena alertar o proprietário que muitas vezes são necessários inúmeros retornos e, algumas vezes, procedimentos invasivos.

Investigation of infertility cases in queen requires veterinary knowledge about the reproductive physiology of the species, correct vaginal cytology interpretation and appropriate ultrasonography examinations of the genital tract of the female. In addition, the veterinarian should know about the duration of the phases of the estrous cycle, the events that occur in each phase, as well as the hormonal aspects that characterize them, which are critical to the resolution of the infertility cases in the species. Both the veterinarian and the owner should be aware that the investigation of infertility cases in queen often takes time and investment and, in some cases, does not come to a conclusive diagnosis. It is worth alerting the owner, that many returns are necessary and sometimes, invasive procedures may be needed.

New approaches to treatment of infertility in the bitch / Novas abordagens ao tratamento de infertilidade em cadelas

Infertility in the bitch has manifold causes. Bacterial endometritis was found to be causative in most cases and since the incidence of B.canis infection in breeding bitches is increasing, serology for B.canis should always be performed. In subclinical or low grade cases of other bacterial infections, conservative treatment may be successful with the repeated application of the antiprogesterone aglepristone and synthetic prostaglandins. Another frequent cause is primary anoestrus or secondary anestrus. Both conditions can be caused by multiple diseases, organ dysfunctions and even medicaments. Treatment of the cause is mostly successful, however, induction of oestrus can be successful in single cases. The GnRH implant deslorelin proved to be useful when implanted in anestrus; resulting pregnancy rates excceded 70%; however, as a side effect, luteal failure may occur. Cystic degenerative and inflammatory conditions of the uterus may cause infertility, resorption or abortion. Diagnosis can be improved by cytological, bacteriological and histological examination of uterine specimens but the risk of endometritis and pyometra has to be considered. Treatment with the antiprogesterone aglepristone and broad spectrum antibiotics is recommended. Abnormalities of the vulva, vestibule and vagina as well as genetical disorders of sexual development are very seldom but should be excluded by a thorough gynaecological examination prior to first breeding. Hormonal imbalances like luteal deficiency and hypothyroidism can be primary or caused by other diseases and should be considered in case of repeated failure of pregnancy. During pregnancy, dietary substitution of folic acid is important to prevent neonatal cleft palate. However, feeding tyrosine during oestrus did not improve copulation behaviour.

Existem diversas causas de infertilidade em cadelas. Endometriose bacteriana tem provado ser a causa na maioria dos casos e como a incidência de infecção com B. canis em cadelas de reprodução está aumentando, a sorologia para B. canis sempre deve ser realizada. Em casos subclínicos ou de baixo grau de outras infecções bacterianas o tratamento conservador pode ter sucesso com a aplicação repetida de antiprogesterona aglepristone e prostaglandinas sintéticas. Outra causa frequente é o anestro primário ou secundário. Ambas as condições podem ser causadas por diversas doenças, disfunções em órgãos e até mesmo medicamentos. O tratamento da causa geralmente tem sucesso, porém, a indução de estro pode ser bem sucedida em casos individuais. O implante GnRH deslorelina provou ser útil quando implantado no anestro, resultando em taxas de gestação acima de 70%; porém, como efeito colateral, falha lútea pode ocorrer. Condições císticas degenerativas e inflamatórias do útero podem causar infertilidade, reabsorção ou aborto. O diagnostico pode ser melhorado por exame citológico, bacteriológico e histológico de amostras do útero, mas o risco de endometriose e piometria deve ser considerado. O tratamento com antiprogesterona aglepristone e antibióticos de grande espectro é recomendado. Anormalidades da vulva, vestíbulo e vagina, além de distúrbios genéticos de desenvolvimento sexual são raros, mas devem ser excluídos através de exame ginecológico antes da primeira reprodução. Desequilíbrios hormonais como deficiência lútea e hipotireoidismo podem ser primários ou causados por outras doenças e devem ser considerados no caso de falha repetida de gestação. Durante a gestação a substituição de ácido fólico na dieta é importante para prevenir fenda palatina neonatal. Porém, a alimentação com tirosina durante o estro não melhorou o comportamento reprodutor.

New approaches to treatment of infertility in the bitch / Novas abordagens ao tratamento de infertilidade em cadelas

Infertility in the bitch has manifold causes. Bacterial endometritis was found to be causative in most cases and since the incidence of B.canis infection in breeding bitches is increasing, serology for B.canis should always be performed. In subclinical or low grade cases of other bacterial infections, conservative treatment may be successful with the repeated application of the antiprogesterone aglepristone and synthetic prostaglandins. Another frequent cause is primary anoestrus or secondary anestrus. Both conditions can be caused by multiple diseases, organ dysfunctions and even medicaments. Treatment of the cause is mostly successful, however, induction of oestrus can be successful in single cases. The GnRH implant deslorelin proved to be useful when implanted in anestrus; resulting pregnancy rates excceded 70%; however, as a side effect, luteal failure may occur. Cystic degenerative and inflammatory conditions of the uterus may cause infertility, resorption or abortion. Diagnosis can be improved by cytological, bacteriological and histological examination of uterine specimens but the risk of endometritis and pyometra has to be considered. Treatment with the antiprogesterone aglepristone and broad spectrum antibiotics is recommended. Abnormalities of the vulva, vestibule and vagina as well as genetical disorders of sexual development are very seldom but should be excluded by a thorough gynaecological examination prior to first breeding. Hormonal imbalances like luteal deficiency and hypothyroidism can be primary or caused by other diseases and should be considered in case of repeated failure of pregnancy. During pregnancy, dietary substitution of folic acid is important to prevent neonatal cleft palate. However, feeding tyrosine during oestrus did not improve copulation behaviour.(AU)

Existem diversas causas de infertilidade em cadelas. Endometriose bacteriana tem provado ser a causa na maioria dos casos e como a incidência de infecção com B. canis em cadelas de reprodução está aumentando, a sorologia para B. canis sempre deve ser realizada. Em casos subclínicos ou de baixo grau de outras infecções bacterianas o tratamento conservador pode ter sucesso com a aplicação repetida de antiprogesterona aglepristone e prostaglandinas sintéticas. Outra causa frequente é o anestro primário ou secundário. Ambas as condições podem ser causadas por diversas doenças, disfunções em órgãos e até mesmo medicamentos. O tratamento da causa geralmente tem sucesso, porém, a indução de estro pode ser bem sucedida em casos individuais. O implante GnRH deslorelina provou ser útil quando implantado no anestro, resultando em taxas de gestação acima de 70%; porém, como efeito colateral, falha lútea pode ocorrer. Condições císticas degenerativas e inflamatórias do útero podem causar infertilidade, reabsorção ou aborto. O diagnostico pode ser melhorado por exame citológico, bacteriológico e histológico de amostras do útero, mas o risco de endometriose e piometria deve ser considerado. O tratamento com antiprogesterona aglepristone e antibióticos de grande espectro é recomendado. Anormalidades da vulva, vestíbulo e vagina, além de distúrbios genéticos de desenvolvimento sexual são raros, mas devem ser excluídos através de exame ginecológico antes da primeira reprodução. Desequilíbrios hormonais como deficiência lútea e hipotireoidismo podem ser primários ou causados por outras doenças e devem ser considerados no caso de falha repetida de gestação. Durante a gestação a substituição de ácido fólico na dieta é importante para prevenir fenda palatina neonatal. Porém, a alimentação com tirosina durante o estro não melhorou o comportamento reprodutor.(AU)

Infertilidade em gatas: abordagem diagnóstica e terapêutica / Infertility in queen: diagnostic and therapeutic approach

A investigação de casos de infertilidade na fêmea felina requer o conhecimento pelo Médico Veterinário da fisiologia reprodutiva da espécie, a correta interpretação dos exames colpocitológicos e a realização de exames ultrassográficos apropriados do aparelho genital da gata. Ademais, o Médico Veterinário não deve se furtar do conhecimento da duração das fases do ciclo estral, dos eventos que ocorrem em cada uma das fases, bem como, dos aspectos hormonais que as caracterizam, que são de suma importância para a resolução de casos de infertilidade na espécie. Tanto Médico Veterinário quanto proprietário devem estar cientes de que a investigação dos casos de infertilidade, muitas vezes, demanda tempo e investimento e que, em alguns casos, não se chega a um diagnóstico conclusivo. Vale a pena alertar o proprietário que muitas vezes são necessários inúmeros retornos e, algumas vezes, procedimentos invasivos.(AU)

Investigation of infertility cases in queen requires veterinary knowledge about the reproductive physiology of the species, correct vaginal cytology interpretation and appropriate ultrasonography examinations of the genital tract of the female. In addition, the veterinarian should know about the duration of the phases of the estrous cycle, the events that occur in each phase, as well as the hormonal aspects that characterize them, which are critical to the resolution of the infertility cases in the species. Both the veterinarian and the owner should be aware that the investigation of infertility cases in queen often takes time and investment and, in some cases, does not come to a conclusive diagnosis. It is worth alerting the owner, that many returns are necessary and sometimes, invasive procedures may be needed.(AU)

Reproductive issues in sickle cell disease.

As medical advances improve survival, reduce disease-related morbidity, and improve quality of life, reproductive issues will take higher priority in the sickle cell disease (SCD) community. A wide variety of topics are addressed in this chapter, including fertility, gonadal failure, erectile dysfunction, and menstrual issues in SCD. Etiologies of impaired male fertility are multifactorial and include hypogonadism, erectile dysfunction, sperm abnormalities, and complications of medical therapies. Much less is known about the prevalence and etiology of infertility in women with SCD. Other reproductive issues in women included in this review are pain and the menstrual cycle, contraception, and preconception counseling. Finally, long-term therapies for SCD and their impact on fertility are presented. Transfusional iron overload and gonadal failure are addressed, followed by options for fertility preservation after stem cell transplantation. Focus is placed on hydroxyurea therapy given its benefits and increasing use in SCD. The impact of this agent on spermatogenesis, azoospermia, and the developing fetus is discussed.

Prospective study of fertility concerns and preservation strategies in young women with breast cancer.

PURPOSE: Most research regarding fertility in young women with breast cancer has focused on long-term survivors. Little is known about how fertility concerns affect treatment decisions or fertility preservation strategies at the time of initial cancer diagnosis. PATIENTS AND METHODS: As part of an ongoing prospective multicenter cohort study, we surveyed women with newly diagnosed early-stage breast cancer at age ≤ 40 years. The baseline survey included sociodemographic, medical, and treatment data as well as a modified Fertility Issues Survey, including fertility concern and preservation items. Univariable and multivariable modeling were used to investigate predictors of greater fertility concern. RESULTS: Among the first 620 eligible respondents included in this analysis, median age was 37 years (range, 17 to 40 years); 425 women (68%) discussed fertility issues with their physicians before starting therapy, and 319 (51%) were concerned about becoming infertile after treatment. Because of concerns about fertility, four women (1%) chose not to receive chemotherapy, 12 (2%) chose one chemotherapy regimen over another, six (1%) considered not receiving endocrine therapy, 19 (3%) decided not to receive endocrine therapy, and 71 (11%) considered receiving endocrine therapy for < 5 years; 65 (10%) used fertility preservation strategies. Greater concern about fertility was associated with younger age, nonwhite race, not having children, and receipt of chemotherapy. CONCLUSION: Many young women with newly diagnosed breast cancer have concerns about fertility, and for some, these substantially affect their treatment decisions. Only a minority of women currently pursue available fertility preservation strategies in this setting.

Prevalência e práticas preventivas em infertilidade entre mulheres atendidas em um serviço público de saúde / Prevalence and preventive practices in infertility among women attending a public health service

Objetivo: O estudo foi feito a fim de avaliar o conhecimento e a prática de medidas preventivas em infertilidade. Método: Durante um mês foi aplicado um questionário às pacientes que frequentam o Ambulatório de Ginecologia da Universidade Federal de Pelotas, de modo consentido e sem se identificar, com perguntas relacionadas à prevenção de infertilidade. Resultados: Os resultados mostram que entre 134 mulheres entrevistadas, 68% nunca se preocuparam com não conseguir ter filhos, 62% responderam saber da existência de medidas que podem prevenir a infertilidade, 49% são sedentárias, 72% fazem uso de preservativos, 36% fumam, 84% evitam ingesta de bebida alcoólica em excesso, 94% não fazem uso de drogas ilícitas, 61% controlam o peso, 77% pensam em ter filhos antes dos 35 anos e 87% consultam regularmente um ginecologista. Conclusão: O índice de apenas 32% das mulheres entrevistadas que se preocupam com não conseguir ter filhos revela a falta de conhecimentos sobre o problema. Embora 62% delas referiram ter conhecimento de medidas que podem prevenir a infertilidade, acredita-se que esse percentual seja menor na população em geral.

Objective: This study was conducted to assess the knowledge and practice of preventive measures in infertility. Methods: For one month a questionnaire was administered to patients who attend the Gynecology, Federal University of Pelotas, so consented and without identifying themselves, with questions related to prevention of infertility. Results: The results show that among 134 women interviewed, 68% never bothered to not be able to have children, 62% said they knew about the measures that can prevent infertility, 49% is sedentary, 72% makes use of condoms, 36% smoke, 84% avoid ingestion of alcohol in excess, 94% did not use illegal drugs, 61% controls weight, 77% think having children before 35 years and 87% of the group regularly consults a gynecologist. Conclusion: Since only 32% of women are concerned with can’t have children, reveals a lack of knowledge about the problem. Although 62% of them reported that he is aware of measures which can prevent infertility, it is believed that this percentage is smaller in the general population.

Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility.

Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility.

Depot GnRH-agonist trigger for breast-cancer patient undergoing ovarian stimulation resulted in mature oocytes for cryopreservation: a case report.

This report describes the case of a 27-year-old woman with breast cancer who underwent ovarian stimulation for fertility preservation with recombinant FSH in conjunction with a gonadotrophin-releasing hormone (GnRH) antagonist and an aromatase inhibitor from the beginning of the treatment. A 3.75-mg triptorelin depot formulation was given intramuscularly when the follicular diameter of three follicles reached ≥ 20 mm and a total of 13 follicles reached ≥ 15 mm. Oocyte retrieval was scheduled for 36 h later and 10 mature oocytes were collected and vitrified. This case report demonstrates that a depot GnRH-agonist trigger effectively leads to mature oocyte retrieval, with the advantage of initiating ovarian suppression for the purpose of fertility preservation during adjuvant chemotherapy in breast-cancer patients.

Assessment of fertility protection and ovarian reserve with GnRH antagonist in rats undergoing chemotherapy with cyclophosphamide.

BACKGROUND: Reproductive function following chemotherapy is of increasing importance given that survival rates are improving. We assessed whether a gonadotropin-releasing hormone antagonist (GnRHant; cetrorelix) could promote ovarian protection against damage due to chemotherapy. METHODS: Forty-two female Wistar rats were used in this study. Animals were divided into four groups: group I (n=9) received placebo twice; group II (n=12) received placebo+cyclophosphamide (CPA); group III (n=12) received GnRHant+CPA; and group IV (n=9) received GnRHant+placebo. After medication, the estrous cycle was studied through vaginal smears. Rats were mated, pregnancy was documented and the number of live pups evaluated. Afterwards, rat ovaries were removed and prepared for histological studies. The ovarian cross-sectional area was measured and follicles were counted. RESULTS: Cyclic changes in vaginal smears were observed in all but one animal after treatment, but group II had a significantly lower rate of animals with proestrus or estrus (p<0.01). The offspring was markedly reduced by CPA treatment (group II, 3.00+/-1.33 pups vs. group I, 11.44+/-0.78 pups, p<0.01) and this effect was partly reversed by pre-treatment with GnRHant (group III, 7.00+/-1.31 pups). The ovarian cross-sectional area was not significantly different between groups, neither was the number of individual follicle types. However, rats in Group IV had a higher total number of ovarian follicles than those in the control group (17.1+/-1.22 vs. 10.9+/-0.70, p<0.05). CONCLUSION: The use of a GnRHant before CPA chemotherapy provided protection of fertility.