Restructuring healthcare services, routines and procedures on reproductive medicine based on respect for differences.

Although the term homosexuality was removed from the International Classification of Diseases and trans identities from mental disorders, these classifications promote the pathologizing of homosexuality. The direct consequence is discrimination, which adds to the difficulty in carrying out accurate information related to the LGBT population and makes it very difficult to organize public policies suited to their needs. An important issue is related to the limited access of that population to assisted reproduction techniques, when compared to traditional families. The desire for same sex couples and transgender persons to have biological children is reportedly the same as for cisgender persons, but parenthood can be a much greater endeavor both medically and psychologically for them. The right to health includes freedom to control one's health and body, including sexual and reproductive issues. Despite these difficulties, we are living in a period of great social progress that increases access to assisted reproduction among novel patient populations. With legalization of gay marriage, individuals and couples who identify as lesbian, gay, bisexual and transgender, may seek to begin or expand their families with assisted reproduction technologies. Therefore, the aim of this review was to assist in the restructuring of healthcare services, routines and procedures, mainly related to reproductive medicine, in order to promote changes in values based on respect for differences. In conclusion, the healthcare personnel of fertility centers should undergo specific training and preparations to meet the specific demands of the LGBT patient population and to overcome communication barriers.

Post-thaw dilution of Rhamdia quelen sperm improves the reproductive success.

The aim was to evaluate the effect of a post-thaw dilution of Rhamdia quelen sperm in 1.1% NaCl (325 mOsm kg-1; pH 7.6; 24 °C) solution on the quality and reproductive capacity. Sperm from eight males were cryopreservation in nitrogen vapor at - 170 °C for 18 h in 0.25 mL straws in a freezing medium containing 5% fructose, 5% Powdered milk, and 10% methanol. The samples were thawed and post-thaw diluted (1:20) in NaCl solution or not (control). The higher spermatozoa velocities were observed in the post-thaw diluted samples (curvilinear (VCL) - 69 ± 11 µm s-1; average path (VAP) - 45 ± 8 µm s-1; straight-line (VSL) - 43 ± 8 µm s-1) compared to the control (VCL - 47 ± 10 µm s-1; VAP - 31 ± 6 µm s-1; VSL - 30 ± 6 µm s-1). Greater straightness (STR), progression (PROG), and beat cross frequency (BCF) were observed in the post-thaw diluted samples (STR - 96 ± 7%; PROG - 666 ± 128 µm; BCF - 42 ± 2 Hz) than in control (STR - 95 ± 5%; PROG - 463 ± 92 µm; BCF - 40 ± 2 Hz). The strongly curled tail was the only morphology change that differ between the post-thaw diluted (5 ± 2%) and control (2 ± 1%). Membrane integrity, mitochondrial activity, and normal larvae rate were not different between treatments. Fertilization and hatching were higher in the post-thaw diluted sperm (93 ± 3%; 82 ± 9%) when compared to control samples (65 ± 13%; 55 ± 17%). Were used oocytes from one female, limiting these results. The post-thaw dilution improved the sperm kinetics and reproductive parameters. Thus, this methodology can be included in the sperm cryopreservation protocol for R. quelen.

Spermatogonial stem cells as a therapeutic alternative for fertility preservation of prepubertal boys / Espermatogônias-tronco como uma alternativa para a preservação da fertilidade de meninos pré-púberes

ABSTRACT Spermatogonial stem cells, which exist in the testicles since birth, are progenitors cells of male gametes. These cells are critical for the process of spermatogenesis, and not able to produce mature sperm cells before puberty due to their dependency of hormonal stimuli. This characteristic of the reproductive system limits the preservation of fertility only to males who are able to produce an ejaculate. This fact puts some light on the increase in survival rates of childhood cancer over the past decades because of improvements in the diagnosis and effective treatment in pediatric cancer patients. Therefore, we highlight one of the most important challenges concerning male fertility preservation that is the toxic effect of cancer therapy on reproductive function, especially the spermatogenesis. Currently, the experimental alternative for fertility preservation of prepubertal boys is the testicular tissue cryopreservationfor, for future isolation and spermatogonial stem cells transplantation, in order to restore the spermatogenesis. We present a brief review on isolation, characterization and culture conditions for the in vitro proliferation of spermatogonial stem cells, as well as the future perspectives as an alternative for fertility preservation in prepubertal boys. The possibility of restoring male fertility constitutes a research tool with an huge potential in basic and applied science. The development of these techniques may be a hope for the future of fertility preservation in cases that no other options exist, e.g, pediatric cancer patients.

RESUMO As espermatogônias-tronco, presentes nos testículos desde o nascimento, são as células progenitoras dos gametas masculinos, e, desse modo, críticas para o processo de espermatogênese. Antes da puberdade, essas células não são capazes de produzir espermatozoides maduros, o que só ocorrerá após o estímulo hormonal. Essa característica do sistema reprodutivo limita a possibilidade de preservação da fertilidade apenas para homens capazes de produzir um ejaculado. Tal fato coloca em evidência o aumento nas taxas de sobrevivência de crianças com câncer nas últimas décadas, devido principalmente à melhora no diagnóstico e ao tratamento dos pacientes pediátricos. Dessa forma, destaca-se um dos mais importantes desafios relativos à preservação da fertilidade masculina, que é o efeito tóxico das terapias anticâncer para o sistema reprodutivo, especialmente a espermatogênese. Tendo isso em vista, a alternativa experimental atualmente estudada para a preservação da fertilidade de pacientes pré-púberes é a criopreservação de tecido testicular para futuro isolamento e transplante de espermatogônias-tronco, a fim de restabelecer a espermatogênese. Apresentamos aqui uma breve revisão sobre isolamento, caracterização e condições de cultivo para a proliferação de espermatogônias-tronco, bem como as futuras perspectivas, como alternativa para preservação da fertilidade de meninos pré-púberes. A possibilidade de restabelecer a fertilidade masculina é uma ferramenta de pesquisa com potencial enorme de uso na pesquisa básica e aplicada. O desenvolvimento dessas técnicas pode fornecer uma esperança futura de preservação de fertilidade nos casos em que não há nenhuma outra opção, como para os pacientes pediátricos de câncer.

Spermatogonial stem cells as a therapeutic alternative for fertility preservation of prepubertal boys.

Spermatogonial stem cells, which exist in the testicles since birth, are progenitors cells of male gametes. These cells are critical for the process of spermatogenesis, and not able to produce mature sperm cells before puberty due to their dependency of hormonal stimuli. This characteristic of the reproductive system limits the preservation of fertility only to males who are able to produce an ejaculate. This fact puts some light on the increase in survival rates of childhood cancer over the past decades because of improvements in the diagnosis and effective treatment in pediatric cancer patients. Therefore, we highlight one of the most important challenges concerning male fertility preservation that is the toxic effect of cancer therapy on reproductive function, especially the spermatogenesis. Currently, the experimental alternative for fertility preservation of prepubertal boys is the testicular tissue cryopreservationfor, for future isolation and spermatogonial stem cells transplantation, in order to restore the spermatogenesis. We present a brief review on isolation, characterization and culture conditions for the in vitro proliferation of spermatogonial stem cells, as well as the future perspectives as an alternative for fertility preservation in prepubertal boys. The possibility of restoring male fertility constitutes a research tool with an huge potential in basic and applied science. The development of these techniques may be a hope for the future of fertility preservation in cases that no other options exist, e.g, pediatric cancer patients.

Avaliação dos parâmetros seminais em doadores de sêmen no período de dez anos na cidade de São Paulo / Evaluation of semen parameters in semen donors in a ten-year period in the city of Sao Paulo

Objective: To evaluate sperm concentration, morphology and motility of Brazilian semen donors from 1992 to 2003, in the city of São Paulo. Methods: Retrospective study analyzing 182 donor semen samples from 1992 to 2003. The first and the second donated sample were analyzed for each donor. Donor average age was 30.8 years. Means with standard errors, medians with minimum and maximum values, and interquartile ranges were calculated for age, sperm concentration, semen volume, oval morphology and motility. The relation between each characteristic of the semen samples and the year of donation, as well as donor age and season of the year were studied by linear and multiple regression analysis. Results: Linear regression analysis showed that the sperm concentration (R2 = 19.1%, R2 = 20.2%, p < 0.0001 respectively) and the oval morphology (R2 = 13%; R2 = 13.5%; p < 0.0001, respectively) decreased significantly, even when the first or the second sperm collection is considered. The ejaculated volume showed slight increase during the period for both samples (R2 = 2.2%, p = 0.048; R-sq = 2.4%. p = 0.038, respectively). All characteristics did not depend on the donors' age or season of the year when the samples were obtained. Conclusions: There was a decrease in spermatic concentration and percentage of oval sperm of semen donors samples from 1992 to 2003, in the city of São Paulo.

Objetivo: Avaliar as características seminais dos doadores de sêmen na cidade de São Paulo, no período de 1992 a 2003. Métodos: Análise retrospectiva das amostras seminais de 182 doadores de um único Banco de Sêmen, na cidade de São Paulo, no período de 1992 to 2003, que tinham a idade média de 30,8 anos. Foram analisadas a primeira e a segunda amostra de cada doador. Médias com desvios padrões, medianas com valores máximos e mínimos e intervalo interquartil foram calculados para idade, volume seminal, concentração, motilidade e morfologia espermática. As relações entre cada característica das amostras seminais e o ano da doação foram estudadas por análise de regressão linear simples. Modelos de regressão linear múltipla foram aplicados para examinar a relação do ano de doação com cada característica seminal, controlando para potencias fatores de confusão, como idade dos doadores e estação do ano em que a coleta foi realizada. Resultados: Análise de regressão linear mostrou que a concentração espermática (R2 = 19,1%, R2 = 20,2%, p < 0,0001, respectivamente) e a morfologia oval dos espermatozoides (R2 = 13%; R2 = 13,5%; p < 0,0001, respectivamente) diminuíram significativamente, na primeira e na segunda coleta seminal. O volume do ejaculado mostrou um discreto, porém significativo, aumento nas duas coletas (R2 = 2,2%, p = 0,048; R- sq = 2,4%, p = 0,038, respectivamente). Todas as alterações não se correlacionaram com a idade do doador nem com a estação do ano em que as coletas de sêmen foram realizadas. Conclusões: Houve diminuição na concentração espermática e na percentagem de espermatozoides nas amostras seminais dos doadores de sêmen, no período de 1992 a 2003, na cidade de São Paulo.

Evaluation of semen parameters in semen donors in a ten-year period in the city of São Paulo.

OBJECTIVE: To evaluate sperm concentration, morphology and motility of Brazilian semen donors from 1992 to 2003, in the city of São Paulo. METHODS: Retrospective study analyzing 182 donor semen samples from 1992 to 2003. The first and the second donated sample were analyzed for each donor. Donor average age was 30.8 years. Means with standard errors, medians with minimum and maximum values, and interquartile ranges were calculated for age, sperm concentration, semen volume, oval morphology and motility. The relation between each characteristic of the semen samples and the year of donation, as well as donor age and season of the year were studied by linear and multiple regression analysis. RESULTS: Linear regression analysis showed that the sperm concentration (R2 = 19.1%, R2 = 20.2%, p < 0.0001 respectively) and the oval morphology (R2 = 13%; R2 = 13.5%; p < 0.0001, respectively) decreased significantly, even when the first or the second sperm collection is considered. The ejaculated volume showed slight increase during the period for both samples (R2 = 2.2%, p = 0.048; R-sq = 2.4%. p = 0.038, respectively). All characteristics did not depend on the donors' age or season of the year when the samples were obtained. CONCLUSIONS: There was a decrease in spermatic concentration and percentage of oval sperm of semen donors samples from 1992 to 2003, in the city of São Paulo.

Acceptable microorganisms concentration in a semen sample for in vitro embryo production

The aim of this study was to report that the acceptable concentration of microorganisms in a semen sample for insemination may not be safe for an in vitro fertilization procedure. It seems that the semen sample should be completely germ-free, because of the excellent microorganism proliferation condition promoted by the in vitro environment.

O objetivo foi relatar que a concentração de microrganismos aceitável para uma amostra de sêmen utilizada para inseminação pode não ser segura para a realização de fertilização in vitro. Aparentemente a amostra deve ser isenta da presença de contaminantes, pois a condição in vitro promove ambiente favorável para seu crescimento.

Finasteride-associated male infertility.

Finasteride is a potent and specific inhibitor of the 5alpha-reductase enzyme in men. Clinical studies have shown that finasteride 1mg/day is effective for promoting hair growth in men with male pattern hair loss. However, there is a concern about the use of finasteride, especially in young fertile patients, because of its action on testosterone metabolism. This paper describes 3 cases of young patients who had very poor seminal quality during finasteride treatment (1 mg/day), and their seminal quality greatly improved after cessation of finasteride treatment. Two of them presented with a left varicocele and the other was obese. We hypothesize that finasteride may not dramatically change the spermatogenesis process in healthy men, but in patients with conditions related to infertility, an amplification of the negative influence of finasteride could occur. Future studies should be done to clarify the extent of the effect of finasteride in patients fertility problems.

Finasteride-associated male infertility

A finasterida é um potente e específico inibidor da enzima 5a-redutase em homens. Estudos clínicos demonstraram que finasterida 1mg/dia diminui a progressão da queda e aumenta o crescimento do cabelo em homens que sofrem de queda de cabelo hereditária. Por sua influência no metabolismo dos andrógenos existe uma preocupação a respeito do seu uso, principalmente em pacientes em idade fértil. Neste trabalho são descritos 3 casos de pacientes jovens, que apresentaram piora do espermograma durante o uso continuado de finasterida 1mg revertida após a suspensão do mesmo. Dois deles tinham varicocele unilateral e o terceiro era obeso. Aparentemente o tratamento com finasterida promoveu alteração significativa na qualidade seminal. Pode-se especular que talvez a finasterida por si só não traga alteração para a espermatogênese como reportado por Overstreet et al. (1999), mas que em pacientes de risco com possíveis causas de infertilidade associadas, possa ocorrer a amplificação da influência deletéria da finasterida. Estudos futuros devem ser realizados para esclarecer a influência da finasterida nestes pacientes.

Sperm tail flexibility test: a simple test for selecting viable spermatozoa for intracytoplasmic sperm injection from semen samples without motile spermatozoa.

PURPOSE: The objective was to describe the results of the injection of immotile spermatozoa with flexible tails when only immotile spermatozoa are present in the semen sample. METHODS: A retrospective study was conducted to analyze the procedure results for 10 couples who participated in our intracytoplasmic sperm injection program. The sperm tail was considered flexible when it moved up and down independently of the head movement, and it was considered inflexible when the movement occurred together (tail plus head). The fertilization and pregnancy rate were analyzed. RESULTS: The normal fertilization rate (presence of 2 pronuclei) was 30.3% (40/132), and the abnormal fertilization rate (presence of less than or more than 2 pronuclei) was 6.81% (9/132). A total of 52 embryos were obtained with 9 transfer procedures performed (pregnancy rate: 11.12%). CONCLUSIONS: The sperm tail flexibility test (STFT) is an easy and cost-effective way for selecting viable immotile spermatozoa and can be used as an alternative method for determining the viability of spermatozoa. This test seems to be a simple and risk-free method when compared to the swelling test.

Sperm tail flexibility test: a simple test for selecting viable spermatozoa for intracytoplasmic sperm injection from semen samples without motile spermatozoa

PURPOSE: The objective was to describe the results of the injection of immotile spermatozoa with flexible tails when only immotile spermatozoa are present in the semen sample. METHODS: A retrospective study was conducted to analyze the procedure results for 10 couples who participated in our intracytoplasmic sperm injection program. The sperm tail was considered flexible when it moved up and down independently of the head movement, and it was considered inflexible when the movement occurred together (tail plus head). The fertilization and pregnancy rate were analyzed. RESULTS: The normal fertilization rate (presence of 2 pronuclei) was 30.3 percent (40/132), and the abnormal fertilization rate (presence of less than or more than 2 pronuclei) was 6.81 percent (9/132). A total of 52 embryos were obtained with 9 transfer procedures performed (pregnancy rate: 11.12 percent). CONCLUSIONS: The sperm tail flexibility test (STFT) is an easy and cost-effective way for selecting viable immotile spermatozoa and can be used as an alternative method for determining the viability of spermatozoa. This test seems to be a simple and risk-free method when compared to the swelling test