Expression of PD-L1 in cervical carcinoma and its impact on survival associated with T-cell infiltration and FoxP3 expression.

Background: The PD-1/PD-L1 signaling axis is currently the most elucidated mechanism for tumor evasion of T-cell-mediated immunity. Nevertheless, few data are available regarding its impact on cervical cancer and the relationship with lymphocytic infiltrates. Methods: A retrospective assessment of all cases of cervical neoplasia treated in Caxias do Sul General Hospital, Brazil, between 2012 and 2016 was performed. Clinical and pathological data were collected from electronic records and analyzed. Original slides were independently reviewed by three pathologists to confirm diagnoses and to assess the immunohistochemical expression of PD-L1 and FoxP3 in tumor cells and lymphocytic infiltrates. Results: PD-L1 staining was present in 32.2% of the 59 cervical samples. Median overall survival time of the PD-L1-negative group was 47.8 months, a time point not yet reached by the PD-L1-positive group (p=0.968). Median progression-free survival was 24.3 months for PD-L1-negative and 11.5 months for PD-L1-positive patients (p=0.263). PD-L1 staining was found in 27.1% of the lymphocytic infiltrates, and survival analysis revealed no difference between PD-L1-positive and PD-L1-negative samples. There was no impact on survival related to FoxP3 staining in neither tumor samples nor lymphocytic infiltrates. Conclusion: Although the median progression-free survival times differed, the difference was not statistically significant. Our study corroborates the rationale that PD-L1 expression in cervical neoplasms has no impact on survival. PD-L1 expression in peritumoral lymphocytes revealed no impact on infiltration volume nor survival. Keywords: uterine cervical neoplasms, tumor-infiltrating lymphocytes, cancer, tumor microenvironment, survival.

Improving Sperm Viability After Spinal Cord Injury Using Hyperbaric Therapy.

BACKGROUND: Infertility is one of many complications of spinal cord injury (SCI) in male patients, who are often at the peak of their reproductive life. This study evaluated effects of hyperbaric therapy (HT) on quality of sperm of rats with SCI and correlated the findings with histologic analysis of the testicles. METHODS: This experimental study comprised 18 rats that were submitted to SCI with a MASCIS Impactor and randomly allocated to either a HT or a control group. Testicular biopsies were performed on the first and 28th day of the study; 4 parameters were evaluated: concentration of sperm per mL, number of round cells per field, number of inflammatory cells per field (peroxidase [Endtz] test), and sperm viability (hypo-osmotic swelling test). RESULTS: There was no difference in sperm concentration between the HT group (P = 0.41) and control group (P = 0.74) during 28 days. From day 1 to day 28, sperm viability decreased twice as much in the control group (P = 0.001) compared with the HT group (P = 0.017). There was no difference between the groups in mean sperm concentration and number of round and inflammatory cells. On the first day, there was no difference in sperm viability between groups. There was a significantly higher (P = 0.001) percentage of viable sperm in the HT group (86.8 ± 5.6) compared with the control group (48.8 ± 21.8) on day 28. CONCLUSIONS: SCI increased the number of round and inflammatory cells and diminished sperm viability in both groups. HT promoted greater sperm viability in rats with SCI.

Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures.

There are many studies in the literature suggesting an acquired, apparently progressive infertility due to varicocele. In fact, varicocelectomy has become the most commonly performed male infertility surgery. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) are also important for couples with male factor infertility associated with varicocele. Therefore, the aim of this study was to evaluate the effect of varicocelectomy on sperm quality and pregnancy rate with ICSI. Data were analyzed from 248 patients who had varicocele or underwent a previous varicocelectomy and were treated with ICSI between 2000 and 2008. Patients with varicocele were divided into two groups: men with clinical varicocele (group 1, n = 79) and men who underwent varicocelectomy before ICSI (group 2, n = 169). In all cases, female infertility was not detected. We evaluated and compared the two groups' semen characteristics as defined by the World Health Organization and Tygerberg's strict criteria: the female partner's age; the number of oocytes retrieved; and the fertilization, implantation, pregnancy, and miscarriage rates. We used the Wilcoxon signed rank test or the Mann-Whitney test for these analyses. No differences were detected in the age of the female partners between group 1 (33.0 ± 0.46 years) and group 2 (33.8 ± 0.38 years; P = .1872). Semen volume was higher in group 1 (3.3 ± 0.3 mL) than it was in group 2 (2.5 ± 0.14; P = .0043). No differences were detected between groups 1 and 2 with regard to sperm concentration (30.08 ± 4.01 million/mL and 24.1 ± 2.42 million/mL, respectively; P = .138), sperm motility (38.2% ± 2.69% and 38.7% ± 2.08%, respectively; P = .881), and morphology according to Tygerberg's strict criteria (2.6% ± 0.44% and 2.4% ± 0.37%, respectively; P = .7202). Also, no differences were detected in the number of oocytes retrieved between group 1 (14.8 ± 1.74) and group 2 (14.9 ± 1.04; P = .9515). The fertilization rate was higher in group 1 (73.2%) than it was in group 2 (64.9%; P = .0377); however, no differences were detected in the pregnancy rates (31.1% vs 30.9%; P = .9806), implantation rates (22.1% vs 17.3%; P = .5882), or miscarriage rates (21.7% vs 23.9%; P = .8401) between groups 1 and 2. Although a varicocelectomy should always be performed before assisted reproduction is pursued, this surgery does not increase pregnancy rates or decrease miscarriage rates following ICSI.

Effects of resveratrol supplementation on cryopreservation medium of human semen.

OBJECTIVE: To analyze oxidative stress markers and seminal standard parameters after using resveratrol (0.1, 1.0, and 10.0 mM), an important antioxidant, in the cryopreservation of human semen. DESIGN: In vitro prospective study. SETTING: Institutional study. PATIENT(S): Infertile and fertile men. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Levels of thiobarbituric acid-reactive species (TBARS), superoxide dismutase (SOD), and catalase (CAT) activities and spermatozoa concentration, motility, and morphology. RESULT(S): Increased TBARS levels were observed in the post-thawing semen in both fertile and infertile men. Infertile men had lower CAT and SOD activities in prefreezing and post-thawing samples when compared with fertile men. The addition of resveratrol in all the concentrations assayed was able to prevent post-thawing lipoperoxidation in both fertile and infertile men. However, this effect was not dose dependent. The cryopreservation process was not able to change sperm concentration or morphology. However, a decrease in sperm motility was observed in both the fertile and infertile men. The addition of resveratrol was not able to prevent this effect. CONCLUSION(S): Resveratrol avoids oxidative damages induced by the cryopreservation of human semen, but it is not able to restore the decrease in sperm motility.

Resveratrol and ascorbic acid prevent DNA damage induced by cryopreservation in human semen.

Cryopreservation of human semen can cause DNA damages, which compromise the fertilization and normal embryo development. The present study showed that the antioxidant resveratrol prevents these damages both in fertile and infertile men. The addition of ascorbic acid before cryopreservation can reduce DNA damages only in infertile men. Although further studies are needed, the present work showed that resveratrol could be considered in human cryopreservation procedures to avoid/minimize DNA damages and preserve sperm integrity.

Sperm banking for male cancer patients: social and semen profiles.

PURPOSE: Report the characteristics of cryopreserved semen from a cohort of male cancer patients, attitudes towards cryopreservation and outcomes of semen samples based on a 12-year cryopreservation program. MATERIAL AND METHODS: Data from 98 male cancer patients whose sperm samples were banked were evaluated. Demographic parameters, semen characteristics, destination of sperm banked samples and questionnaires answered by the patients regarding cryopreservation time were evaluated. RESULTS: The cancer diagnoses were testicle (56.1%), prostate (15.3%), Hodgkin's lymphomas (9.2%), non-Hodgkin's lymphomas (7.1%), leukemia (3.1%) and other malignancies (9.2%). The patients with testicular cancer presented lower sperm concentration (p < 0.001); however, there were no differences with the percentage of normozoospermic patients among cancer type groups (p = 0.185). A shorter time between cancer diagnosis and sperm banking was observed for testicular and prostate cancer patients (p < 0.001). Most of the patients (89.5%) favored sperm banking as a fertility preservation method. CONCLUSIONS: Although less than 20% of banked sperm samples were disposed of, the majority of patients related sperm banking with safe for fertility preservation. Our results show that all male cancer patients of reproductive age facing cancer treatment could be offered sperm banking.

Sperm banking for male cancer patients: social and semen profiles

PURPOSE: Report the characteristics of cryopreserved semen from a cohort of male cancer patients, attitudes towards cryopreservation and outcomes of semen samples based on a 12-year cryopreservation program. MATERIAL AND METHODS: Data from 98 male cancer patients whose sperm samples were banked were evaluated. Demographic parameters, semen characteristics, destination of sperm banked samples and questionnaires answered by the patients regarding cryopreservation time were evaluated. RESULTS: The cancer diagnoses were testicle (56.1 percent), prostate (15.3 percent), Hodgkin’s lymphomas (9.2 percent), non-Hodgkin’s lymphomas (7.1 percent), leukemia (3.1 percent) and other malignancies (9.2 percent). The patients with testicular cancer presented lower sperm concentration (p < 0.001); however, there were no differences with the percentage of normozoospermic patients among cancer type groups (p = 0.185). A shorter time between cancer diagnosis and sperm banking was observed for testicular and prostate cancer patients (p < 0.001). Most of the patients (89.5 percent) favored sperm banking as a fertility preservation method. CONCLUSIONS: Although less than 20 percent of banked sperm samples were disposed of, the majority of patients related sperm banking with safe for fertility preservation. Our results show that all male cancer patients of reproductive age facing cancer treatment could be offered sperm banking.

Poor semen quality and ROS-TAC scores in patients with idiopathic infertility.

INTRODUCTION: To compare the semen quality score and the seminal oxidative stress reactive oxygen species (ROS) and total antioxidant capacity (ROS-TAC score) in men with idiopathic infertility with normal donors and to a known group of fertile and infertile men. MATERIAL AND METHODS: Principal component analysis was applied to provide a standardized score in 36 men with idiopathic infertility and 19 controls attending our infertility clinic. A logistic regression analysis comparing the fertile and infertile men was used. RESULTS: Compared to controls, patients with idiopathic infertility had significantly lower sperm concentration, sperm motility and normal morphology (p < 0.05) and lower semen quality scores (83.0 +/- 14.5 vs. 100.0 +/- 10.0; p < 0.001). Compared to controls, the ROS levels were higher in the idiopathic infertility group (2.3 +/- 0.21 vs. 1.3 +/- 0.3; p = 0.006), whereas the TAC levels were lower in the idiopathic infertility (1,014.75 +/- 79.22 vs. 1,653 +/- 115.29; p = 0.001). Idiopathic infertility patients had lower ROS-TAC scores (32.8 +/- 14.2) than controls (50.0 +/- 10.0) (p < 0.001). 64% of men with idiopathic infertility will remain infertile during 1-year follow-up. CONCLUSIONS: Patients with idiopathic infertility have lower scores of semen quality and ROS-TAC.

Cigarette smoking is related to a decrease in semen volume in a population of fertile men.

OBJECTIVE: To evaluate the semen quality and hormonal levels in fertile men according to their level of cigarette smoking. SUBJECTS AND METHODS: We evaluated 889 fertile men who came for a vasectomy for sterilization purposes. The men included 522 non-smokers, 143 mild smokers (<10 cigarettes/day), 154 moderate smokers (11-20/day), and 70 heavy smokers (>20/day). We evaluated sperm concentration, motility, motion variables and hormonal levels in these men. RESULTS: There were no significant differences among the groups in sperm concentration or motility, or in levels of follicle-stimulating hormone, luteinizing hormone, or serum total testosterone. Also, sperm motion characteristics did not differ across the groups. Semen volume was the only semen variable which tended to decrease according to the number of cigarettes smoked. CONCLUSIONS: Cigarette smoking had no apparent effect on sperm concentration, motility or reproductive hormonal levels, but tended to reduce semen volume.

Multi-institutional validation of vasectomy reversal predictor.

PURPOSE: Some urologists who perform vasectomy reversals are not experienced with performing VE. A model to preoperatively identify patients who may require referral to an experienced VE surgeon was created (). We tested the model at multiple institutions. MATERIALS AND METHODS: The model had previously been designed in 483 patients who underwent vasectomy reversal at 1 institution (100% sensitive and 59% specific for predicting the need for VE). It was based on time since vasectomy and patient age. We tested it prospectively in 33 patients and retrospectively in a total of 312 at 6 other institutions. The predictive accuracy of the model was compared to using a simple duration from vasectomy cutoff alone, as is used in clinical practice. RESULTS: The model had 84% sensitivity and 58% specificity for detecting the need for VE in a total of 345 patients at 7 institutions. If using only a duration from vasectomy cutoff of 10 years to predict the need for VE, sensitivity was only 69%. At a cutoff of 4 years sensitivity was 99% but specificity was only 23%. Thus, the model performed better than any specific duration cutoff alone. CONCLUSIONS: The predictive model provides 84% sensitivity for detecting patients who may require VE during vasectomy reversal across 7 institutions (58% specificity). The model more accurately predicts the need for VE than using a specific duration from vasectomy cutoff alone.

Sperm concentration and normal sperm morphology decrease and follicle-stimulating hormone level increases with age.

OBJECTIVE: To assess hormone levels, testicular volume, and semen characteristics of fertile men of various age groups. PATIENTS AND METHODS: The records of 889 men who sought a vasectomy between September 1999 and March 2003 were reviewed. Patients were divided into five groups by age; we evaluated semen volume, sperm concentration, motility, morphology and complex sperm motion variables. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone levels and both testicular volumes were compared. RESULTS: There were no differences among the groups in the levels of LH, testosterone, or right and left testicular volumes. There were differences among the five groups in FSH levels, semen volume, sperm concentration and motility. Normal morphology according to the World Health Organisation criteria was significantly lower in patients aged > 45 years. From a linear regression analysis, semen volume, sperm concentration and motility decreased by 0.01 mL, 2.1%, and 0.27%, respectively, per year, and the FSH level increased by 0.27%. CONCLUSIONS: Sperm concentration and motility decrease and FSH levels increase with age. Normal sperm morphology decreases from 45 years old. Thus, the ageing effect should be considered when proposing standard values for semen characteristics in routine semen analysis.

Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermic patients.

OBJECTIVE: To assess fertilization, pregnancy, and miscarriage rates after intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa from different types of azoospermia. DESIGN: Retrospective study. SETTING: Academic medical center and private fertility center. PATIENT(S): Two hundred twelve patients underwent 257 ICSI cycles. INTERVENTION(S): Cycles of ICSI were divided into four groups according to the etiology of azoospermia: A (nonobstruction), B (postvasectomy), C (congenital obstruction), and D (obstruction due to infection). Testicular sperm aspiration and percutaneous epididymal sperm aspiration were the sperm retrieval methods used for ICSI. MAIN OUTCOME MEASURE(S): Fertilization, pregnancy, and miscarriage rates. RESULT(S): Normal fertilization rates were higher in groups C (67.7%) and B (64.1%) compared with groups A (47.3%) and D (58.9%). Although lower pregnancy rates were seen in group A, no statistical differences were detected among groups. However, the miscarriage rate was higher in group A (45.6%) compared with groups B (25.25%), C (24%), and D (22.58%). CONCLUSION(S): Although no differences were detected in the pregnancy rates across groups, fertilization and implantation rates were higher in patients with congenital obstruction of the seminal path. The pregnancy rate was higher and the miscarriage rate lower when epididymal sperm was used compared with testicular sperm.

Sperm retrieval techniques in rats with suppressed spermatogenesis by experimental cryptorchidism.

OBJECTIVE: Our aim was to assess the suppression of spermatogenesis and sperm retrieval rate after testicular sperm extraction (TESE) or testicular sperm aspiration (TESA) in adult rats with surgically induced cryptorchidism. METHODS: Adult rats were submitted to TESE and TESA procedures after 15 days of induced cryptorchidism. After spermatozoa retrieval, the testicles were extracted, weighed and a morphological analysis by conventional light microscopy was done. The numbers of spermatozoa retrieved in both TESA and TESE were rated and compared. RESULTS: Histological analysis of the testicles revealed Sertoli cell-only syndrome in 60% of the testicles, and maturation arrest in the remaining cryptorchid testicles. Significant differences were seen in the number of spermatozoa retrieved (P < 0.05) between cryptorchidic and control rats. When sperm retrieval techniques were compared, no differences were detected in the number of spermatozoa obtained (P > 0.05). CONCLUSIONS: It seems that a 15 day period of cryptorchidism is enough to induce spermatogenesis disorders. No differences were detected in the number of spermatozoa retrieved in the right or left testicles, irrespective of the testicular pole. Furthermore, and even more importantly, no differences in the retrieval rate were seen between the two techniques.

Relationship of interleukin-6 with semen characteristics and oxidative stress in patients with varicocele.

OBJECTIVES: To examine levels of interleukin-6 (IL-6) in fertile semen donors and patients with varicocele and examine its association with semen characteristics and levels of reactive oxygen species (ROS). METHODS: We conducted a prospective study consisting of 15 fertile donors (controls) and 35 infertile patients with varicocele. Semen analysis was performed according to the World Health Organization guidelines. IL-6 levels were measured using the enzyme-linked immunosorbent assay. ROS (x10(4) counted photons per minute per 20 x 10(6) sperm) and total antioxidant capacity (molar trolox equivalents) were measured using a chemiluminescence assay. RESULTS: The sperm concentration and motility were significantly greater in the donors compared with the infertile patients with varicocele (P <0.0001 and P = 0.01, respectively). The IL-6 (log10 [IL-6 +1]) and ROS (log10 [ROS +1]) levels were significantly greater in infertile patients with varicocele than in the donors (IL-6: 2.1 [1.7, 2.4] versus 0.7 [0, 1.9], P = 0.003; ROS: 1.8 [1.2, 2.6] versus 1.0 [0.7, 1.6], P = 0.04). The total antioxidant capacity levels were significantly lower in the varicocele patients (1166.7 +/- 366.2) than in the donors (1556.4 +/- 468.1; P = 0.003). The IL-6 levels correlated significantly with the ROS levels in the infertile patients with varicocele (r = -0.39; P = 0.01). CONCLUSIONS: Infertile patients with varicocele exhibited elevated levels of IL-6 and ROS and decreased levels of total antioxidant capacity. Pro-inflammatory cytokine IL-6 and oxidative stress may play a role in the pathophysiology of infertility in these patients.

The efficacy of repeat percutaneous epididymal sperm aspiration procedures.

PURPOSE: The development of intracytoplasmic sperm injection spawned new methods of sperm retrieval for men with obstructive azoospermia who did not want to undergo reconstruction of the seminal tract. There is a wide array of different procedures that may be performed in these cases, for instance percutaneous epididymal sperm aspiration (PESA) and microepididymal sperm aspiration. However, concerns regarding the presence of sperm in a second PESA attempt due to possible fibrosis have been suggested by many authors. We evaluate if it is worthwhile to repeat percutaneous epididymal sperm aspiration. MATERIALS AND METHODS: The records of 20 patients (23 attempts) who underwent repeat PESA from January 1996 to September 2000 for assisted reproductive technique purposes were reviewed. In all patients the repeat procedure was performed on the same side as the previous PESA. Data were collected on patient age, presence of motile sperm during PESA, epididymal side, pregnancies and abortion rates. RESULTS: Mean patient age +/- SD was 32.4 +/- 5.6 years. One patient was excluded from our analysis due to lack of information on the chart regarding the side of the procedure. Repeat PESA was performed in the right epididymis in 12 attempts and in the left in 10. Of the remaining 19 patients 14 (73.68%) did not and 5 (26.3%) have sperm in the epididymal fluid. In these 5 patients 8 repeat PESA procedures were performed (3 procedures in 1 and motile sperm was always found (8 of 22 attempts, 36.4%). Three patients achieved pregnancy with the motile sperm retrieved from the repeat PESA (3 of 8 repeat attempts, 37.5%). No abortions were detected. CONCLUSIONS: More than a third of repeat PESA attempts resulted in the presence of motile sperm. Before performing testicular sperm aspiration or extraction in patients who have undergone previous PESA without achieving pregnancy, repeat PESA may be done. Further attempts should be added in the future to confirm these results.

Induction of spermatogenesis in azoospermic men after varicocele repair.

BACKGROUND: The purpose of this study was to assess the treatment outcome after varicocele repair in azoospermic men and to correlate this outcome with the testicular histology patterns. METHODS: Medical records of 15 azoospermic men who underwent testis biopsy and microsurgical repair of clinical varicocele between July 1999 and November 2000 were reviewed. All patients had at least two semen analyses showing azoospermia taken before the surgery and two semen analyses post-operatively. Hypospermatogenesis was identified in four, maturation arrest in six, and germ cell aplasia in five men. RESULTS: Induction of spermatogenesis was achieved in seven men (47%). Of these, four had germ cell aplasia and three had maturation arrest. The improvement in sperm concentration and motility in patients with germ cell aplasia ranged from 1.8 to 7.9 x 10(6)/ml, and from 32 to 76% respectively. Of these seven patients with improvement in semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). One patient with maturation arrest established a pregnancy. CONCLUSIONS: Azoospermic patients may have an improvement in semen quality following varicocelectomy. Semen samples should be cryopreserved after an initial improvement following varicocelectomy, as relapse to a state of azoospermia may occur.

Gonadal function in male adolescents and young males with juvenile onset systemic lupus erythematosus.

OBJECTIVE: To evaluate gonadal function in male adolescents and young men with juvenile onset systemic lupus erythematosus (SLE). METHODS: Four young men with SLE underwent clinical and laboratory evaluation, testicular ultrasound, follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, and anti-sperm antibody determination. The semen analyses were performed according to the WHO guidelines and Kruger strict criteria. All patients were asked to provide 3 semen samples over a period of 2 months. A new sample was collected 6 months later. RESULTS: The median disease duration was 6.6 years. The median age at initial ejaculation was 13.5 years. All 4 patients had severe disease with renal involvement (WHO class IV or V). The SLICC/ACR damage index at the time of study entry ranged between 0 and 3. The patients' Tanner stage was P5G5; all reported normal erection and libido. Gonadal evaluation by thorough examination of the genitalia and ultrasound was normal. Anti-sperm antibodies were negative in all patients. Only one patient showed high FSH and LH levels. The initial and final semen evaluations of the 4 patients were abnormal (azoospermia, oligoastenoteratospermia, or teratospermia). One patient was receiving azathioprine and 2 were receiving cyclophosphamide at the time of study entry. CONCLUSION: Although these patients had normal sexual activity and normal external genitalia, their fertility was decreased based on the sperm abnormalities. Serial semen analyses in larger study populations will be necessary to clarify the degree and duration of sperm abnormalities in male patients with SLE in general.

Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonobstructive azoospermia.

PURPOSE: We assessed fertilization, pregnancy and miscarriage rates in patients with obstructive and nonobstructive azoospermia who underwent intracytoplasmic sperm injection. MATERIALS AND METHODS: From June 1996 to March 2000, 166 consecutive patients (198 intracytoplasmic sperm injection cycles) with azoospermia were studied. Of these 198 cycles 68 were performed due to nonobstructive azoospermia using testicular spermatozoa and 130 were performed due to obstructive azoospermia using epididymal spermatozoa. RESULTS: The normal (2 pronuclei) and abnormal (1 plus 3 pronuclei) fertilization rates for obstructive and nonobstructive azoospermia were 60.5% and 16.6%, and 54% and 16.4%, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 30%, 39.8% and 28% for obstructive azoospermia, and 22%, 28.3% and 40% for nonobstructive azoospermia (p <0.05). The normal and abnormal fertilization rates were 58.7% and 21.4% for percutaneous epididymal sperm aspiration (PESA), 62.3% and 10.4% for PESA plus testicular sperm aspiration (TESA), and 57.3% and 14.5% for TESA, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 34.6%, 54.5% and 11.1% for PESA, 37.5%, 37.5% and 33.3% for PESA plus TESA, and 26.1%, 31% and 41% for TESA, respectively (PESA versus PESA plus TESA p >0.05, and PESA and PESA plus TESA versus TESA p <0.05). Epididymal or testicular motile sperm resulted in a lower abortion rate than epididymal or testicular immotile sperm (p = 0.03). CONCLUSIONS: No differences were noted in the fertilization and embryo transfer rates irrespective of etiology (obstructive versus nonobstructive) and type of spermatozoa (epididymal versus testicular). Testicular sperm retrieval results in lower fertilization and pregnancy rates as well as higher abortion rates than epididymal sperm retrieval.

Complicaçöes intestinais da ascaridíase em crianças / Intestinal complications of ascaridiasis in children

Os autores relatam um caso de perfuraçao de anastomose intestinal por Ascaris Lombricóides, com subseqüente peritonite. Realizam ainda uma breve revisao da literatura a respeito das complicaçoes abdominais da ascaridíase. As verminoses, em especial a ascaridíase, constituem um importante problema de saúde pública (3). Acometem predominantemente crianças entre l e 5 anos, de classes sociais menos favorecidas, que vivem em condiçoes de saneamento precárias (l,5). A ascaridíase, por si só, traz danos ao crescimento e pode vir acompanhada de sérias complicaçoes, como obstruçao intestinal, volvo, gangrena, obstruçao da via biliar e pancreática e perfuraçao intestinal, todas com significativa morbimortalidade (4,5). Neste artigo, é relatada a nossa experiência com uma complicaçao pouco comum, a perfuraçao de anastomose intestinal por vermes.