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1.
Medicine (Baltimore) ; 99(42): e22768, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080745

RESUMO

INTRODUCTION: The purpose of this paper is to evaluate the efficacy and safety of acupuncture for POSEIDON patients undergoing IVF/ICSI. METHODS: and analysis We will electronically search Pubmed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database and Wan-fang Database from their inception. Also, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and grey literature. The clinical randomized controlled trials or quasi randomized controlled trials related to acupuncture treatment for POSEIDON patients in IVF/ICSI will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by two researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The clinical pregnancy rate (CPR) and live birth rate (LBR) will be the primary outcomes. The ongoing pregnancy, miscarriage rate (MR) and adverse events will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals (CIs), while dichotomous data will be expressed in the form of relative risk with 95% CIs. ETHICS AND DISSEMINATION: The protocol of this systematic review (SR) does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION: OSF Registries, DOI: 10.17605/OSF.IO/6WP2F (https://osf.io/6wp2f).


Assuntos
Terapia por Acupuntura , Fertilização In Vitro , Metanálise como Assunto , Injeções de Esperma Intracitoplásmicas , Revisões Sistemáticas como Assunto , Feminino , Humanos , Infertilidade/terapia , Gravidez , Taxa de Gravidez , Projetos de Pesquisa
2.
PLoS One ; 15(10): e0239779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044971

RESUMO

BACKGROUND: The conditions of diminished ovarian reserve and primary ovarian insufficiency, characterized by poor fertility outcomes, currently comprise a major challenge in reproductive medicine, particularly in vitro fertilization. Currently in the IVF industry, blastocyst developmental success rate per treatment is routinely overlooked when a live birth results from treatment. Limited data are available on this significant and actionable variable of blastocyst development optimization, which contributes to improvement of treatment success Women with elevated basal FSH concentration are reported to still achieve reasonable pregnancy rates, although only a few studies report correlations with blastocysts development. Diagnostic values of AMH/basal FSH concentrations can be useful for determining the optimal stimulation protocol as well as identification of individuals who will not benefit from IVF due to poor prognosis. The objective of this study is to identify actionable clinical and culture characteristics of IVF treatment that influence blastocyst developmental rate, with the goal of acquiring optimal success. METHODS AND FINDINGS: A retrospective observational study was performed, based on 106 women undergoing IVF, regardless of prognosis, over a six-month period from January 1, 2015 to June 31, 2015. Rate of high-quality blastocyst production, which can be used for embryo transfer or vitrification, per normally fertilized oocyte, was evaluated. Treatment was determined successful when outcome was ≥ 40% high-quality blastocysts. The data were initially evaluated with the Evtree algorithm, a statistical computational analysis which is inspired by natural Darwinian evolution incorporating concepts such as mutation and natural selection (see Supplementary Material). The analysis processes all variables simultaneously against the outcome, aiming to maximize discrimination of each variable to then create a "branch" of the tree which can be used as a decision in treatment. The final model results in only those variables which are significant to outcomes. Generalized linear model (GLM) employing logistic regression and survival analysis with R software was used and the final fitting of the model was determined through the use of random forest and evolutionary tree algorithms. Individuals presenting with an [AMH] of >3.15 ng/ml and a good prognosis had a lower success per treatment (n = 11, 0% success) when total gonadotropin doses were greater than 3325 IU. Individuals that presented with an [AMH] of <1.78 ng/ml and a poor prognosis exhibited a greater success per treatment (n = 11, 80% success). AMH emerged as a superior indicator of blastocyst development compared to basal FSH. The accuracy of the prediction model, our statistical analysis using decision tree, evtree methodology is 86.5% in correctly predicting outcome based on the significant variables. The likelihood that the outcome with be incorrect of the model, or the error rate is 13.5%. CONCLUSIONS: [AMH] is a superior indicator of ovarian stimulation response and an actionable variable for stimulation dose management for optimizing blastocyst development in culture. Women whose [AMH] is ≥3.2 mg/ml, having a good prognosis, and developing >12 mature follicles result in <40% blastocysts when gonadotropin doses exceed 3325 IU per treatment. IVF treatments for poor responders that present with infertility due to diminished ovarian reserve, if managed appropriately, can produce more usable blastocyst per IVF treatment, thus increasing rate of blastocyst developmental success and ultimately increasing live birth rates. Future studies are needed to investigate the intra-follicular and the intra-cellular mechanisms that lead to the inverse relationship of blastocysts development and total gonadotropin doses in good responders in contrast to poor responders.


Assuntos
Hormônio Antimülleriano/sangue , Blastocisto/metabolismo , Blastocisto/fisiologia , Desenvolvimento Embrionário/fisiologia , Hormônio Foliculoestimulante/sangue , Adulto , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/métodos , Humanos , Infertilidade/sangue , Infertilidade/terapia , Nascimento Vivo , Masculino , Folículo Ovariano/metabolismo , Reserva Ovariana/fisiologia , Ovário/metabolismo , Ovário/fisiologia , Indução da Ovulação/métodos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 99(37): e22009, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925733

RESUMO

BACKGROUND: Human assisted reproductive technology (ART) has become an important part of infertility treatments throughout the world, including IVF, ICSI, embryo culture, and embryo cryopreservation. In China and East Asia, Chinese herbal medicine (CHM) has been used to treat various diseases and improves the success chance of live birth among infertile couples undergoing ART treatment. The aim of this study is to assess the effect and safety of Chinese herbal medicine among women undergoing ART. METHODS: Cochrane Library, MEDLINE, EMBASE, CNKI, VIP, CBM and WANGFANG will be searched. All randomized controlled trials will be included if they recruited participants undergoing ART for assessing the effect and safety of Chinese herbal medicine. Primary outcomes will be live birth. Two authors will independently scan all the potential articles, extract the data and assess the risk of bias using Cochrane tool of risk of bias. Based on the guideline of Cochrane Collaboration, all analysis will be performed by RevMan 5.3 software. Dichotomous variables will be expressed as RR with 95% CIs and continuous variables will be reported as MD with 95% CIs. If possible, a fixed or random effects models will be conducted and the confidence of cumulative evidence will be assess using GRADE. RESULTS: This study will be to assess the effect and safety of Chinese herbal medicine among women undergoing ART. CONCLUSIONS: This study will assess the effect and safety of Chinese herbal medicine among women undergoing ART and move forward to help inform clinical decisions.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Infertilidade/terapia , Metanálise como Assunto , Técnicas de Reprodução Assistida , Revisões Sistemáticas como Assunto , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Nascimento Vivo , Gravidez
5.
PLoS One ; 15(9): e0239120, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970718

RESUMO

OBJECTIVE: To investigate the impact of endometrial thickness on the embryo transfer(ET) day on the clinical pregnancy outcomes of frozen-thawed embryo transfer cycles which have undergone hormone replacement therapy(HRT-FET). METHODS: A total of 10,165 HRT-FET cycles performed between January 2013 to December 2017 in the Reproductive Medicine Center of Henan Provincial People's Hospital were studied retrospectively. All patients were grouped according to their endometrial thickness on the ET day (each group having an increment of 1mm between two neighboring groups). Multivariate regression analysis, curve fitting and threshold effect analysis were performed on all data. RESULTS: After adjusting for the age, duration of infertility, body mass index(BMI), infertility type and number and type of embryos transferred, a significant correlation was observed to be between the endometrial thickness and implantation rates (aOR: 1.08; 95% CI: 1.06-1.10, p < 0.0001), clinical pregnancy rate(aOR: 1.10; 95% CI: 1.07-1.14, p < 0.0001)and live birth rate (aOR: 1.09; 95% CI: 1.06-1.12, p < 0.0001). The numerical value of the cut-off point for the endometrial thickness was 8.7 mm. When the endometrial thickness was less than 8.7 mm, with each additional 1 mm of endometrial thickness, the implantation rate increased by 32%, the clinical pregnancy rate increased by 36%, and the live birth rate increased by 45%. CONCLUSIONS: In the HRT-FET cycles, the optimal live birth rate would be obtained when the endometrial thickness remains within the range of 8.7-14.5 mm. If the endometrium is too thin or too thick, the live birth rate will be reduced.


Assuntos
Transferência Embrionária/métodos , Endométrio/anatomia & histologia , Terapia de Reposição Hormonal , Infertilidade/terapia , Nascimento Vivo/epidemiologia , Adulto , China/epidemiologia , Criopreservação , Implantação do Embrião/fisiologia , Endométrio/diagnóstico por imagem , Endométrio/fisiologia , Endossonografia , Feminino , Humanos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Resultado do Tratamento
6.
Emerg Top Life Sci ; 4(2): 207-227, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32691841

RESUMO

Human pregnancy, critical for our species survival, is inefficient and prone to complications such as infertility, spontaneous miscarriages and preeclampsia (PE). Immunological factors may be important as the embryo is 50% paternal and foreign to the mother. Mouse pregnancy models, and in particular the murine CBA/J x DBA/2 mating combination, has been widely used to investigate mechanisms causing and preventing partner-specific recurrent miscarriages (RM) and PE. Occult losses can represent T cell-mediated rejection, and antigen-specific regulatory T cells (Tregs) with classical αß T cell receptors (TcR) activated by semen antigens at the time of mating are protective. If there is no occult loss, an inadequate Treg response can also predispose to RM. In RM, proinflammatory cytokines from natural killer (NK)-type cells and macrophages of the innate immune system are responsible and cells with γδ TcR protect via release of TGF-ß-type molecules. Immunization of abortion-prone female CBA/J mice or administration of cell-associated or soluble CD200, an immune check point inhibitor, can prevent abortions by augmenting uterine decidual suppressor cell activity. Human studies suggest that is also true in couples with RM. Environmental activators of the innate immune system, such as bacterial LPS and stress, can cause abortions as well as occult losses. The endogenous level of Tregs and activation of Tregs specific for the male H-Y antigen may determine success rates and alter the male:female birth ratio. Intralipid alters LPS clearance, prevents abortions in the CBAxDBA/2 model, and is effective in increasing live birth rates in couples undergoing IVF treatment.


Assuntos
Aborto Habitual/imunologia , Modelos Animais de Doenças , Eclampsia/imunologia , Infertilidade/imunologia , Aborto Habitual/prevenção & controle , Aborto Habitual/terapia , Animais , Antígenos CD/metabolismo , Citocinas/metabolismo , Eclampsia/prevenção & controle , Eclampsia/terapia , Implantação do Embrião , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Humanos , Infertilidade/prevenção & controle , Infertilidade/terapia , Células Matadoras Naturais/metabolismo , Masculino , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos CBA , Camundongos Endogâmicos DBA , Gravidez , Complicações na Gravidez , Resultado da Gravidez , Receptores de Antígenos de Linfócitos T gama-delta/metabolismo , Razão de Masculinidade , Linfócitos T Reguladores/metabolismo
9.
Psychiatr Hung ; 35(3): 337-353, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-32643622

RESUMO

INTRODUCTION: Infertility and its treatment impose significant physical and emotional burden on infertile couples. The most commonly used assisted reproductive technology is the In Vitro Fertilization (IVF). Approximately one third of the treatments results in pregnancy. The aim of our study is to explore psychosocial factors that have an influence on the chance of IVF treatment success. METHODS: 104 infertile couples undergoing IVF treatment participated in our research, of which 49 couples achieved pregnancy after treatment and 55 couples did not. The emotional state was assessed by the Positive and Negative Affect Schedule, the short form of the Beck Depression Inventory and the Spielberger State-Trait Anxiety Inventory. The coping abilities were measured by the short form of the Ways of Coping Inventory, the Psychological Immune Competence Inventory and the Connor-Davidson Resilience Scale. The negative life events were assessed by the short and revised form of the Paykel's Life Events Scale. Data were collected at three occasions: at the beginning of the treatment (T1), before embryo transfer (T2), and before pregnancy test (T3). RESULTS: According to the most important results of the logistic regression analysis, the outcome of the treatment is negatively influenced by the female (p<0.01) and male age (p<0.05). For women, positive affectivity at T1, the Problem analysis coping strategy, the Sense of self-growth personality trait, the Personal competence and Tolerance of negative affect factors were found to be adaptive in respect of treatment success (p<0.05). For men, the IVF outcome was positively influenced by the lower level of depression at T1, the Problem analysis coping strategy and the Sense of control personality trait (p<0.05). CONCLUSION: Emotional attitudes of couples towards childbearing and treatment and their coping mechanisms have an influence on the treatment outcome. Therefore, assessment and conscious shaping of these factors may increase the chance of successful treatment.


Assuntos
Adaptação Psicológica , Emoções , Infertilidade/psicologia , Infertilidade/terapia , Técnicas de Reprodução Assistida , Feminino , Fertilização In Vitro , Humanos , Masculino , Gravidez
10.
Reprod Biomed Online ; 41(3): 425-427, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32600945

RESUMO

RESEARCH QUESTION: What is the psychological impact of the COVID-19 pandemic on infertility patients? DESIGN: An anonymous cross-sectional online survey was sent to patients who attended a large university-affiliated infertility practice in the USA between 1 January 2019 and 1 April 2020. At three different time-points respondents were asked to note their top three stressors, from a list of 10 commonly reported life stressors. RESULTS: The questionnaire was sent to 10,481 patients, with 3604 responses (response rate 34%) received. A total of 2202 non-pregnant female respondents were included in the final analysis. One-third of respondents had a prior diagnosis of an anxiety disorder, and 11% reported taking anxiolytic medications; over one-quarter had a prior diagnosis of a depressive disorder and 11% reported taking antidepressant medications. At all three time-points, infertility was noted to be the most frequent top stressor. Coronavirus was noted to be the third most common stressor among the respondents in early March but, at the time of writing, is similar to that of infertility (63% and 66%, respectively). A total of 6% of patients stated that infertility treatment, including IVF, should not be offered during the COVID-19 pandemic. CONCLUSION: Despite the unprecedented global pandemic of COVID-19, causing economic and societal uncertainty, the stress of infertility remains significant and is comparable a stressor to the pandemic itself.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Infertilidade/psicologia , Pandemias , Pneumonia Viral/psicologia , Estresse Psicológico/epidemiologia , Adulto , Ansiedade/tratamento farmacológico , Ansiedade/psicologia , Estudos Transversais , Depressão/tratamento farmacológico , Depressão/psicologia , Feminino , Humanos , Infertilidade/terapia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Inquéritos e Questionários
11.
Reprod Biomed Online ; 41(2): 151-153, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32553464

RESUMO

Coronavirus disease 2019 (COVID-19) was declared a pandemic on 11 March 2020 by the World Health Organization, halting the principal income activities worldwide. The International Monetary Fund predicts that the imminent economic recession will be worse than the global financial crisis of 2008, which severely affected the economy of Southern European countries such as Greece, Italy and Spain. There was then an abysmal drop in the Spanish yearly population growth curve as families could not afford to have children in that economic context; this only worsened the already existing demographic problems in that Spain has a constantly ageing population and one of the lowest fertility indicators in Europe. Taking into consideration that female age is the most important independent variable of success at the time of conception, probably thousands of potentially fertile couples were lost while waiting for more promising circumstances. With the COVID-19 pandemic a similar situation is being faced, where reproductive rights are imperiled by not being able to choose when to have children due to economic coercion. Therefore, governments worldwide should take measures to palliate the possible sociodemographic crisis that will follow the economic recession and try to ease the burden that many families might face during the following years.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infertilidade/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Direitos Sexuais e Reprodutivos , Adulto , Fatores Etários , Infecções por Coronavirus/economia , Recessão Econômica , Europa (Continente)/epidemiologia , Feminino , Grécia/epidemiologia , Humanos , Infertilidade/economia , Infertilidade/terapia , Itália/epidemiologia , Masculino , Pandemias/economia , Pneumonia Viral/economia , Direitos Sexuais e Reprodutivos/economia , Espanha/epidemiologia , Organização Mundial da Saúde
13.
Sci Rep ; 10(1): 7719, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32382043

RESUMO

This multicentre, randomised, controlled cross-over trial was designed to investigate the effect of intra-uterine slow-release insemination (SRI) on pregnancy rates in women with confirmed infertility or the need for semen donation who were eligible for standard bolus intra-uterine insemination (IUI). Data for a total of 182 women were analysed after randomisation to receive IUI (n = 96) or SRI (n = 86) first. The primary outcome was serological pregnancy defined by a positive beta human chorionic gonadotropin test, two weeks after insemination. Patients who did not conceive after the first cycle switched to the alternative technique for the second cycle: 44 women switched to IUI and 58 switched to SRI. In total, there were 284 treatment cycles (IUI: n = 140; SRI: n = 144). Pregnancy rates following SRI and IUI were 13.2% and 10.0%, respectively, which was not statistically significant (p = 0.202). A statistically significant difference in pregnancy rates for SRI versus IUI was detected in women aged under 35 years. In this subgroup, the pregnancy rate with SRI was 17% compared to 7% with IUI (relative risk 2.33; p = 0.032) across both cycles. These results support the hypothesis that the pregnancy rate might be improved with SRI compared to standard bolus IUI, especially in women aged under 35 years.


Assuntos
Fertilização In Vitro/métodos , Infertilidade/terapia , Inseminação Artificial/métodos , Taxa de Gravidez , Adolescente , Adulto , Gonadotropina Coriônica/metabolismo , Feminino , Humanos , Infertilidade/patologia , Nascimento Vivo/epidemiologia , Masculino , Gravidez , Doadores de Tecidos , Adulto Jovem
14.
Reprod Biomed Online ; 41(1): 1-5, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32451301

RESUMO

The emergence of the novel coronavirus infection that arose in Wuhan, China in December 2019 has resulted in an epidemic that has quickly expanded to become one of the most significant public health threats in recent times. Unfortunately, the disease has spread globally. On March 11th (2020) World Health Organization (WHO) declared Covid-19 a pandemic and has called governments to take urgent and aggressive action to change the course of the outbreak. Within the context of Assisted Reproduction, both reproductive medicine professionals and patients are also fighting against this unprecedented viral pandemic. In view of events, most of us had to make serious decisions, some of them with a lack of scientific evidence due to the circumstances and with the only objective of ensuring the safe care of our patients, reduce non-essential contacts and prevent possible maternal and fetal complications in future pregnancies. Pregnant women should not be considered at high risk for developing severe infection. Up to date, there are no reported deaths in pregnant women with Covid-19, while in the cases that have presented pneumonia because of Covid-19, the symptoms have been moderate and with a good prognosis in recovery.


Assuntos
Infecções por Coronavirus/epidemiologia , Clínicas de Fertilização , Pneumonia Viral/epidemiologia , Serviços de Saúde Reprodutiva , Feminino , Guias como Assunto , Humanos , Infertilidade/terapia , Itália , Idade Materna , Pandemias , Assistência ao Paciente , Gravidez , Técnicas de Reprodução Assistida , Espanha , Fatores de Tempo
16.
Arch Gynecol Obstet ; 302(1): 31-45, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32445067

RESUMO

PURPOSE: The use of assisted reproductive technology (ART) has increased in the last 2 decades and continuous surveillance is needed. This systematic review aims to assess the risk of adverse neonatal outcomes (preterm birth [PTB], low birth weight [LBW], small-for-gestationalage [SGA] and large for gestational-age [LGA]), in singleton pregnancies conceived by fresh or frozen embryo transfer (FET) compared to spontaneous conceptions. METHODS: Cohort studies were identified from MEDLINE, Embase, Cochrane Library (January 2019), and manual search. Meta-analyses were performed to estimate odds ratios (OR) using random effects models in RevMan 5.3 and I-squared (I2) test > 50% was considered as high heterogeneity. RESULTS: After 3142 titles and abstracts were screened, 1180 full-text articles were assessed, and 14 were eligible. For fresh embryo transfer, the pooled ORs were PTB 1.64 (95% CI 1.46, 1.84); I2 = 97%; LBW 1.67 (95% CI 1.52, 1.85); I2 = 94%; SGA 1.46 [95% CI 1.11, 1.92]; I2 = 99%, LGA 0.88 (95% CI 0.80, 0.87); I2 = 80%). For frozen, the pooled ORs were PTB 1.39 (95% CI 1.34, 1.44); I2 = 0%; LBW 1.38 (95% CI 0.91, 2.09); I2 = 98%; SGA 0.83 (95% CI 0.57, 1.19); I2 = 0%, LGA 1.57 (95% CI 1.48, 1.68); I2 = 22%). CONCLUSIONS: When compared with spontaneous pregnancies, fresh, but not frozen was associated with LBW and SGA. Both fresh and frozen were associated with PTB. Frozen was uniquely associated with LGA. Despite improvements in ART protocols in relation to pregnancy rates, attention is needed towards monitoring adverse neonatal outcomes in these pregnancies.


Assuntos
Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Fertilização , Retardo do Crescimento Fetal/etiologia , Infertilidade/terapia , Nascimento Prematuro/etiologia , Técnicas de Reprodução Assistida , Estudos de Coortes , Criopreservação , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Nascimento Prematuro/epidemiologia , Resultado do Tratamento
18.
Proc Natl Acad Sci U S A ; 117(14): 7837-7844, 2020 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-32229564

RESUMO

The blood-testis barrier (BTB) is thought to be indispensable for spermatogenesis because it creates a special environment for meiosis and protects haploid cells from the immune system. The BTB divides the seminiferous tubules into the adluminal and basal compartments. Spermatogonial stem cells (SSCs) have a unique ability to transmigrate from the adluminal compartment to the basal compartment through the BTB upon transplantation into the seminiferous tubule. Here, we analyzed the role of Cldn11, a major component of the BTB, in spermatogenesis using spermatogonial transplantation. Cldn11-deficient mice are infertile due to the cessation of spermatogenesis at the spermatocyte stage. Cldn11-deficient SSCs failed to colonize wild-type testes efficiently, and Cldn11-deficient SSCs that underwent double depletion of Cldn3 and Cldn5 showed minimal colonization, suggesting that claudins on SSCs are necessary for transmigration. However, Cldn11-deficient Sertoli cells increased SSC homing efficiency by >3-fold, suggesting that CLDN11 in Sertoli cells inhibits transmigration of SSCs through the BTB. In contrast to endogenous SSCs in intact Cldn11-deficient testes, those from WT or Cldn11-deficient testes regenerated sperm in Cldn11-deficient testes. The success of this autologous transplantation appears to depend on removal of endogenous germ cells for recipient preparation, which reprogrammed claudin expression patterns in Sertoli cells. Consistent with this idea, in vivo depletion of Cldn3/5 regenerated endogenous spermatogenesis in Cldn11-deficient mice. Thus, coordinated claudin expression in both SSCs and Sertoli cells expression is necessary for SSC homing and regeneration of spermatogenesis, and autologous stem cell transplantation can rescue congenital defects of a self-renewing tissue.


Assuntos
Fertilidade/genética , Infertilidade/terapia , Espermatogônias/transplante , Transplante de Células-Tronco , Animais , Modelos Animais de Doenças , Fertilidade/fisiologia , Humanos , Infertilidade/genética , Infertilidade/patologia , Masculino , Camundongos , Espermatogênese/genética , Espermatogônias/crescimento & desenvolvimento , Espermatozoides/crescimento & desenvolvimento , Espermatozoides/transplante , Células-Tronco/citologia , Transplante Autólogo/métodos
20.
Urol Clin North Am ; 47(2): 193-204, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32272991

RESUMO

Although infertility is now recognized as a disease by multiple organizations including the World Health Organization and the American Medical Association, private insurance companies rarely include coverage for infertility treatments. In this review, the authors assess the current state of care delivery for male infertility care in the United States. They discuss the scope of male infertility as well as the unique burdens it places on patients and review emerging market forces that could affect the future of care delivery for male infertility.


Assuntos
Assistência à Saúde/métodos , Assistência à Saúde/tendências , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/terapia , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Comorbidade , Assistência à Saúde/estatística & dados numéricos , Previsões , Política de Saúde/legislação & jurisprudência , Humanos , Infertilidade/diagnóstico , Infertilidade/economia , Infertilidade/terapia , Infertilidade Masculina/economia , Infertilidade Masculina/epidemiologia , Masculino , Estados Unidos/epidemiologia
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