Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

impact of pituitary blockage with GnRH antagonist and gonadotrophin stimulation length on the outcome of ICSI cycles in women older than 36 years

Background: The objective of this retrospective cohort study was to evaluate whether the length of pituitary blockage with gonadotrophin-releasing hormone [GnRH] antagonists or the stimulation period influence intracytoplasmic sperm injection [ICSI] outcomes in patients older than 36 years of age

Materials and Methods: In this retrospective study, a total of 138 couples with maternal age >36 years undergoing ICSI with an antagonist protocol were included. The influences of stimulation and suppression length on the response to ovarian stimulation and ICSI outcomes were investigated. Receiver operating characteristic curve [ROC] analysis was performed to assess the predictive value of the stimulation period for achievement of implantation and pregnancy

Results: The gonadotrophin stimulation length negatively influenced the implantation rate [RC: -4.200; p=0.023]. The area under ROC curve [AUC] could distinguish between women with positive and negative implantation [AUC: 0.611; CI: 0.546-0.673] and pregnancy [AUC: 0.593; CI: 0.528-0.656]. The threshold value demonstrated a high negative predictive value on likelihood of implantation [p=0.0032, 90% sensitivity] and pregnancy [p=0.0147, 87.1% sensitivity] when patients underwent more than 10 days of stimulation

Conclusion: The stimulation period negatively influences the implantation rate in women older than 36 years. A stimulation interval greater than 10 days is associated with a negative predictive value for the chance of implantation and pregnancy

developmental competence of oocytes retrieved from the leading follicle in controlled ovarian stimulated cycles

This study compares the developmental capacity of gametes retrieved from the largest follicle with small follicles of a cohort in controlled ovarian stimulated cycles. This prospective study performed in a private assisted fertilization center included 1016 follicles collected from 96 patients who underwent intra cytoplasmic sperm injection [ICSI]. After follicular aspiration, oocytes were assigned to two groups according to the diameter of the derived follicle. The large follicle group [n=96] comprised oocytes derived from the leading follicle of the cohort and the small follicle group [n=920] consisted oocytes derived from the smaller follicles of the cohort. The fertilization and percentage of top quality embryos were compared between groups by Chi-square or Fisher's exact test, where appropriate. The effect of the follicular diameter on oocyte dimorphism was assessed by binary logistic regression. A significantly higher percentage of oocytes derived from the leading follicle were in the metaphase II [MII] stage [100 vs. 70.0%, p<0.001]. However we observed no significant differences regarding the percentage of degenerated oocytes between the large [6.25%] and small follicle [5.0%] groups [p=0.550]. Regression analysis demonstrated a nearly two-fold increase in the incidence of vacuoles in oocytes derived from the largest follicle of the cohort [OR: 1.81, p=0.046]. The fertilization rate [50.0 vs. 38.8%, p=0.038] and the percentage of top quality embryos [84.7 vs. 76.4%, p=0.040] were significantly higher for oocytes derived from the largest follicle. However, the percentage of abnormal fertilized oocytes was equally distributed between the large follicle [15.0%] and small follicle [12. 8%] groups [p=0.550]. Our data suggest that intrafollicular mechanisms within the larger follicle of the cohort may allow for these follicles to amplify the responsiveness to exogenous gonadotropin, which leads to the formation of more competent oocytes with higher fertilization and developmental capacities

Confecção de uma guia cirúrgica avançada para cirurgia guiada em maxila edêntula

O desenvolvimento de guias cirúrgicas para a cirurgia avançada de implantes osseointegrados é uma realidade que está sendo alcançada graças ao aparecimento de softwares e ferramentas específicas...

Tratamento da Leishmaniose Tegumentar Americana / Treatment of american cutaneous leishmaniasis

A leishmaniose tegumentar americana é doença infecciosa da pele e mucosa, cujo agente etiológico é um protozoário do gênero Leishmania. Seu tratamento é desafio porque as drogas disponíveis apresentam elevada toxicidade, e nenhuma delas é bastante eficaz. A recidiva, a falha terapêutica em pacientes imunodeprimidos e a resistência ao tratamento são fatores que motivam a busca de uma droga ideal.

American cutaneous leishmaniasis is an infectious disease of the skin and mucosa caused by a protozoon of the genus Leishmania. Its treatment is a challenge since the drugs available are highly toxic and none is completely effective. Recurrence, therapeutic failure in immunosuppressed patients and treatment resistance are some factors that encourage searching an ideal drug.