O hormônio antimulleriano e a reserva ovariana: uma revisão integrativa da literatura / The anti-mullerian hormone and the ovarian reserve: an integrative literature review

O hormônio antimulleriano é secretado pelas células da granulosa dos folículos que estão em desenvolvimento no ovário. Por meio da sua dosagem, é possível avaliar a reserva ovariana. A mulher tem seu número máximo de oócitos no perío- do fetal, mas, conforme o tempo passa, existe uma queda do número de células germinativas. Desse modo, para mulheres que têm o desejo de engravidar, a dosa- gem de hormônios e a avaliação da reserva ovariana podem ajudar no processo. O objetivo do estudo foi encontrar evidências na literatura que comprovem que o hormônio antimulleriano é o melhor marcador da reserva ovariana. Para isso, foi realizada uma revisão integrativa, classificada como qualitativa; a busca de da- dos foi realizada no PubMed, utilizando a seguinte palavra-chave: "hormônio anti- mulleriano (HAM)". Foram encontrados oito artigos que abordavam diretamente o tema, e há evidências que corroboram a hipótese de que o hormônio antimulleria- no é um bom marcador da reserva ovariana, sendo necessários mais estudos para determinar a sua superioridade.

The anti-mullerian hormone is secreted by the granulosa cells of follicles that are developing in the ovary. Though its dosage is possible to evaluate the ovarian re- serve. Women have their maximum number of oocytes in the fetal period, but there is a decrease in the number of germinative cells as time goes by. Thus, women that desire to get pregnant can have hormones dosed and the ovarian reserve evalua- ted to help them with this process. The objective of this study was to find evidence in the literature that proves that the anti-mullerian hormone is the best marker of ovarian reserve. For this purpose, an integrative review was conducted, using the key word: "anti-mullerian hormone (AMH)". Eight articles were found on the subject and there is evidence that proves the hypothesis of the anti-mullerian hormone as a good marker, however more studies are needed to determine its superiority.

Intenções de fecundidade: uma revisão da literatura acerca da variável em países de renda alta e no Brasil / Fertility intentions: a literature review on high-income countries and Brazil / Intenciones de fecundidad: una revisión de la literatura sobre la variable en países de ingresos altos y en Brasil

Resumo A literatura sobre intenções de fecundidade tem ganhado crescente relevância em estudos demográficos porque, sendo um determinante próximo da fecundidade, auxilia o entendimento do comportamento reprodutivo de diferentes populações. Contudo, esta literatura não foi ainda organizada segundo os principais e mais recorrentes aspectos dispersos na literatura. Estudos geralmente utilizam uma única característica acerca das intenções de fecundidade, seja por meio dos seus conceitos, das principais teorias ou de principais indicadores. Este trabalho possui, portanto, o objetivo de organizar e articular os principais e mais recorrentes aspectos presentes nos estudos sobre intenções de fecundidade. Ao longo da discussão, aprofunda-se na relação existente entre intenções de fecundidade e fecundidade observada. A princípio, foca-se nos países de renda alta, sobre e para os quais a literatura referente ao tema foi desenvolvida. Contudo, também são abordados países de renda média e fecundidade baixa, com ênfase no Brasil, para os quais a produção, especialmente a partir de uma abordagem teórica, ainda é incipiente.

Abstract The literature on fertility intentions has gained increasing relevance in demographic studies because, as a close determinant of fertility, it helps understand the reproductive behavior of different populations. However, this literature has not yet been organized according to the main and most recurrent aspects covered. Studies generally use one single aspect of fertility intentions, whether through its concepts, main theories or main indicators. Therefore, the goal of this work is to organize and articulate the main and most recurrent aspects present in studies on fertility intentions. It begins by presenting the main concepts. Then, it discusses important theoretical approaches on the formation of fertility intentions, as well as its main determinants. Finally, it contextualizes fertility intentions (and their levels) in different scenarios. Throughout the discussion, for each topic presented, the paper delves deeper into the relationship between fertility intentions and observed fertility. Its first focus is on high-income countries covered in the literature on the subject. However, it also discusses middle-income countries with low fertility, focusing on Brazil, for which academic production, especially from a theoretical approach, is still incipient.

Resumen La literatura sobre las intenciones de fecundidad ha ganado relevancia en los estudios demográficos porque, al ser estas determinantes próximos de la fecundidad, ayudan a entender el comportamiento reproductivo de diferentes poblaciones. Sin embargo, esta literatura no se ha organizado según sus aspectos principales y más recurrentes. Así, los estudios trabaja en general sobre un solo aspecto de las intenciones de fecundidad, sea a través de sus conceptos, de sus principales teorías o de sus principales indicadores. El objetivo de este artículo es, por lo tanto, organizar y articular los principales y más recurrentes aspectos presentes en los estudios sobre intenciones reproductivas. Así, comienza presentando sus conceptos principales. Luego, discute importantes corrientes teóricas sobre la formación de intenciones de fecundidad y también analiza sus principales determinantes. Finalmente, contextualiza las intenciones de fecundidad (y sus niveles) en diferentes escenarios. A través de cada tema presentado, se profundiza en la relación entre las intenciones de fecundidad y la fecundidad observada en las poblaciones. Es para ello que se centra, en un primer momento, en los países de ingresos altos, sobre y para los cuales se elaboró la literatura sobre el tema. Sin embargo, también se analizan los países de ingresos medios y de baja fecundidad, con énfasis en Brasil, cuya producción, especialmente desde un enfoque teórico, es aún incipiente.

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China / 北京大学学报(医学版)

OBJECTIVE@#To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province.@*METHODS@#Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression.@*RESULTS@#The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66).@*CONCLUSION@#The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.

A survey on the current status of cognition of birth safety among married HIV-infected people aged 18-45 years / 中华流行病学杂志

Objective: To understand the current status of fertility safety cognition among married HIV-infected people aged 18-45 years and to provide evidence for fertility safety intervention in HIV-infected families. Methods: Six districts in Chongqing and Zigong City in Sichuan Province were selected. A questionnaire survey was conducted among married HIV-infected people aged 18-45 years who were followed up from November 2021 to April 2022 to collect their general demographic characteristics, histories of sex experience, fertility intention, and knowledge of birth safety. Unconditional logistic regression and Poisson regression were used to analyze the factors affecting the cognition of birth safety. Results: A total of 266 HIV-infected people were included in the study; 58.3% (155/266) were women, and 48.9% (130/266) had fertility desire. The cognition rate of knowledge of birth safety was 59.4% (158/266). The cognition rate of women's knowledge of birth safety was 2.14 (95%CI: 1.25-3.66) times that of men's. The cognition rate of knowledge of birth safety among HIV-infected persons with a high school education level or above was 1.88 (95%CI: 1.08-3.27) times that of those with a low education level. The cognition rate of knowledge of reproductive safety among HIV-infected people with fertility intention was 1.88 (95%CI: 1.10-3.22) times that of those without fertility intention. The cognition rate of knowledge of birth safety among HIV-infected persons who received AIDS knowledge promotion and education was 9.06 (95%CI: 2.46-33.32) times that of those who did not. The cognition rate of measures of birth safety was 5.3% (14/266). The Poisson regression analysis showed no significant difference in the cognition rate of specific measures among gender, age, education and other factors. Conclusions: HIV-infected people aged 18-45 years and married with a spouse have a low awareness of birth safety, and there are risks of HIV transmission between couples and mother-to-child in the family. Targeted birth safety education and intervention should be strengthened to reduce HIV transmission.

A pre-conception cohort study of fertility and its related factors among couples with the intention of conception / 中华预防医学杂志

Objective: To describe fertility and explore factors associated with it among pre-conception couples of childbearing age. Methods: Based on the pre-conceptional offspring trajectory study of the School of Public Health of Fudan University, couples of childbearing age who participated in the pre-conception physical examination in Shanghai Jiading District from 2016 to 2021 were recruited and followed up. Couples' time to pregnancy (TTP) was analyzed and Cox proportional hazards regression model was used to explore the factors associated with TTP. Kaplan-Meier was used to calculate each menstrual cycle's cumulative pregnancy rate. Results: A total of 1 095 preconception couples were included in the analysis, the M(Q1,Q3)of TTP was 4.33 (2.41, 9.78) menstrual cycles. Age of women (FR=0.90, 95%CI: 0.85-0.95, P<0.001), women who were overweight or obese before pregnancy (FR=0.36, 95%CI: 0.24-0.55, P<0.001), women who were exposed to second-hand smoking (FR=0.63, 95%CI: 0.44-0.92, P=0.016), women whose home or office had been renovated in the past 2 years and had a particular smell (FR=0.46, 95%CI: 0.26-0.81, P=0.008) were risk factors for impaired fertility. Regular menstrual cycles (FR=1.64, 95%CI: 1.16-2.31, P=0.005), females who often drank tea/coffee (FR=1.55, 95%CI: 1.11-2.17, P=0.011) and males who took folic acid before conception (FR=2.35, 95%CI: 1.38-4.23, P=0.002) were associated with better fertility. The cumulative pregnancy rate of 3, 6, and 12 menstrual cycles was 37.6%, 64.4%, and 78.4%, respectively. Conclusion: Older couples, overweight or obesity before pregnancy, irregular menstruation, exposure to secondhand smoke and decoration pollutants in females are associated with impaired fertility. Frequent tea/coffee drinking before pregnancy in females and taking folic acid before pregnancy in males are associated with shortened conception time.

Mortalidade de mulheres em idade fértil no Brasil de 2006 a 2019: causas e tendências / Mortality of women of fertile age between 2006 and 2019: causes and trends / Mortalidad de mujeres en edad fértil entre 2006 y 2019: causas y tendencias

Resumo O objetivo deste estudo é analisar a tendência das principais causas de óbito de mulheres em idade fértil (MIF) no Brasil, por faixa etária, no período de 2006 a 2019. Utilizaram-se dados do Sistema de Informações sobre Mortalidade (SIM) e do Instituto Brasileiro de Geografia e Estatística (IBGE). As principais causas de morte de MIF (10 a 49 anos) foram classificadas por capítulos da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10). Posteriormente realizou-se análise de tendência temporal por meio de modelos de regressão polinomial das principais causas de morte de MIF segundo faixa etária. No Brasil, as maiores taxas de mortalidade por causas p/100 mil MIF deveram-se a neoplasias (25,34), doenças do aparelho circulatório (20,15), causas externas (18,69), doenças infecciosas e parasitárias (8,79) e doenças do aparelho respiratório (6,37). Para o período analisado, após padronização, as taxas de mortalidade por doenças do aparelho circulatório, do aparelho respiratório e infecciosas e parasitárias apresentaram tendência decrescente, com uma queda expressiva de 26,6% para as doenças do aparelho circulatório; já as taxas de mortalidade por causas externas e neoplasias registraram tendência crescente de 2006 a 2012 e decrescente de 2013 em diante. As causas externas e as neoplasias foram as principais causas de óbito, especialmente entre as mulheres mais jovens e com tendência crescente. Sendo este um importante problema de saúde pública, faz-se necessário planejar ações que otimizem os recursos e melhorem a qualidade de vida e saúde das mulheres.

Abstract The aim of this study is to analyze the trend of the main causes of death of women of reproductive age (WRA) in Brazil by age group from 2006 to 2019. Data used are from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE) of Brazil. The main causes of death of WRA (10 to 49 years) were divided by chapters as per the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Subsequently, a temporal trend analysis was performed using polynomial regression models for the main causes of death in WRA. In Brazil, the highest mortality rates by cause by 100,000 WRA occurred due to: neoplasms (25.34), diseases of the circulatory system (20.15), external causes (18.69), infectious and parasitic diseases (8.79) and respiratory system diseases (6.37). For the analyzed period, after standardization, the mortality rate due to diseases of the circulatory and respiratory systems, and infectious and parasitic conditions showed a decreasing trend, with a significant drop of 26.6% for diseases of the circulatory system; while external causes and neoplasms showed an increasing trend from 2006 to 2012 and decreasing from 2013 onwards. Identifying the main causes of death of WRA in each age group is required to guide the planning of actions to optimize resources and obtain better results in women's health.

Resumen El objetivo de este estudio es analizar la tendencia de las principales causas de muerte de mujeres en edad fértil (MEF) en Brasil por grupo de edad desde 2006 hasta 2019. Con datos del Sistema de Información de Mortalidad (SIM) y del Instituto Brasileiro de Geografía y Estadísticas (IBGE) de Brasil, las principales causas de muerte de MEF (10 a 49 años) fueron divididas por capítulos de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud (CIE-10). Luego se hizo un análisis de tendencia temporal mediante modelos de regresión polinomial de las principales causas de muerte en MEF. En Brasil, las mayores tasas de mortalidad por causa en MEF/100.000 mujeres ocurrieron por neoplasias (25,34), enfermedades del aparato circulatorio (20,15), causas externas (18,69), enfermedades infecciosas y parasitarias (8,79) y enfermedades del sistema respiratorio (6,37). Para el período analizado, después de la estandarización, la tasa de mortalidad por neoplasias y por enfermedades de los sistemas circulatorio, respiratorio e infeccioso y parasitario mostró una tendencia decreciente, con una caída significativa del 26,6 % para enfermedades del sistema circulatorio, mientras que las causas externas y neoplasias mostraron una tendencia creciente entre 2006 y 2012 y decreciente desde 2013 en adelante. Identificar las principales causas de muerte en MEF en cada grupo de edad orienta la planificación de acciones para optimizar recursos y obtener mejores resultados en la salud de la mujer.

Preservação de fertilidade: cultivo de folículos ovarianos e novo dispositivo para criopreservação seminal / Fertility preservation: ovarian follicle culture and a new device for seminal cryopreservation

INTRODUÇÃO: A oncofertilidade tem o desafio de buscar estratégias para preservar a função reprodutiva. Este estudo explorou duas possibilidades como implementação para as técnicas de preservação da fertilidade feminina e masculina. OBJETIVO: Analisar a eficiência do cultivo de folículos pré-antrais de camundongos suplementado com lisado de plaquetas humanas e desenvolver um protótipo para criopreservação de sêmen humano. MATERIAIS E MÉTODOS: Os folículos pré-antrais foram isolados mecanicamente de ovários de fêmeas de camundongos e foram cultivados individualmente em sistema entre camadas de óleo mineral. Os folículos foram cultivados divididos em 4 grupos, sendo um controle, sem o uso do lisado de plaquetas e três grupos com diferentes concentrações de lisado de plaquetas humanas (PLTMax®). Foram avaliadas a sobrevivência celular, desenvolvimento folicular e características oocitárias. Para o segundo estudo foi desenvolvido e impresso em 3D com filamentos de acrilonitrilo butadieno-estireno (ABS) um protótipo que suporte 10 palhetas com amostras seminais no vapor de nitrogênio líquido (N2L), etapa essencial para criopreservação de sêmen humano. Para os testes foram utilizadas 40 amostras seminais. A temperatura ambiente e no interior das palhetas de envase das amostras foram medidas e estabelecida a curva de resfriamento. Os parâmetros de motilidade, vitalidade e fragmentação do DNA espermático foram avaliados antes do congelamento e após o descongelamento. Foram realizados dois testes, um de posicionamento das palhetas e outro comparativo entre o protótipo e um dispositivo com suporte em poliestireno expandido (EPS). RESULTADOS: O cultivo de 11 dias induziu um aumento no tamanho folicular em todas as condições, sendo maior no grupo controle, seguido do grupo com 10% de PLTMax®, mas com diferença significativa (p<0,001). O grupo controle apresentou maior número de oócitos intactos (>50%) em relação aos demais (<35%). Todos os 4 grupos apresentaram taxas de vitalidade celular acima de 70%. Quanto aos testes com o protótipo em ABS foi verificado que as curvas de refrigeração foram notavelmente reproduzíveis. O material do protótipo resistiu a inúmeros mergulhos (>300) no N2L, sem demonstrar danos ao material. Diferenças significativas (p<0,001) foram observadas para a taxa de recuperação média da motilidade e vitalidade espermática em relação aos dados da amostra 2 fresca em ambos os testes. A motilidade, a vitalidade e a fragmentação do DNA espermático antes do congelamento e após o descongelamento não mostraram diferenças em relação a posição das palhetas. Também não houve diferença quanto ao índice de fragmentação verificada das amostras criopreservadas com uso do protótipo em ABS e o suporte em EPS, mesmo após o cultivo, após 24 horas de cultivo. Contudo, houve diferença em relação a amostra fresca (p<00,1). Quanto a recuperação das taxas de motilidade e vitalidade não houve diferença entre o ABS e EPS após o descongelamento e 24 horas de cultivo. CONCLUSÃO: O PLTMax®, embora tenha apresentado menor desempenho que o HSA, é um candidato de suplementação para o cultivo de folículos pré-antrais que merece ser mais explorado. O protótipo em ABS demonstrou resistência, praticidade e segurança para criopreservação seminal de forma reprodutível e eficiente.

INTRODUCTION: Oncofertility has the challenge of seeking strategies to preserve reproductive function. This study explored two possibilities as implementations for female and male fertility preservation techniques. PURPOSE: To analyze the efficiency of mouse preantral follicle culture supplemented with human platelet lysate and to develop a prototype for human semen cryopreservation. MATERIAL AND METHODS: Preantral follicles were mechanically isolated from female mouse ovaries and were individually cultured using a mineral oil interlayer system. The follicles were cultured divided into 4 groups, one control, without the use of platelet lysate and three groups with different concentrations of human platelet lysate (PLTMax®). Cell survival, follicular development and oocyte characteristics were evaluated. For the second study, a prototype was developed and printed in 3D with acrylonitrile butadiene styrene (ABS) filaments to support 10 straws with seminal samples in liquid nitrogen (N2L) vapor, an essential step for human semen cryopreservation. For the tests 40 seminal samples were used. Ambient and internal temperatures inside the sample straws were measured and the cooling curve was established. The parameters of motility, vitality and sperm DNA fragmentation were evaluated before freezing and after thawing. Two tests were performed, one for positioning the straws and the other comparing the prototype and a device with expanded polystyrene (EPS) support. RESULTS: The 11-day culture induced an increase in follicular size in all conditions, being higher in the control group followed by the group with 10% PLTMax®, but with significant difference (p<0.001). The control group presented a higher number of intact oocytes (>50%) compared to the others (<35%). All 4 groups presented cell vitality rates above 70%. As for the ABS prototype tests, it was verified that the cooling curves were remarkably reproducible. The prototype withstood numerous dips (>300) in N2L without showing damage to the material. Significant differences (p<0.001) were observed for the mean recovery rate of sperm motility and vitality compared to the fresh sample data in both tests. Motility, vitality and sperm DNA fragmentation before freezing and after thawing showed no differences with respect to the position of the straws. There was also no difference in the fragmentation index verified for samples cryopreserved using the ABS prototype and the EPS support, even after 24 hours of culture. However, there was a difference compared to the fresh 4 sample (p<00.1). As for the recovery of motility and vitality rates there was no difference between ABS and EPS after thawing and 24 hours of culture. CONCLUSION: PLTMax®, although it showed lower performance than HSA, is a supplementation candidate for preantral follicle culture that deserves further exploration. The ABS prototype demonstrated strength, practicality and safety for seminal cryopreservation in a reproducible and efficient manner.

Argentina's fertility regime (1980-2010): the end of the first demographic transition or an emergent second one? / O regime de fecundidade na Argentina (1980-2010): o fim da primeira transição demográfica ou uma segunda emergente? / El régimen de fecundidad en Argentina (1980-2010): ¿El final de la primera transición demográfica o una segunda emergente?

Abstract Argentina's fertility transition has exceptional characteristics. Compared to most Latin American countries, Argentina's fertility declined relatively early and, unlike fertility transitions in Western Europe, this decline did not lead to a high period of natural population growth. By the beginning of the twenty-first century, Argentina seemed to experience fertility stagnation despite women's increased formal education and labor force participation, and increased availability of contraceptives. Using the 1980, 1991, 2001, and 2010 Population Censuses, I demonstrate that fertility has continued its downward trend from 1980 to 2010. Changes in fertility behaviors are given by a decrease in the mean number of children per woman, but not by an increase in childlessness. However, there is evidence of postponement of childbearing. Results show that although Argentina is completing its first demographic transition, as it has not reached below-replacement fertility yet, this country could show signs of an emerging second demographic transition.

Resumo A transição da fecundidade na Argentina tem características excepcionais. Em comparação com a maioria dos países da América Latina, a fecundidade na Argentina diminuiu relativamente cedo e, diferentemente das transições de fecundidade na Europa Ocidental, esse declínio não levou a um período de alto crescimento natural da população. No início do século 21, a Argentina parecia experimentar uma estagnação da fecundidade, apesar do aumento da educação formal e da participação laboral das mulheres e de uma maior disponibilidade de contraceptivos. Utilizando os dados dos Censos Populacionais de 1980, 1991, 2001 e 2010, o presente trabalho mostra que a fecundidade continuou sua tendência de queda de 1980 a 2010. As mudanças no comportamento da fecundidade são dadas por uma diminuição no número médio de filhos por mulher, mas não por um aumento da nuliparidade. No entanto, há evidências de um adiamento da fecundidade. Os resultados mostram que, embora a Argentina esteja completando sua primeira transição demográfica, já que ainda não atingiu a fecundidade abaixo do nível de reposição, o país pode mostrar sinais de uma emergente segunda transição demográfica.

Resumen La transición de la fecundidad en Argentina tiene características excepcionales. Comparada con la mayoría de los países latinoamericanos, la fecundidad en Argentina disminuyó relativamente temprano y, a diferencia de las transiciones de fecundidad en Europa occidental, este descenso no condujo a un período de alto crecimiento natural de la población. A principios del siglo XXI, Argentina parecía experimentar un estancamiento de la fecundidad a pesar del aumento de la educación formal y de la participación laboral de las mujeres y de una mayor disponibilidad de anticonceptivos. Utilizando los Censos de Población de 1980, 1991, 2001 y 2010, demuestro que la fecundidad ha continuado su tendencia descendente desde 1980 hasta 2010. Los cambios en los comportamientos de fecundidad vienen dados por una disminución del número promedio de hijos por mujer, pero no por un aumento de la nuliparidad. Sin embargo, hay evidencia de un aplazamiento de la fecundidad. Los resultados muestran que, aunque Argentina está completando su primera transición demográfica, ya que aún no ha alcanzado una fecundidad por debajo del nivel de reemplazo, este país podría mostrar signos de una segunda transición demográfica emergente.

Fertility desire and associated factors among people on antiretroviral treatment at a public health facility in Hawassa city, Southern Ethiopia

Background: Fertility desire is the plan of people to have a child or more children in the face of being diagnosed with HIV and plan to a commitment to implement the desire. Methods: An institutional-based cross-sectional study was conducted in Hawassa city public health facilities from May 09 ­July 07/07/2019. Four hundred (400) study participants were selected using a simple random sampling technique. Data were collected by using interviewer-administered pre-tested structured questionnaires and chart review. The collected data were entered into EPI data version 3.1 software and then transported to SPSS version 20 for cleaning and data analysis. Bivariate and multivariate logistic regression was used to identify associated factors at p<0.05 was taken as a significant value with a 95% confidence level. Results: A total of 400 clients were included in the study giving a response rate of 97 %. The overall fertility desire was 53.6 % (95%CI: 48.7%, 58.2%). Age, sexual practice in the last six months and discussing reproductive health with ART providers were significantly associated with fertility desire. Younger age was positively associated with fertility desire, age group (18-29), [Adjust odds ratio = 5.75 95%CI (2.85, 11.57)], age group (30-39), [Adjust odds ratio= 4.71 95%CI:(2.55, 8.71)] Sexual practice in the last six months [Adjust odds ratio = 3.00 95%1.46, 6.16)] and counseling reproductive health with ART provider [Adjust odds ratio = 3.10 95%CI:(1.86,5.15)] Conclusion: The prevalence of fertility desire in this study was higher than previous studies while factors associated with fertility desire were age, sexual practice in the last six months, and discussing reproductive health with ART providers

Provincial differentials of the effect of internal migration on teenage fertility in South Africa

This study investigated the association between internal migration and teenage fertility in South Africa. Data were from the 2007 and 2016 South African community surveys, N2007= 89800 and N2016=239733, age range 12 to 19, black teenagers= 81.5% and 89.4%, respectively. Results showed that between 2007 and 2016 internal migration levels decreased by 2% nationally, but increased for Gauteng, Western Cape and KwaZulu Natal provinces. Teenage fertility levels decreased in all provinces except the Northern Cape in the study period. In both years teenage fertility was observed at higher levels among girls that were older, heads of households, and who were in secondary schooling. Random-intercept multilevel binary logistic regression revealed that the risk of teenage fertility differed between more rural and urban provinces. In provinces that were predominantly rural the risk of teenage pregnancy increased as community-levels of internal migration increased while the risk decreased as internal migration increased in provinces that were predominantly urban. Findings suggest that the effects of internal migration on teenage pregnancy are largely dependent on the local context making it necessary to create interventions that are context-specific at sub-national levels.

Religion and non-marital fertility: A qualitative study of the perspectives and experiences of South African Muslim women

In light of the rising number of children born outside of formal marriage, there is increasing concern about the well-being of these mothers and children, especially since they mostly come from disadvantaged populations. This study aims to determine the role religion plays in the experience of non­marital fertility. This study draws on data from ten in-depth interviews with women in Durban, South Africa. The study found that women did not anticipate the negative impact of non­marital fertility prior to experiencing their first birth. The main reason contributing to the experience of non­marital fertility was the lack of sex education.Many women believed that Islam allowed only married women to use contraceptives because unmarried women are expected to practice celibacy and their religion advocates for a two-parent household. As a result, unmarried women with children found themselves often ostracised from their community. The study recommends a comprehensive sexual education regime to address the challenges associated with non-marital fertility. (Afr J Reprod Health 2022; 26[7]: 49-58).

Impact of a large dam on reproduction of a non-migratory teleost species, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae) / Impacto de uma grande barragem na reprodução de uma espécie de teleósteo não migradora, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae)

The release of water from the reservoir hypolimnion, lower concentration of oxygen and the anthropogenic regulation of the river flow, could affect the reproduction of fish, especially migratory species. However, little is known about the effects of these changes in water on non-migratory species. In this sense, the reproduction of Acestrohynchus lacustris was evaluated in two sections of São Francisco River, Minas Gerais, Brazil. Section 1, located immediately downstream from Três Marias Dam (18°09'31.65"S and 45°13'36.00"W) and section 2, located at the confluence of the São Francisco and the Abaeté Rivers (18°02'47.78"S and 45°10'57.95"W). For this, we obtained the physico-chemical parameters of water of each study section. Additionally, biometric data and biological indices of all specimens were measured. Fecundity and follicles diameters were measured in females. Temperature, dissolved oxygen and flow showed lower values in section 1. Fish captured in this section, had lower values of GSI in both sexes, and females presented decreased values of fecundity and follicles diameter. This species showed reproductive activity in the two sections analyzed, however, in section 1 where the temperature and dissolved oxygen presented significant lower values, the reproductive capacity of A. lacustris, was negatively affected.

A liberação de água do hipolímnio do reservatório, baixa concentração de oxigênio e a regulação antropogênica do fluxo do rio podem afetar a reprodução de peixes, principalmente espécies migradoras. No entanto, pouco se sabe sobre os efeitos dessas mudanças nas condições da água em espécies não migradoras. A reprodução de Acestrohynchus lacustris foi avaliada em duas seções do rio São Francisco. Seção 1, localizada imediatamente a jusante da barragem de Três Marias e seção 2, localizada na confluência dos rios São Francisco e Abaeté. Para isso, foram obtidos os parâmetros físico-químicos da água de cada seção do estudo. Além disso, dados biométricos e índices biológicos de todos os peixes capturados foram obtidos. Adicionalmente, nas fêmeas foram medidos os diâmetros dos folículos vitelogênicos e a fecundidade. Temperatura, oxigênio dissolvido e fluxo apresentaram valores mais baixos na seção 1. Os peixes capturados nesta seção apresentaram menores valores de IGS em ambos os sexos, e as fêmeas apresentaram menores valores de fecundidade e diâmetro dos folículos. Essa espécie apresentou atividade reprodutiva nas duas seções analisadas, porém, na seção 1, onde os parâmetros da água apresentam piores condições para o processo reprodutivo de peixes, a capacidade reprodutiva de A. lacustris foi afetada negativamente.

CRISPR/Cas9-mediated genome editing reveals 12 testis-enriched genes dispensable for male fertility in mice / 亚洲男科学杂志(英文版)

Gene expression analyses suggest that more than 1000-2000 genes are expressed predominantly in mouse and human testes. Although functional analyses of hundreds of these genes have been performed, there are still many testis-enriched genes whose functions remain unexplored. Analyzing gene function using knockout (KO) mice is a powerful tool to discern if the gene of interest is essential for sperm formation, function, and male fertility in vivo. In this study, we generated KO mice for 12 testis-enriched genes, 1700057G04Rik, 4921539E11Rik, 4930558C23Rik, Cby2, Ldhal6b, Rasef, Slc25a2, Slc25a41, Smim8, Smim9, Tmem210, and Tomm20l, using the clustered regularly interspaced short palindromic repeats /CRISPR-associated protein 9 (CRISPR/Cas9) system. We designed two gRNAs for each gene to excise almost all the protein-coding regions to ensure that the deletions in these genes result in a null mutation. Mating tests of KO mice reveal that these 12 genes are not essential for male fertility, at least when individually ablated, and not together with other potentially compensatory paralogous genes. Our results could prevent other laboratories from expending duplicative effort generating KO mice, for which no apparent phenotype exists.

Impact of a large dam on reproduction of a non-migratory teleost species, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae) / Impacto de uma grande barragem na reprodução de uma espécie de teleósteo não migradora, Acestrorhynchus lacustris (Characiformes: Acestrorhynchidae)

The release of water from the reservoir hypolimnion, lower concentration of oxygen and the anthropogenic regulation of the river flow, could affect the reproduction of fish, especially migratory species. However, little is known about the effects of these changes in water on non-migratory species. In this sense, the reproduction of Acestrohynchus lacustris was evaluated in two sections of São Francisco River, Minas Gerais, Brazil. Section 1, located immediately downstream from Três Marias Dam (18°09'31.65"S and 45°13'36.00"W) and section 2, located at the confluence of the São Francisco and the Abaeté Rivers (18°02'47.78"S and 45°1057.95"W). For this, we obtained the physico-chemical parameters of water of each study section. Additionally, biometric data and biological indices ofall specimens were measured. Fecundity and follicles diameters were measured in females. Temperature, dissolvedoxygen and flow showed lower values in section 1. Fish captured in this section, had lower values of GSI in bothsexes, and females presented decreased values of fecundity and follicles diameter. This species showed reproductiveactivity in the two sections analyzed, however, in section 1 where the temperature and dissolved oxygen presentedsignificant lower values, the reproductive capacity of A. lacustris, was negatively affected.

A liberação de água do hipolímnio do reservatório, baixa concentração de oxigênio e a regulação antropogênica do fluxo do rio podem afetar a reprodução de peixes, principalmente espécies migradoras. No entanto, pouco se sabe sobre os efeitos dessas mudanças nas condições da água em espécies não migradoras. A reprodução de Acestrohynchus lacustris foi avaliada em duas seções do rio São Francisco. Seção 1, localizada imediatamente a jusante da barragem de Três Marias e seção 2, localizada na confluência dos rios São Francisco e Abaeté. Para isso, foram obtidos os parâmetros físico-químicos da água de cada seção do estudo. Além disso, dados biométricos e índices biológicos de todos os peixes capturados foram obtidos. Adicionalmente, nas fêmeas foram medidos os diâmetros dos folículos vitelogênicos e a fecundidade. Temperatura, oxigênio dissolvido e fluxo apresentaram valores mais baixos na seção 1. Os peixes capturados nesta seção apresentaram menores valores de IGS em ambos os sexos, e as fêmeas apresentaram menores valores de fecundidade e diâmetro dos folículos. Essa espécie apresentou atividade reprodutiva nas duas seções analisadas, porém, na seção 1, onde os parâmetros da água apresentam piores condições para o processo reprodutivo de peixes, a capacidade reprodutiva de A. lacustris foi afetada negativamente.

Clinical outcomes analysis of fertility-preserving therapy for atypical endometrial hyperplasia and early endometrial carcinoma / 中华肿瘤杂志

Objective: To analyze the clinical efficacy of fertility-preserving therapy in patients with atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EC). Methods: The general condition, pathological type, treatment plan, tumor outcomes and pregnancy outcomes of 110 patients with AEH and EC treated with fertility-preserving therapy in Peking University People's Hospital from December 2005 to September 2019 were retrospectively analyzed. Kaplan-Meier and Log rank tests were used for survival analysis. Results: The response rate of 110 cases of AEH (62 cases) and EC (48 cases) was 94.5% (104/110) after fertility-preserving therapy. There were 93 cases (84.5%) achieved complete response and 11 cases (10.0%) achieved partial response, and the recurrence rate was 29.0% (27/93). The complete response rates of AEH and EC were 90.3% (56/62) and 77.1% (37/48), respectively, without significant difference (P=0.057). The recurrence rates of EC were significantly higher than that of AEH (40.5% vs 21.4%; P=0.022). Forty-one patients with complete response had pregnancy intention, the pregnancy rate was 70.7% (29/41), and the live birth rate was 56.1% (23/41). The live birth rate of AEH was 68.2% (15/22) and that of EC was 42.1% (8/19), the difference was statistically significant (P=0.032). The pathological type was related with the recurrence (P=0.044). Conclusions: Patients with AEH and EC can obtain high complete response rate and pregnancy rate after fertility-preserving therapy. The recurrence rate of EC is higher than that of AEH, while the live birth rate of AEH is higher than that of EC.

Evaluation of fertility and embryo implantation in rats after the oral administration of Salvia officinalis (sage) extract / Evaluación de la fertilidad y la implantación de embriones en ratas después de la administración oral de extracto de Salvia officinalis (salvia)

SUMMARY: In Saudi Arabia, it is widely believed that women with reproductive problems can use the extract of the sage plant as a tea drink. This study was conducted to investigate the effects of this herb on the fertility of female rats and embryo implantation. Forty-eight Wistar virgin female rats were divided into four groups at random, with 12 rats in each group. The control group received distilled water orally. The three treatment groups received different concentrations of sage extract: 15, 60, or 100 mg/kg for 14 days before mating, then mated with a male and sacrificed on the 7th day of gestation, the uterine horns removed, and photographed. The total body weight of mothers, weight of uteri and ovaries and number of fetuses were determined. Ovarian and uteri tissues were cut into 5 µ sections and stained with hematoxylin and eosin. Serum FSH, LH were determined by the ELISA method. The present study showed that low dose of sage (15 mg/kg) have no effects on serum concentration levels of FSH and LH hormones, also has no effect on the number of growing follicles. The present study showed a significant differences (P≤0.05) in body weight, ovary and uterus weight in the groups treated with high doses of Salvia officinalis as compared to control group. Also a significant differences (P≤0.05) found in FSH, LH hormones. Histological study showed overall histomorphological structural configurations including growing and matured graafian follicular countable changes, besides a number of corpora lutea and regressed follicles in the treated groups with high doses of Salvia officinalis as compared to control group. The researchers concluded that the extract of the sage plant with high doses can stimulate the growth graafian follicles and improve fertility in female rats.

RESUMEN: En Arabia Saudita, se cree ampliamente que las mujeres con problemas reproductivos pueden usar el extracto de la planta de salvia como bebida de té. Este estudio se realizó para investigar los efectos de esta hierba sobre la fertilidad de las ratas hembra y la implantación del embrión. Se dividieron cuarenta y ocho ratas hembra vírgenes Wistar en cuatro grupos al azar, con 12 ratas en cada grupo. El grupo control recibió agua destilada por vía oral. Los tres grupos de tratamiento recibieron diferentes concentraciones de extracto de salvia: 15, 60 o 100 mg/kg durante 14 días antes del apareamiento, luego se aparearon con un macho y se sacrificaron el día 7 de gestación, se extrajeron los cuernos uterinos y se fotografiaron. Se determinó el peso corporal total de las madres, el peso del útero y los ovarios y el número de fetos. Los tejidos ováricos y uterinos se cortaron en secciones de 5 µ y se tiñeron con hematoxilina y eosina. FSH sérica, LH se determinaron por el método ELISA. El presente estudio mostró que dosis bajas de salvia (15 mg/kg) no tienen efectos sobre los niveles de concentración sérica de las hormonas FSH y LH, tampoco tienen efecto sobre el número de folículos en crecimiento. El presente estudio mostró diferencias significativas (P≤0,05) en el peso corporal, peso de ovario y útero en los grupos tratados con altas dosis de Salvia officinalis en comparación con el grupo control. También se encontraron diferencias significativas (P≤0,05) en las hormonas FSH, LH. El estudio histológico mostró configuraciones estructurales histomorfológicas generales que incluyen cambios contables en los folículos maduros (de Graaf) y en crecimiento, además de una cantidad de cuerpos lúteos y folículos en regresión en los grupos tratados con altas dosis de Salvia officinalis en comparación con el grupo de control. Los investigadores concluyeron que el extracto de la planta de salvia en altas dosis puede estimular el crecimiento de los folículos maduros y mejorar la fertilidad en ratas hembra.

Fertility trends during successive novel infectious disease outbreaks: Zika and COVID-19 in Brazil / Tendências de fecundidade durante sucessivas epidemias de doenças infecciosas novas: Zika e COVID-19 no Brasil / Tendencias de fecundidad durante los sucesivos brotes de nuevas enfermedades infecciosas: Zika y COVID-19 en Brasil

This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.

O objetivo desta contribuição de dados é estimar as tendências de fecundidade no Brasil nos anos 2010 e início dos anos 2020 durante epidemias consecutivas de doenças infecciosas novas, ou seja, Zika vírus e COVID-19. Utilizamos dados do Ministério da Saúde e do Registro Civil Nacional de 2011-2021 para calcular as taxas mensais de fecundidade nos níveis nacional e estadual. Também utilizamos o modelo ARIMA sazonal para prever taxas de fecundidade por mês e por estado em 2021, e comparamos essas previsões com as taxas de fecundidade observadas. Encontramos que as taxas de fecundidade eram estáveis entre 2011 e 2015, sem variação significativa, seguido por um declínio abrupto durante o surto de Zika em 2016, e seguido por sua vez por um retorno aos níveis pré-Zika depois do fim da epidemia. Além disso, para avaliar o efeito da pandemia de COVID-19, comparamos as taxas observadas e previstas de 2020-2021, mostrando que as quedas geralmente eram maiores nas taxas observadas do que nas previstas, porém sem significância estatística. Argumentamos que o recrudescimento da pandemia de COVID-19 em 2021 poderá levar a mais quedas nas taxas, na medida em que as mulheres não tenham tido tempo suficiente para reagir e se ajustarem aos efeitos da epidemia de Zika. Também discutimos a importância da disponibilidade oportuna de dados sobre nascidos vivos durante uma crise de saúde pública com consequências imediatas para as taxas de fecundidade.

El objetivo de esta aportación de datos es estimar las tendencias de fecundidad en Brasil en la década de 2010 y principios de 2020, durante el período de brotes consecutivos de nuevas enfermedades infecciosas -ZIKV y COVID-19. Se usaron datos procedentes del Ministerio de Salud y del Registro Civil Nacional (ARPEN) desde 2011-2021 para calcular mensualmente las tasas de fecundidad en nivel nacional y en el estado. Se utilizó el ARIMA estacional para pronosticar las tasas de fecundidad por mes y estado en 2021, y se compararon estas predicciones con las tasas de fecundidad observadas. Encontramos que las tasas de fecundidad se mantuvieron estables entre 2011 y 2015, sin variaciones significativas, seguido de un fuerte descenso durante el brote de Zika en 2016, para posteriormente volver a los niveles anteriores al Zika tras el fin de la epidemia. Asimismo, con el fin de evaluar el efecto de la pandemia de COVID-19, hicimos comparaciones con lo observado y la previsión de tasas desde 2020-2021, que muestran que los descensos fueron en general mayores para los índices observados que para los previstos, aunque insignificantes desde el punto de vista estadístico. Sostenemos que el resurgimiento de la pandemia de COVID-19 en 2021 podría provocar nuevos descensos, ya que las mujeres podrían no haber tenido suficiente tiempo para adaptarse a los efectos de la epidemia de Zika. También se discute la importancia de disponer a tiempo de los datos de los nacidos vivos durante una crisis de salud pública con consecuencias inmediatas para las tasas de fecundidad.