Male infertility in spinal cord trauma

Every year there are 10 thousand new cases of patients victimized by spinal cord trauma (SCT) in the United States and it is estimated that there are 7 thousand new cases in Brazil. Eighty percent of patients are fertile males. Infertility in this patient group is due to 3 main factors resulting from spinal cord lesions: erectile dysfunction, ejaculatory disorder and low sperm counts. Erectile dysfunction has been successfully treated with oral and injectable medications, use of vacuum devices and penile prosthesis implants. The technological improvement in penile vibratory stimulation devices (PVS) and rectal probe electro-ejaculation (RPE) has made such procedures safer and accessible to patients with ejaculatory dysfunction. Despite the normal number of spermatozoa found in semen of spinal cord-injured patients, their motility is abnormal. This change does not seem to be related to changes in scrotal thermal regulation, frequency of ejaculation or duration of spinal cord damage but to factors related to the seminal plasma. Despite the poor seminal quality, increasingly more men with SCT have become fathers through techniques ranging from simple homologous insemination to sophisticated assisted reproduction techniques such as intracytoplasmic sperm injection (ICSI).

Single nucleotide polymorphisms of the heat shock protein 90 gene in varicocele-associated infertility

PURPOSE: Varicoceles are associated with impaired testicular function and male infertility, but the molecular mechanisms by which fertility is affected have not been satisfactorily explained. Spermatogenesis might be affected by increased scrotal temperature, such as that caused by varicocele. HSP90 is a molecular chaperone expressed in germ cells and is related to spermatogenesis, motility, and both heat and oxidative stress. Possible correlations between coding single region nucleotide polymorphisms (cSNPs) in the HSP90 gene in patients with varicocele associated with infertility were analyzed, and polymorphisms in these exons were characterized through DNA sequencing. MATERIALS AND METHODS: PCR-SSCP and DNA sequencing were used to search for mutations in 18 infertile patients with varicocele, 11 patients with idiopathic infertility and 12 fertile men. DNA was extracted from leucocytes for PCR amplification and SSCP analysis. DNA from samples with an altered band pattern in the SSCP was then sequenced to search for polymorphisms. RESULTS: Three silent polymorphisms that do not lead to amino acid substitutions were identified. CONCLUSION: Mutations in the HSP90 gene do not appear to be a common cause of male factor infertility. The low incidence of gene variation, or SNPs, in infertile men demonstrates that this gene is highly conserved and thus confirms its key role in spermatogenesis and response to heat stress.

Search and identification of spermatozoa and spermatids in the ejaculate of non-obstructive azoospermic patients

OBJECTIVE: To search and to identify spermatozoa and spermatids, present in the ejaculate of non-obstructive azoospermic patients. MATERIALS AND METHODS: 27 patients, aged between 18 and 48 years, with initial diagnosis compatible with non-obstructive azoospermia, underwent up to 3 seminal samples, with assessment of macroscopic and microscopic parameters differentiated for each sample. In the first sample, 5 æL of semen were analyzed in a Horwell chamber in order to assess the presence or absence of spermatozoa. The procedure was repeated with 2 other aliquots. In the absence of spermatozoa, the entire sample was transferred to a conic tube and following centrifugation the sediment was freshly analyzed. The second seminal sample was collected only when no spermatozoa were found in the first sample and the research was performed in the same way. In cases where spermatozoa were not seen, the sample was centrifuged and the obtained sediment was stained by the panoptic method and observed under common light microscopy (1250X). The third seminal sample was collected only in cases when patients had not shown spermatozoa in the first and second seminal samples. RESULTS: 4/27 (14.8 percent) patients presented spermatozoa in the first seminal sample and 6/23 (26.1 percent), in the second seminal sample. No spermatozoa were seen in the third sample, however, 11/17 (64.7 percent) presented spermatids. CONCLUSION: In clinical situations where the initial diagnosis is non-obstructive azoospermia, one single routine seminal analysis is not enough to confirm this diagnosis and the analysis of the centrifuged sediment can have relevant clinical consequences. Among patients considered non-obstructive azoospermic, when duly assessed, 37 percent presented spermatozoa and 64.7 percent, spermatids.

Effects of the technique of cryopreservation and dilution/centrifugation after thawing on the motility and vitality of spermatozoa of oligoasthenozoospermic men

OBJECTIVE: Comparing in human semen samples with low initial quality, the effects of 2 techniques of cryopreservation and dilution/centrifugation after thawing on the spermatic motility and vitality. MATERIALS AND METHODS: Semen samples from 15 oligo and/or asthenozoospermic individuals assisted in the infertility sector of a tertiary hospital were obtained through masturbation. The samples were divided into 2 portions of equal volume, and diluted (1:1; v/v) with the cryoprotector containing glycerol (Test yolk buffer). One portion was frozen through the technique of liquid nitrogen vapor with static phases (group I - GI), while the other was frozen through a programmable biological freezer with linear speed (Planer, Kryo 10, series III) (group II - GII). The following parameters were assessed before freezing and after thawing: percentage of spermatozoa with progressive motility (Prog percent) and percentage of live spermatozoa (Vit percent). After defrosting, Prog percent was assessed before and after removal of cryoprotector diluent, in different time intervals (zero, 3 h, and 24 h). The statistical analysis has been accomplished by using the non-parametric tests of Wilcoxon and Friedman. RESULTS: There was significant reduction of Prog percent and Vit percent from before freezing to after defrosting in both groups, I and II (p < 0.001). Values of Prog percent and Vit percent were not statistically different between groups, after thawing. It has been observed a significant reduction in Prog percent among portions frozen with the automated technique after dilution and centrifugation for removal of cryoprotector (p = 0.006). After cryoprotector removal, Prog percent has been kept unaltered, in both groups, during the first 3 hours of incubation, although being superior in group I (p = 0,04). There was a significant decrease in Prog percent after 24 hours of incubation, in both groups (p < 0,01). CONCLUSION: For human semen samples with low initial quality, freezing through vapor technique or through the automated technique showed to be equivalent in regarding recovery of live spermatozoa with progressive motility. The effects of dilution and centrifugation to remove the cryoprotector had a negative impact only in samples frozen through the automated technique. In both techniques, progressive motility is kept constant during the first 3 hours after thawing and removal of the cryoprotector, but is drastically diminished by the end of an incubation...

Microcirurgia e recanalizaçäo tubária: resultados / Microsurgery and fallopian tube reconstruction: results

A laqueadura tubária é um método contraceptivo largamente utilizado em países de baixo nível sócio-econômico, sendo este fato o reflexo da deficiência dos serviços de planejamento familiar nestes países. Como conseqüência, observa-se um aumento na procura de pacientes por serviços especializadas na reversao da laqueadura. Neste estudo, analisamos os resultados obtidos em 22 pacientes submetidas a recanalizaçao tubária no período de junho de 1991 a junho de 1993. A cirurgia foi realizada empregando-se os princípios da microcirurgia permitindo uma melhor recuperaçao funcional das tubas uterinas. Em 20 pacientes foi realizada a anastomose bilateral (74 por cento) e em duas pacientes a anastomose unilateral (7 por cento). Dezenove pacientes foram acompanhadas por um período de um ano, as outras três abandonaram o ambulatório. Destas 19 pacientes, 15 (79 por cento) tiveram gestaçao tópica e uma (5 por cento) apresentou gestaçao ectópica em duas ocasioes, no terceiro e no quinto mês pós-operatório. Com esses resultados obtivemos uma taxa de gravidez de 84 por cento, comparável com o descrito na literatura.

Consulta de pós-parto: etapa fundamental no ciclo grávido-puerperal / Postpartum appointment: fundamental step in pregnancy and puerperium

A importância da consulta de pós-parto é reforçada nesse trabalho, especialmente em relaçao à realizaçao da contracepçao, à avaliaçao e conduta nas mulheres portadoras de patologias e o reforço à amamentaçao exclusiva. As mulheres escolheram principalmente DIU, salpingotripsia bilateral e minipílula para realizar a sua contracepçao. A amamentaçao foi relatada por 87,7 por cento das mulheres, sendo 60 por cento exclusiva. A hipertensao foi a patologia com maior freqüência entre as puérperas. A consulta pode ser realizada com segurança em torno de 30 dias após o parto.