Avaliação da função gonadal em pacientes do sexo masculino com síndrome antifosfolípide / Evaluation of gonadal function in male patients with antiphospholipid syndrome

INTRODUÇÃO. A síndrome antifiosfolípide (SAF) é uma condição trombofílica autoimune associada a títulos elevados e persistentes de anticorpos antifosfolípides. Caracteriza-se por tromboses em diversos órgãos, incluindo os testículos. OBJETIVO. Realizar uma avaliação global da função gonadal em pacientes masculinos com SAF primária (SAFP) e SAF associada ao lúpus eritematoso sistêmico (SAF-LES). MÉTODOS. Estudo transversal realizado em 22 pacientes (12 com SAFP e 10 com SAF-LES) e 20 controles saudáveis pareados por sexo e idade. Os pacientes foram avaliados em relação a dados demográficos, exame urológico, ultrassonografia testicular, perfil hormonal, análise do sêmen, anticorpos antiespermatozóides e características clínicas e laboratoriais. RESULTADOS. A mediana da idade atual foi semelhante nos pacientes com SAFP e controles (p=0,27), assim como naqueles com SAF-LES e controles (p=0,31). Disfunção erétil foi significantemente maior nos pacientes com SAFP comparado aos controles (25% vs. 0%, p=0,044), e nos SAF-LES comparado aos controles (30% vs. 0%, p=0,029). Com relação à antropometria do pênis, a análise dos subgrupos de pacientes com (n=7) e sem (n=5) tromboses arteriais prévias demonstrou que a mediana da circunferência do pênis foi significantemente menor em SAFP com trombose arterial versus sem trombose arterial [8,1 (6-10) vs. 10,2 (10-11) cm, p=0,007], bem como também observado em pacientes com SAF-LES com (n=2) e sem (n=8) eventos arteriais prévios [7,5 (7-8) vs. 9,18 (8-10,5) cm, p=0,039]. A mediana da circunferência do pênis foi significantemente menor nos pacientes com SAFP com disfunção erétil versus sem essa alteração [7,5 (6-9,5) vs. 9,5 (7,5-11) cm, p=0,039], assim como no grupo de SAF-LES [8,17 (8-8,5) vs. 9,14 (7-10,5) cm, p=0,0397]. Com relação à avaliação da função testicular, todos os parâmetros foram semelhantes nos pacientes com SAFP e controles (p>0,05). Por sua vez, as medianas de concentração e de mobilidade dos espermatozóides...

INTRODUCTION. Antiphospholipid syndrome (APS) is an autoimmune thrombophilic condition associated with persistent high titers of antiphospholipid antibodies. It is characterized by thrombosis in various organs including the testes. OBJECTIVE. To perform a global testicular assessment in male primary antiphospholipid syndrome (PAPS) and secondary systemic lupus erythematosus-APS (SLE-APS) patients, and healthy controls. METHODS. A cross-sectional study was conducted in 22 APS (12 PAPS and 10 SLE-APS) male patients, and 20 healthy controls. They were assessed by demographic data, systematic urological examination, testicular ultrasound, hormone profile, sperm analysis, antisperm antibodies, clinical features and treatment. RESULTS. The median of current age was similar in PAPS patients and controls (p=0.27), likewise in SLE-APS and controls (p=0.31). Erectile dysfunction was significantly higher in PAPS patients compared than controls (25% vs. 0%, p=0.044), and in SLE-APS and controls (30% vs. 0%, p=0.029). Regarding the penile anthropometry, the analysis of subgroups of PAPS patients with (n=7) and without (n=5) previous arterial thrombosis demonstrated that the median circumference penis was significantly lower in PAPS with arterial thrombosis versus without [8.1 (6-10) vs. 10.2 (10-11) cm, p=0.007], as also observed in SLE-APS patients with (n=2) and without (n=8) previous arterial events [7.5 (7-8) vs. 9.18 (8-10.5) cm, p=0.039]. In addition, the median penis circumference was significantly lower in PAPS patients with erectile dysfunction versus without this alteration [7.5 (6-9.5) vs. 9.5 (7.5-11) cm, p=0.039], likewise in SLE-APS patients [8.17 (8-8.5) vs. 9.14 (7-10.5) cm, p=0.0397]. Regarding gonadal evaluation, these parameters were uniformly normal in PAPS versus controls (p>0.05). In contrast, the median of sperm concentration and sperm motility were significantly lower in SLE-APS patients compared to controls [41.1 (0-145) vs. 120.06 (34.5-329)...

Trastornos inmunológicos de la reproducción: presentación de un caso / Immunological disorder of reproduction: presentation of a case

Existen una serie de eventos inmunitarios que rodean la fertilización, un 3 por ciento de las parejas en las cuales se descarta toda explicación orgánica, hormonal o autoinmune para la infertilidad, parecen ser infértiles por mecanismos inmunológicos. Se conoce que hay anticuerpos antiespermatozoides en el suero del hombre y de la mujer, en las secreciones vaginales de la mujer y en el esperma de hombres infértiles. Se presenta un caso de infertilidad de causa no explicada, se trata de un hombre con semen normal y una mujer con ovulación normal y trompas permeables. Se evaluó el moco cervical posterior a lo cual se realizó prueba poscoital; se determinó la presencia de anticuerpos anti espermatozoides de la clase IgA e IgG adheridos al espermatozoide, en el moco cervical y plasma seminal mediante la prueba de Inmunobeads directo e indirecto. Detectamos una prueba poscoital anormal, 6 por ciento de anticuerpos antiespermatozoides de la clase IgG, asociados al espermatozoide y un 8 por ciento de anticuerpos antiespermatozoides de la clase IgG en el moco cervical. Los anticuerpos antiespermatozoides en el plasma seminal fueron negativos.

A series of inmune events exists that surround the fertilization, 3 percent of copules in which all the organic, hormonal or autoimmune explanation is discarded for the infertility, seem to be infertile because of immunological mechanisms. It is known the existence of anti spermatozoa antibodies in the serum of the man and the woman, in vaginal secretions of the woman and in the sperm of infertile men. A case of infertility of nonexplained cause appears, it is about a man with normal semen and a woman with normal ovulation and permeable tubes. The cervical snot was subsequently evaluated to which a postcoital test was done; the presence of anti spermatozoa antibodies of the IgA and IgG class was determined associated to the spermatozoon, in the cervical snot and seminal plasma by means of the test of direct and indirect Inmunobeads. It was detected an abnormal postcoital test, 6 percent of anti spermatozoa antibodies of the IgG class, associated to the spermatozoon and 8 percent of anti spermatozoa antibodies of the IgGG class in the cervical snot. The anti spermatozoa antibodies in the seminal plasma were negative.