El laboratorio de fertilidad masculina, su evolución en los últimos 20 años / The male fertility laboratory, its evolution over the last 20 years / O laboratório de fertilidade masculina, sua evolução ao longo dos últimos 20 anos

Resumen La mayor accesibilidad a los tratamientos de reproducción asistida (RA) y los avances de la criobiología produjeron cambios en los laboratorios de andrología. El objetivo de este trabajo fue analizar la demanda y evolución de las variables seminales en las últimas dos décadas, caracterizar el laboratorio andrológico actual, evaluar el impacto de la incorporación del aseguramiento de la calidad y la inclusión de los sistemas computarizados (CASA). Se utilizaron datos de las medias mensuales del control de calidad interno (n=22 528) y encuestas a profesionales de laboratorios andrológicos (n=65) y a médicos especialistas en fertilidad (n=33). La demanda global se redujo significativamente con el aumento de las solicitudes de primera vez. El volumen y recuento, variables dependientes de andrógenos, disminuyeron con los años. El criterio estricto en morfología disminuyó el porcentaje de normales; la mitad de los médicos encuestados recibieron resultados entre 0 y 10% y el 40% consideró que ponía en riesgo el valor clínico de la variable. El sistema CASA permitió objetivar la cinética espermática e incrementar el porcentaje de progresivos rápidos, pero pocos laboratorios lo incorporaron. El 66% de los médicos resuelven el factor andrológico severo por tratamientos clínicos y el 95% utiliza técnicas de RA. El análisis de semen es ejecutado fundamentalmente por bioquímicos especializados, con baja adhesión a la automatización y acreditación del laboratorio, pero con participación en programas de evaluación externa de calidad. La demanda disminuyó como consecuencia del aumento del tratamiento por RA. La reducción del porcentaje de formas normales compromete su utilidad clínica.

Abstract Increasing availability to assisted reproduction (AR) treatments in Argentina and advances in cryobiology resulted in changes in andrology laboratories. The aim of this study was to evaluate the demand and evolution of seminal variables in the last two decades, characterise the current andrology laboratory, evaluate the impact of the incorporation of quality assurance and the introduction of computer assisted semen analysis (CASA). Data were taken from internal quality control (IQC) monthly means (n=22 528) and professionals in charge of laboratories (n=65) and fertility physicians' (n=33) surveys. Overall demand decreased significantly while first-time orders increased. Sperm volume and sperm count -androgen dependent parameters- decreased over the years. Strict morphology criteria reduced the percentage of normal results; half of the physicians received results between 0 and 10% and 40% considered that it compromised the clinical value of the variable. The CASA system made it possible to objectify sperm kinetic, increasing the percentage of fast progressives, but few laboratories have incorporated it. Sixty-six percent of physicians resolve severe andrological factor by clinical treatments and 95% use AR techniques in those cases. Semen analysis is mainly performed by specialised biochemists, with low adherence to laboratory automatisation and accreditation, but with participation in external quality assessment programmes. The demand decreased because of the increase in AR treatment. The lower percentage of normal forms compromises their clinical utility.

Resumo O aumento do acesso aos tratamentos de reprodução assistida (RA) e os avanços na criobiologia levaram a mudanças nos laboratórios de andrologia. O objetivo deste trabalho foi analisar a demanda e a evolução das variáveis de sêmen nas últimas duas décadas, caracterizar o laboratório de andrologia atual, avaliar o impacto da incorporação da garantia da qualidade e a inclusão dos sistemas computadorizados (CASA). Foram utilizados dados das médias mensais do controle de qualidade interno (n= 22 528) e pesquisas a profissionais de laboratórios andrológicos e a médicos especialistas em fertilidade (n=33). A demanda geral diminuiu significativamente com o aumento das solicitações de primeira vez. O volume e a contagem de esperma, parâmetros dependentes de andrógenos, diminuíram ao longo dos anos. O critério morfológico rigoroso diminuiu a porcentagem de normais; metade dos médicos entrevistados recebeu resultados entre 0 e 10% e 40% considerou que isso comprometía o valor clínico do parâmetro. O sistema CASA, permitiu objetivar a cinética espermática e aumentar o percentual de progressões rápidas, mas poucos laboratórios o incorporaram. 66% dos médicos resolvem o fator andrológico grave por tratamentos clínicos e 95% utilizam técnicas de RA nesses casos. A análise do sêmen é realizada principalmente por bioquímicos especializados, com baixa aderência à automação e acreditação laboratorial, mas com participação em programas de avalação externa de qualidade. A demanda diminuiu como consequência do aumento do tratamento por RA. A diminuição em percentagem de formas normais compromete sua utilidade clínica.

Fecundidad adolescente en la provincia de Cienfuegos. Período 2012-2021

Fundamento el estudio de la fecundidad adolescente, así como su cambio en el tiempo es de gran importancia, ya que permite mostrar los avances o retrocesos de la misma. Objetivo caracterizar el comportamiento de la fecundidad adolescente en la provincia de Cienfuegos. Métodos estudio descriptivo, de corte transversal, que tuvo como universo de investigación toda la población femenina de 15-49 años de Cienfuegos en el período 2012-2021, así como los nacimientos ocurridos por este grupo de edad, además los de las madres menores de 15 años. Se analizaron los indicadores: tasa específica de fecundidad, haciendo énfasis en la tasa de fecundidad adolescente (15-19 años), edad media y peso de la tasa de fecundidad adolescente al total de la fecundidad. Los datos fueron obtenidos de los anuarios estadísticos de la Oficina Nacional de Estadística e Información, de la Dirección Nacional y Provincial de Estadísticas del Ministerio de Salud Pública. Resultados la tasa de fecundidad adolescente presenta ligeras oscilaciones, pasando de 46,7 hijos por mujer en el año 2012 a 45, 4 en el 2021. El grupo de edad de mayor fecundidad es el 20-24 años, la edad media se ubica en el grupo etario 25-29 años y los municipios de mayor peso a la fecundidad total son Abreus y Aguada de Pasajeros. Conclusiones la tasa de fecundidad adolescente muestra resistencia a la disminución, comportamiento que demuestra la necesidad de enfatizar en las políticas y estrategias de educación sexual a los grupos de edades más vulnerables dentro del grupo reproductivo.

Foundation: the adolescent fertility study, as well as its change over time, is of great importance, since it allows us to show its progress or setbacks. Objective: characterize the fertility behavior in the Cienfuegos province. Methods: descriptive, cross-sectional study, which had as the research universe the entire female population aged 15-49 years old of Cienfuegos from 2012 to 2021, as well as the births that occurred in this age group, in addition to those of 15 years old younger mothers. The analyzed indicators were: specific fertility rate, emphasizing the adolescent fertility rate (15-19 years old), average age and weight of the adolescent fertility rate to total fertility. The data were obtained from the National Office of Statistics and Information statistical yearbooks, of the National and Provincial Public Health Ministry Directorate of Statistics. Results: the adolescent fertility rate presents slight oscillations, going from 46.7 children per woman in 2012 to 45.4 in 2021. The age group with the highest fertility is 20-24 years old, the average age is in the age group 25-29 years old and the municipalities with the greatest weight in total fertility are Abreus and Aguada de Pasajeros. Conclusions: the adolescent fertility rate shows resistance to decline, a behavior that demonstrates the need to emphasize sexual education policies and strategies for the most vulnerable age groups within the reproductive group.

Analysis of birth surveillance results in Baoshan Districtfrom 2013 to 2022 / 预防医学

Objective @#To investigate the fertility level of registered population in Baoshan District, Shanghai Municipality and the incidence of adverse birth outcomes of live births from 2013 to 2022, so as to provide the evidence for improving maternal and child health care strategies. @*Methods@#The data pertaining to live births registered in Baoshan District from 2013 to 2022 were collected through the Shanghai Birth Medical Information System, including the basic information of live births and maternal fertility. The indicators such as fertility level, parity, birth age and incidence of adverse birth outcomes of live births were descriptively analyzed. The trend of crude birth rate and total fertility rate was analyzed by annual percent change (APC). @*Results@#A total of 56 719 live births were registered in Baoshan District from 2013 to 2022. The crude birth rate was 6.54‰, the total fertility rate was 31.78‰, and the sex ratio at birth was 105.61. The crude birth rate showed a downward trend from 2016 to 2022 (APC=-11.054%, P<0.05), and the total fertility rate showed a downward trend from 2017 to 2022 (APC=-10.377%, P<0.05). The proportion of second parity and above showed an increasing trend from 2013 to 2017 (P<0.05) and a decreasing trend from 2017 to 2022 (P<0.05). The maternal childbearing age showed an increasing trend from 2013 to 2022 (P<0.05), the incidence of premature infants and low birth weight infants showed an increasing trend (both P<0.05). The incidence of premature infants and low birth weight infants increased with the rising childbearing age (both P<0.05). @*Conclusions@#The fertility level in Baoshan District was relatively low from 2013 to 2022. The proportion of second parity and above showed an upward trend followed by a downward trend. The incidence of premature infants and low birth weight infants increased with the rising childbearing age.

Ethical Thinking on Fertility Preservation of Female Patients with Cancer / 中国医学伦理学

Fertility preservation technology provides an effective method of protecting fertility resources for young patients with malignant tumors, allowing them to offspring after their fertility is impaired. However, the development of this technology has caused many social and ethical controversies. From the perspective of ethics, this paper discussed the ethical issues faced by young female patients in the implementation of fertility preservation, including whether it is necessary to preserve fertility, the ownership of the preserved fertility resources and the fair and equitable distribution of health resources involved in its implementation process, and identifies these issues and controversies from ethical view. In order to eliminate public doubts and misunderstandings about the technology of fertility preservation, ethical principles of benefit and non-harm, informed consent, prudent application, and ethical supervision have to be followed in the process of providing fertility preservation services, so as to promote the further development and application of fertility preservation technology.

Fertility preservation in female cancer patients in Brazil: perceptions and attitudes of infertility specialists

Objective: Fertility preservation is a priority in oncology for female cancer patients. However, there is a lack of communication between infertility specialists and oncologists. This study aimed to evaluate infertility specialists' perceptions and experiences regarding fertility preservation. Methods: Conduct an online survey to profile infertility specialists. Participants were infertility affiliated with the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO). The specialists received an online survey, which response rate were 30.9%, most of whom were in southern and southeastern. The survey consisted on 14 questions about the infertility specialists' location, techniques in clinical practice, treatment successful rate, patients idea, etc. Results: The average experience in human reproduction were 15.5 ± 10.2 years (mean ± standard deviation, range 1-40). Among reproductive-aged female cancer patients recommended for fertility preservation, 60.3 ± 28.8% (range 10-100%) underwent preservation procedures. Main barriers were cost (41%), oncologists' knowledge or acceptance (35%) and accessibility (9%). Most infertility specialists (58%) considered 40 years the limit for fertility preservation. Leukemia, lymphoma, breast and ovarian cancers were prioritized for fertility preservation, while lung, thyroid, gastric, and brain cancers were less relevant. Conclusion: This is the first Brazilian study about infertility specialists' perceptions on oncology patients access to fertility preservation. These patients primarily receive treatment in the public health system, while infertility specialists mainly work in the private healthcare. This healthcare mode is currently fragmented, but integrating these experts is enhancing patient access to fertility preservation. Studies on this topic are still warranted.

Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

Abstract Objective: Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Methods: Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Results: Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Conclusion: Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

Pacientes con embarazo en cicatriz de cesárea tratadas con metotrexato. Serie de casos de terapia combinada sistémica y percutánea en un centro de tercer nivel de Colombia / Management of cesarean scar pregnancy with methotrexate. A case series of combined systemic and percutaneous therapy in a III level center in Colombia

Resumen OBJETIVO: Describir un esquema de atención no quirúrgica en pacientes con embarazo en cicatriz de cesárea en el contexto de un sistema de salud con bajos recursos. Además, describir la tolerancia, vigilancia, evolución y desenlace de cada una de las pacientes tratadas con el esquema propuesto. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo de serie de casos de pacientes que acudieron al servicio de Urgencias de una institución de tercer nivel de atención en Barranquilla, Colombia, entre los meses de mayo de 2020 a marzo 2023 debido a síntomas obstétricos o fueron remitidas a la institución con diagnóstico, confirmado por ultrasonografía, de embarazo en cicatriz de cesárea. Parámetros de estudio: medición de variables sociodemográficas, obstétricas, de evolución clínica y complicaciones maternas. Se efectuó el análisis descriptivo de los datos. RESULTADOS: Se documentaron 11 pacientes que dieron una incidencia de 1.85 casos por cada 5000 embarazos. El dolor pélvico y el sangrado fueron los síntomas más prevalentes. Cinco pacientes tuvieron dos o más cesáreas, el resto una sola previa y cinco antecedente de legrado obstétrico. Nueve de 11 pacientes se atendieron con menos de 8 semanas de embarazo. La tasa de éxito alcanzada fue en las 11 pacientes, con negativización de la beta hCG a los 38.7 días en promedio. No se registraron complicaciones severas ni requerimiento de atención quirúrgica. CONCLUSIONES: Se describió la implementación de un esquema combinado sistémico y local con metotrexato que resultó seguro y efectivo, con preservación de la fertilidad.

Abstract OBJECTIVE: To report a scheme of non-surgical care in patients with cesarean scar pregnancy in the context of a health system with low resources. In addition, to describe the tolerance, monitoring, evolution and outcome of each of the patients treated with the proposed scheme. MATERIALS AND METHODS: Descriptive study of a case series of patients who, between May 2020 and March 2023, attended the emergency room of a tertiary care institution in Barranquilla, Colombia, because of obstetric symptoms or were referred to the institution with a diagnosis of cesarean scar pregnancy confirmed by ultrasound. Study parameters: measurement of sociodemographic, obstetric, clinical evolution and maternal complication variables. Descriptive analysis of data was performed. Results: Eleven patients were documented, giving an incidence of 1.85 cases per 5000 pregnancies. Pelvic pain and bleeding were the most common symptoms. Five patients had two or more previous cesarean sections, the remainder had only one previous cesarean section, and five had a history of obstetric curettage. Nine of the 11 patients were treated at less than 8 weeks'; gestation. The success rate was 100%, with a mean beta-hCG negativity of 38.7 days. There were no major complications and no surgical intervention was required. CONCLUSIONS: We describe the implementation of a combined systemic and local regimen with methotrexate that was safe and effective, with preservation of fertility.

Endometrial mesenchymal stromal/stem cells improve regeneration of injured endometrium in mice

BACKGROUND: The monthly regeneration of human endometrial tissue is maintained by the presence of human endometrial mesenchymal stromal/stem cells (eMSC), a cell population co-expressing the perivascular markers CD140b and CD146. Endometrial regeneration is impaired in the presence of intrauterine adhesions, leading to infertility, recurrent pregnancy loss and placental abnormalities. Several types of somatic stem cells have been used to repair the damaged endometrium in animal models, reporting successful pregnancy. However, the ability of endometrial stem cells to repair the damaged endometrium remains unknown. METHODS: Electrocoagulation was applied to the left uterine horn of NOD/SCID mice causing endometrial injury. Human eMSC or PBS was then injected into the left injured horn while the right normal horn served as controls. Mice were sacrificed at different timepoints (Day 3, 7 and 14) and the endometrial morphological changes as well as the degree of endometrial injury and repair were observed by histological staining. Gene expression of various inflammatory markers was assessed using qPCR. The functionality of the repaired endometrium was evaluated by fertility test. RESULTS: Human eMSC successfully incorporated into the injured uterine horn, which displayed significant morphological restoration. Also, endometrium in the eMSC group showed better cell proliferation and glands formation than the PBS group. Although the number of blood vessels were similar between the two groups, gene expression of VEGF-α significantly increased in the eMSC group. Moreover, eMSC had a positive impact on the regeneration of both stromal and epithelial components of the mouse endometrium, indicated by significantly higher vimentin and CK19 protein expression. Reduced endometrial fibrosis and down-regulation of fibrosis markers were also observed in the eMSC group. The eMSC group had a significantly higher gene expression of anti-inflammatory factor Il-10 and lower mRNA level of pro-inflammatory factors Ifng and Il-2, indicating the role of eMSC in regulation of inflammatory reactions. The eMSC group showed higher implantation sites than the PBS group, suggesting better endometrial receptivity with the presence of newly emerged endometrial lining. CONCLUSIONS: Our findings suggest eMSC improves regeneration of injured endometrium in mice.

Fallo en la regulación de la fertilidad posparto en mujeres en vulnerabilidad social en Colombia / Failured to regulate postpartum fertility in vulnerable women in Colombia

Objetivo: Evaluar la prevalencia de fallo en la regulación de la fertilidad posparto y la asociación con otros factores en un municipio colombiano (2017). Método: Estudio observacional de corte transversal con 148 mujeres. Se aplicó un muestreo no aleatorio para incluir mujeres que hubieran tenido un parto en los últimos 5 años. Se calcularon la prevalencia y las razones de prevalencia. Se exploró la asociación con la prueba χ2 o la prueba exacta de Fisher bajo una significancia estadística de 0,05. Resultados: Se encontró una prevalencia de fallo de la regulación de la fertilidad posparto del 40,5%. La prevalencia se asoció con ejercer oficios del hogar, tener uno o dos hijos, no planificar o no acceder a métodos de planificación y haber tenido un embarazo con periodo intergenésico menor de 2 años (p < 0,05). Conclusiones: Es necesario implementar estrategias para identificar barreras de acceso a la planificación, impactando en el espaciamiento entre embarazos y el acceso a los servicios. Lo anterior para generar múltiples beneficios para la madre, su hijo/a, el sistema de salud y la sociedad.

Objective: To evaluate the prevalence of regulated postpartum fertility failure and possible associated factors in a Colombian municipality (2017). Method: Cross-sectional observational study of 148 women. A non-random sampling method was used to include women who had given birth to a child in the last five years. Prevalence and prevalence ratios were calculated. Associations were examined at 0.05 statistical significance using χ2 test or Fishers exact test. Results: The prevalence of postpartum fertility failure was found to be 40.5%. The prevalence was associated with household work, having one or two children, not planning, or not having access to planning methods, and having a pregnancy with an interval between pregnancies of less than 2 years (p < 0.05). Conclusions: It is necessary to implement strategies to identify barriers to access to planning, which have an impact on the spacing between pregnancies and access to services. This will have multiple benefits for mother, child, health system and society.

El árbol Acacia mangium (Fabaceae) facilita la recuperación de áreas mineras en la selva lluviosa del Chocó, Colombia

Introducción: Las áreas impactadas por minería en bosques tropicales requieren de la aplicación de estrategias de restauración ecológica, pero este proceso, muchas veces involucra el uso de especies vegetales exóticas, desconociendo los efectos sobre la regeneración ecológica de los sitios donde se introducen. Objetivo: Evaluar el efecto de las plantaciones de Acacia mangium (planta exótica) sobre la rehabilitación ecológica temprana (suelo y vegetación) de áreas impactadas por minería de oro a cielo abierto en la selva pluvial tropical del Chocó, Colombia. Métodos: Se seleccionaron 16 áreas mineras como unidades de muestreo (ocho reforestadas con A. mangium y ocho en sucesión natural) en dos localidades. En cada unidad de muestreo se estableció una parcela de 2 × 50 m (cuatro parcelas por escenario de muestreo y localidad), donde se analizó la fertilidad del suelo (parámetros físicos y químicos) y se cuantificó el número de individuos de cada especie de planta vascular. Resultados: Se registraron 73 especies (69 géneros, 45 familias). La densidad de individuos fue mayor en áreas de sucesión natural que en aquellas reforestadas con A. mangium; por el contrario, la riqueza y diversidad de especies fueron superiores bajo las plantaciones de A. mangium. La similitud florística fue baja entre escenarios sucesionales (especies compartidas 35.6 %). El suelo mostró mejores condiciones (especialmente, N-NHO3) en áreas con A. mangium que en áreas en regeneración natural. Conclusiones: Las plantaciones de A. mangium parecen facilitar la rehabilitación temprana de la fertilidad del suelo y la vegetación en las minas abandonadas; por lo tanto, esta especie puede jugar un papel importante para la implementación de estrategias de restauración ecológica de áreas impactadas por minería de oro a cielo abierto en el Chocó y otros sistemas forestales tropicales con condiciones ambientales y de perturbación similares.

Introduction: Mining-impacted areas in tropical forests require the application of ecological restoration strategies, but this process often involves use of exotic plant species ignoring the effects on the ecological regeneration of the sites where they are introduced. Objective: To evaluate the effect of Acacia mangium plantations (exotic plant) on early ecological rehabilitation (soil and vegetation) of areas impacted by open-pit gold mining in the tropical rain forest of Chocó, Colombia. Methods: 16 mining areas were selected as sampling units (eight reforested with A. mangium and eight in natural succession) in two locations. In each sampling unit, a 2 × 50 m plot was established (four plots per sampling scenario and locality), where soil fertility (physical and chemical parameters) was analyzed and the number of individuals of each vascular plant species was quantified. Results: 73 species (69 genera, 45 families) were recorded. The density of individuals was higher in areas of natural succession than in those reforested with A. mangium; conversely, species richness and diversity were higher under the A. mangium plantations. Floristic similarity was low between successional scenarios (shared species 35.6 %). The soil showed better conditions (especially N-NHO3) in mining areas with A. mangium than in those in natural regeneration. Conclusions: A. mangium plantations appears to facilitate the early rehabilitation of soil fertility and vegetation in abandoned mines; therefore, this species can play an important role in the implementation of ecological restoration strategies in areas impacted by open-pit gold mining in the Chocó and other tropical forest systems with similar environmental and disturbance conditions.

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.

Desfechos reprodutivos e de sobrevida em adolescente tratada com cirurgia preservadora de fertilidade por tumor borderline de ovário em estádio avançado: relato de caso e revisão da literatura / Reproductive and survival outcomes in an adolescent treated with fertility- sparing surgery for advanced stage borderline ovarian tumor: case report and review of the literature

Existem poucos dados na literatura sobre os resultados obstétricos e oncológicos de adolescentes com tumores borderline de ovário em estádio avançado trata- das com cirurgia preservadora da fertilidade. Uma adolescente de 15 anos com diagnóstico de tumor borderline de ovário estádio IIIc foi inicialmente tratada com tumorectomia ovariana bilateral e quimioterapia adjuvante com esquema de platina/taxano (seis ciclos). Durante o seguimento, foi submetida a outras três tumorectomias devido a tumor borderline de ovário (duas vezes) e cistadenoma ovariano (uma vez). Outra recidiva de tumor borderline de ovário ocorreu seis anos após o diagnóstico inicial, quando ela estava grávida; foi tratada com tumorecto- mia realizada durante a cesariana. Em sua última consulta ambulatorial, a mulher de 27 anos não apresentava evidência da doença e tinha um filho saudável. Mesmo em estádio avançado, a cirurgia de preservação da fertilidade foi segura e factível nessa paciente com tumor borderline de ovário.

There are few data in the literature regarding obstetric and oncological outcomes of adolescents with advanced-stage borderline ovarian tumors treated with fertility spa- ring surgery. A 15 years old adolescent who was diagnosed with a stage IIIc borderline ovarian tumor, was treated with bilateral ovarian tumorectomies and adjuvant chemotherapy with platinum/taxane regimen (six cycles). During follow up she was submitted to other three tumorectomies due to borderline ovarian tumor(twice) and ovarian cysta- denoma (once). Another borderline ovarian tumorrecurren- ce occurred six years after initial diagnosis, when she was pregnant; treated with tumorectomy performed during ce- sarean section. At her last outpatient visit, the 27-year-old woman had no evidence of disease and a had healthy child. Even at an advanced stage, fertility sparing surgery was safe and feasible in this patient with borderline ovarian tumor.

Embarazo ectópico en cicatriz de cesárea: reporte de un caso

La gestación extrauterina se denomina embarazo ectópico, esta es una emergencia obstétrica del primer trimestre, que cada vez está teniendo una incidencia mayor. Una de las localizaciones en las que se pueden generar estas gestaciones es la cicatriz de cesárea previa, lo cual supone un reto para el ginecólogo tratante debido a su dificultad diagnóstica y opciones terapéuticas. Se reporta el caso de una paciente de 37 años que ingresó por el servicio de emergencia con 6 semanas de amenorrea, y con el antecedente de 2 cesáreas. Se le realizó un legrado uterino que se complicó y terminó en la realización de una histerectomía. El embarazo ectópico en cicatriz de cesárea es raro, sin embargo, es importante pensar en esta opción diagnóstica en gestantes con sangrado en el primer trimestre con antecedente de cesárea para poder buscar signos ecográficos en la evaluación.

Extrauterine gestation is called ectopic pregnancy, this is an obstetric emergency of the first trimester, which is having an increasing incidence. One of the locations in which these pregnancies can be generated is the scar from a previous cesarean section, which is a challenge for the treating gynecologist due to its diagnostic difficulty and therapeutic options. We report the case of a 37-year-old patient who was admitted to the emergency service with 6 weeks of amenorrhea, and with a history of 2 cesarean sections. She underwent a uterine curettage that was complicated and ended in a hysterectomy. Ectopic pregnancy in cesarean section scar is rare, however, it is important to consider this diagnostic option in pregnant women with bleeding in the first trimester with a history of cesarean section to be able to look for ultrasound signs in the evaluation.

Estudio exploratorio de las motivaciones para la criopreservación de ovocitos en forma electiva / An exploratory study of motivations for elective oocyte cryopreservation

Introducción La vitrificación de óvulos es un avance científico que ha cambiado la perspectiva reproductiva de la sociedad humana. Este procedimiento se ha ofrecido como alternativa a la postergación voluntaria del embarazo, confiriéndole a la mujer una nueva perspectiva en su autonomía reproductiva. El número de mujeres que consultan y luego optan por congelar ovocitos ha aumentado en forma casi exponencial en Chile y en todo el mundo. En nuestro país, hay poco conocimiento acerca de la motivación, experiencia y resultados de la criopreservación electiva de ovocitos en Chile. El objetivo fue conocer la motivación, experiencia y el deseo reproductivo futuro de este grupo de mujeres sometidas a esta técnica. Métodos Estudio descriptivo transversal, basado en un cuestionario enviado por correo electrónico en el que participaron mujeres que se habían sometido previamente a criopreservación electiva de ovocitos entre enero de 2011 y diciembre de 2019 en Clínica Alemana, Santiago de Chile. Resultados De 342 mujeres que habían completado un ciclo de criopreservación electiva de ovocitos, 193 aceptaron participar y de estas, 98 (51%) de las mujeres contestaron la encuesta en forma satisfactoria. Se establecieron criterios de exclusión a aquellas mujeres que se habían sometido a este procedimiento por indicación médica como la endometriosis, el cáncer y la baja reserva ovárica. El motivo más frecuente para realizarse el procedimiento fue la edad (44%). En relación al procedimiento; el 94% no se arrepiente de haberlo realizado y 74% de las mujeres cree que utilizará sus ovocitos en algún momento de su vida. Por último, desde que se realizaron la criopreservación de ovocitos a la fecha, el 11% de las mujeres encuestadas ha usado sus ovocitos vitrificados y 27% ha logrado embarazarse con estos. Conclusión Las mujeres que se someten a criopreservación electiva de ovocitos por razones sociales, son principalmente mujeres sin pareja que tiene como motivación principal su edad reproductiva y la gran mayoría de ellas no se arrepienten de haberlo realizado.

Introduction Oocyte vitrification is a scientific advance that has changed the reproductive perspective of human society. This procedure has been offered as an alternative to the voluntary postponement of pregnancy, giving women a new perspective on their reproductive autonomy. The number of women who consult and then choose to freeze oocytes has increased almost exponentially in Chile and throughout the world. There is little knowledge about the motivation, experience, and results of elective oocyte cryopreservation in Chile. The objective was to know the motivation, experience, and future reproductive desire of the women who underwent this technique. Methods Cross-sectional descriptive study based on a questionnaire sent by e-mail in which females who had previously undergone elective oocyte cryopreservation between January 2011 and December 2019 at Clínica Alemana, Santiago, Chile, participated. Results Of 342 women who had completed a cycle of elective oocyte cryopreservation, 193 agreed to participate, and of these, 98 (51%) answered the survey satisfactorily. Women who underwent this procedure for medical indication, including endometriosis, cancer, and low ovarian reserve, were excluded. The most frequent reason for the procedure was age (44%). Concerning the procedure: 94% do not regret having it done, and 74% of the women believe that they will use their oocytes at some point in their lives. Finally, from the time of oocyte cryopreservation to date, 11% of the surveyed women have used their vitrified oocytes, and 27% have become pregnant. Conclusions Women who undergo elective oocyte cryopreservation for social reasons are mainly women without a partner whose main motivation is their reproductive age. The vast majority do not regret doing so.

Perfil reprodutivo de uma população de alta vulnerabilidade / Reproductive profile of a high vulnerability population

Introdução: padrões sexuais e reprodutivos são influenciados por fatores biopsicossociais. Dentre esses fatores, há a vulnerabilidade, conceito amplo, complexo e que determina maior atenção das políticas públicas. Objetivo: conhecer o perfil reprodutivo das mulheres que residem em uma área de alta vulnerabilidade na cidade de Curitiba-PR. Metodologia: descritivo, documental de caráter analítico observacional transversal. Coleta e análise de dados das Declarações de Nascidos Vivos (DNV) na Unidade de Saúde do Capanema e análise de dados públicos fornecidos pelo IBGE. Resultados: foram analisados 1199 DNVs, sendo 1011 mulheres com idades entre 13 e 49 anos, compreendidos entre os anos de 2003 a 2018. Foi possível a análise da Taxa de Fecundidade Total (TFT), via de parto, estado civil e escolaridade das parturientes. Discussão: a menor TFT foi apresentada na faixa etária de 13 a 15 anos (1,05 filhos/mulher) e a maior entre 36 a 49 anos (4,47 filhos/mulher). A via de parto vaginal correspondeu a 64% dos partos, enquanto que a via cirúrgica por cesárea aconteceu em 36% dos casos. Em relação à escolaridade, 3% apresentaram-se como analfabetas; 48% possuíam nível fundamental; 40% nível médio completo e 9% possuíam nível superior completo ou incompleto. Houve 0,5% de omissão da que escolaridade no momento do preenchimento dos dados. Os dados coletados sobre o estado civil foram considerados inconclusivos. Conclusão: Conclui-se que a Taxa de Fecundidade da população estudada está acima da Taxa de Fecundidade Total projetada para 2015 no Brasil nas faixas etárias acima de 19 anos e da taxa de fecundidade ideal para que haja uma reposição da população segundo o DATASUS (2021). Tais dados podem estar relacionados com a vulnerabilidade da comunidade em questão, corroborando com estudos que relatam maiores taxas de fecundidade relacionada a menor renda e menor escolaridade.

Introduction: sexual and reproductive patterns are influenced by biopsychosocial factors. Among these factors, there is vulnerability, a broad and complex concept that requires greater attention from public policies. Objective: to know the reproductive profile of women who live in an area of high vulnerability in the city of Curitiba-PR. Methodology: descriptive, documental, cross-sectional observational analysis. Collection and analysis of data from the Birth Certificates (BC) at the Capanema Health Unit and analysis of public data provided by the IBGE. Results: 1199 BCs were analysed, with 1011 women aged between 13 and 49 years old, between the years 2003 and 2018. It was possible to analyse the Total Fertility Rate (TFR), mode of delivery, marital status and level of education of the parturients. Discussion: the lowest TFR was observed in the age group from 13 to 15 years old (1.05 children/woman) and the highest between 36 to 49 years old (4.47 children/woman). Vaginal delivery corresponded to 64% of deliveries, while surgical caesarean section occurred in 36% of cases. Regarding schooling, 3% were illiterate; 48% had a fundamental level; 40% completed high school and 9% had completed or incomplete higher education. There was 0.5% omission of schooling attainment at the time of filling in the data. Data collected on marital status were considered inconclusive. Conclusion: it is concluded that the Fertility Rate of the studied population is above the Total Fertility Rate projected for 2015 in Brazil in the age groups above 19 years and the ideal fertility rate so that there is a replacement of the population according to DATASUS (2021). Such data may be related to the vulnerability of the community in question, corroborating with studies that report higher fertility rates related to lower income and lower education.

Intervenção psicossocial para mulheres com histórico de tentativas de gravidez / Psychosocial intervention for women with a history of pregnancy attempts / Intervención psicosocial para mujeres con antecedentes de intentos de embarazo

OBJETIVO: A dificuldade ou impossibilidade para engravidar representa um problema vivenciado por mulheres no mundo inteiro, o que necessita de ações na área da saúde. OBJETIVO: Descrever um relato de experiência de uma intervenção psicossocial para mulheres com histórico de tentativas de gravidez. MÉTODO: Foram realizados seis encontros por meio do sistema remoto com o auxílio do Google Meet. Participaram sete mulheres, na faixa etária entre 30 e 37 anos, casadas, e com histórico de tratamentos para engravidar. Utilizou-se metodologia da Investigação Ação Participante (IAP) e os encontros iniciavam-se com uma temática proposta para discussão buscando fomentar o compartilhamento de experiências. RESULTADOS: Observou-se que as discussões possibilitaram a expressão de suas angústias provenientes das dificuldades para engravidar, o que inclui pressões sociais, percepções de inferioridade, incompletude, e falta de realização pessoal. CONCLUSÃO: O grupo de discussão representou uma estratégia promotora de mudanças e de reflexão/ação. Este espaço permitiu construir o apoio social para o enfrentamento dos desafios inerentes ao projeto maternal. Sugere-se a continuidade destas intervenções nas unidades de saúde e centros especializados para fomentar a promoção da saúde integral, assim como intervenções futuras que focalizem a inclusão dos cônjuges.

OBJECTIVE: The difficulty or impossibility of getting pregnant represents a problem experienced by women all over the world, which requires actions in the health area. OBJECTIVE: To describe an experience report of a psychosocial intervention for women with a history of pregnancy attempts. METHOD: Six meetings were held through the remote system with the help of Google Meet. Seven women participated, aged between 30 and 37 years old, married, and with a history of treatments to get pregnant. Participating Action Research (PAR) methodology was used and the meetings began with a proposed theme for discussion, seeking to encourage the sharing of experiences. RESULTS: It was observed that the discussions made it possible to express their anxieties arising from difficulties in getting pregnant, which includes social pressures, perceptions of inferiority, incompleteness, and lack of personal fulfillment. CONCLUSION: The discussion group represented a strategy to promote changes and reflection/action. This space made it possible to build social support to coping challenges inherent to the maternal project. It is suggested that these interventions be continued in health units and specialized centers to foster the promotion of comprehensive health, as well as future interventions that focus on the inclusion of spouses.

OBJETIVO: La dificultad o imposibilidad de quedar embarazada representa un problema vivido por mujeres de todo el mundo, que requiere acciones en el área de la salud. OBJETIVO: Describir un relato de experiencia de una intervención psicosocial para mujeres con antecedentes de intentos de embarazo. MÉTODO: Se realizaron seis reuniones a través del sistema remoto con la ayuda de Google Meet. Participaron siete mujeres, con edades entre 30 y 37 años, casadas y con antecedentes de tratamientos para quedar embarazadas. Se utilizó la metodología de Investigación Acción Participativa (IAP) y las reuniones comenzaron con una propuesta de tema de discusión, buscando incentivar el intercambio de experiencias. RESULTADOS: Se observó que las discusiones permitieron expresar sus angustias derivadas de las dificultades para quedar embarazada, que incluye presiones sociales, percepciones de inferioridad, incompletitud y falta de realización personal. CONCLUSIÓN: El grupo de discusión representó una estrategia para promover cambios y reflexión/acción. Este espacio permitió construir apoyo social para enfrentar los desafíos inherentes al proyecto materno. Se sugiere continuar con estas intervenciones en unidades de salud y centros especializados para promover la promoción de la salud integral, así como futuras intervenciones que se centren en la inclusión de los cónyuges.

Embarazo postmanga gástrica en pacientes con irregularidades menstruales / Pregnancy after gastric sleeve in patients with menstrual irregularities

Resumen OBJETIVO: Estimar la cantidad de pacientes con irregularidades menstruales que se embarazaron luego de una cirugía bariátrica (manga gástrica) y describir los desenlaces de los embarazos. MATERIALES Y MÉTODOS: Estudio retrospectivo de serie de casos de pacientes obesas y con irregularidades menstruales intervenidas mediante cirugía bariátrica (manga gástrica). Se operaron entre el 1 de junio de 2014 y el 31 de diciembre de 2019 en el Centro Médico Imbanaco Cali, Colombia. RESULTADOS: De 1418 cirugías bariátricas, tipo manga gástrica, 117 pacientes cumplieron con los criterios de inclusión, 80 de ellas se localizaron telefónicamente y aceptaron incluirse al estudio. Luego de la manga gástrica, el 86.25% (n = 69) de las pacientes logró la regularización de sus ciclos menstruales. Además, el 31% (n = 25) consiguió el embarazo, 80% (n = 20) de ellas tenían la intención de buscar el embarazo. Los desenlaces de esos embarazos fueron favorables, con partos a término, con adecuado peso y talla al nacer. CONCLUSIONES: Después de la cirugía bariátrica, tipo manga gástrica, en mujeres con irregularidades menstruales, 25 de las 80 pacientes se embarazaron y los desenlaces obstétricos fueron satisfactorios. Sin duda, hacen falta más estudios prospectivos para poder afirmar, con una mejor representación estadística, las repercusiones de la disminución del peso corporal en la tasa de fertilidad.

Abstract OBJECTIVE: To estimate the number of patients with menstrual irregularities who became pregnant after bariatric surgery (gastric sleeve) and to describe the pregnancy outcomes. MATERIALS AND METHODS: Retrospective study of a series of cases of obese patients with menstrual irregularities who underwent bariatric surgery (gastric sleeve). They were operated between June 1, 2014 and December 31, 2019 at the Imbanaco Cali Medical Center, Colombia. RESULTS: Of 1418 bariatric surgeries, gastric sleeve type, 117 patients met the inclusion criteria, 80 of them were located by telephone and agreed to be included in the study. After gastric sleeve, 86.25% (n = 69) of the patients achieved regularization of their menstrual cycles. In addition, 31% (n = 25) achieved pregnancy, 80% (n = 20) of them intended to seek pregnancy. The outcomes of these pregnancies were favorable, with full-term deliveries, with adequate weight and height at birth. CONCLUSIONS: After bariatric surgery, gastric sleeve type, in women with menstrual irregularities, 25 of the 80 patients became pregnant and the obstetric outcomes were satisfactory. Undoubtedly, more prospective studies are needed to be able to affirm, with a better statistical representation, the repercussions of the decrease in body weight on the fertility rate.

Nest refuse of Acromyrmex balzani (Hymenoptera: Formicidae) increases the plant vigor in Turnera subulata (Turneraceae) / O substrato de descarte de Acromyrmex balzani (Hymenoptera: Formicidae) aumenta o vigor da planta Turnera subulata (Turneraceae)

Abstract Some studies report the positive effect of organic residues from ant nests on soil properties and on the structure of the adjacent plant community in field experiments, but there is a gap about the effect on individual species. The purpose of the present study was to compare the soil nutrient content and the development of Turnera subulata Smith, an ornamental species, in the presence of the nest refuse (basically composed of fragments of grass leaves and the symbiotic fungus) produced by the leaf-cutting ant Acromyrmex balzani (Emery, 1890) or in control soil through a greenhouse pot experiment. The experiment was carried out with two treatments: control soil and soil with 25% of nest refuse. The plants were kept in 1L pots for 90 days. We evaluated the parameters: plant height, stem diameter, root length, number of leaves, dry weight of the root, dry and fresh aboveground biomass. Additionally, the relative chlorophyll content and leaf nutrients were used as nutritional parameters. As a result, plants that grew in the soil with nest refuse showed significant higher values of all parameters evaluated when compared to the control treatment (p < 0.001). We conclude that this biofertilizer contributed to the production of more vigorous plants, being able to act on the local dynamics of nutrients in the ecosystems where A. balzani occurs. As it is relatively abundant and easy to collect, the refuse of A. balzani has the potential to be used as an alternative substrate in the production of shortlife cycle plants.

Resumo Alguns estudos relatam o efeito positivo de resíduos orgânicos de formigueiros nas propriedades do solo e na estrutura da comunidade de plantas adjacentes em experimentos de campo, mas há uma lacuna sobre o efeito em espécies individuais. O objetivo do presente estudo foi comparar o desenvolvimento de Turnera subulata Smith, uma espécie ornamental, na presença do substrato de descarte (SD) de formigueiros produzido pela formiga cortadeira Acromyrmex balzani (Emery, 1890) por meio de experimento em casa de vegetação. O experimento foi conduzido com dois tratamentos: solo controle e solo com 25% de SD. As plantas foram mantidas em vasos de 1L por 90 dias. Foram avaliados os parâmetros: altura da planta, diâmetro do caule, comprimento da raiz, número de folhas, massa seca da raiz, biomassa seca e fresca da parte aérea. Além disso, o conteúdo relativo de clorofila e os nutrientes foliares foram usados como parâmetros fisiológicos. Como resultado, as plantas que cresceram no solo com SD apresentaram valores significativamente maiores de todos os parâmetros avaliados quando comparadas ao tratamento controle (p < 0.001). Concluímos que esse biofertilizante contribuiu para a produção de plantas mais vigorosas, podendo atuar na dinâmica local de nutrientes nos ecossistemas onde A. balzani ocorre. Além disso, por ser relativamente abundante e fácil de coletar, o SD de A. balzani tem potencial para ser utilizado como biofertilizante na produção de plantas de ciclo de vida curta.

Research progresses in the radiotherapy effect on ovarian function and its protection / 中华放射医学与防护杂志

The survival rate of cancer patients was improved due to the development of cancer treatment techniques, and thus the fertility protection for young female cancer patients has attracted increasing attention. Radiotherapy, as one of the comprehensive cancer treatment, could cause ovarian damage in adolescent and child-bearing women, which leads to fertility decline and a series of side effects. Radiation can cause ovarian damage not only by acting on biological macromolecules directly, but also by increasing oxidative stress between oocytes and ovarian granulosa cells indirectly. At present, the fertility preservation of female cancer patients undergoing radiotherapy mainly includes physical protection, drug protection and biological protection. Recently, the development of new technologies for the preservation of fertility in female cancer patients has also brought new hope, including factors such as protective effects, patient age, and the selection of specific cancer treatment measures, which are the main considerations in the selection process of fertility preservation measures. This article reviews the research progress on radiation-induced ovarian damage, with a focus on the introduction of the fertility preservation measures and new technologies for young female tumor patients receiving radiotherapy.

Progress in adverse effects of sleep deprivation on body fertility / 中国药理学与毒理学杂志

Sleep is essential for the maintenance of human normal functions.Nowadays,the occurrence of active sleep deprivation(ASD)or passive sleep depriva-tion(PSD)is becoming more and more common due to the inability of the body adapting to the rapid changes in the internal and external environment.SD is not only an action,a brief process or a result,but also a directly or indirectly sustained state,which is associated to sleep time,circadian rhythm or sleep quality.SD can lead to numerous adverse effects on the body,such as sleep-related acute and chronic diseases.Long-term SD increases the risk of neurological and cardiovascular dis-eases as well as immune system dysfunction.In addi-tion,SD may affect the reproductive health of the body,giving rise to a series of potential fertility problems.In recent years,the correlation research and mechanism between SD and the related diseases have become a focus of scholars' attention.Numerous lines of evidence suggest that pathological sleep,such as insomnia and sleep apnea syndrome,is associated with impaired repro-ductive function.Disruptions in the circadian rhythm can also lead to impaired hypothalamic-pituitary-gonadal(HPG)axis function and thereby interfere with the repro-ductive process.Our research team has demonstrated that SD significantly affects the fertility of male and female rats and has adverse effects on reproduction.By new generation sequencing(NGS)and RT-PCR verifica-tion,we have identified differently expressed genes that are involved in mediating the effect of SD on fertility.However,the mechanisms and biological macromolecules regulated by SD are worthy of being further explored.This paper provides a brief review of SD research and then focuses on the adverse impact of SD on fertility,conducting a literature review to sort out the ideas and pro-vide references for research in this field.