Human reproduction: current status / Reprodução humana: estado atual

SUMMARY The concern about the maintenance of the human species has existed since the earliest civilizations. Progress in the diagnosis and treatment of infertility has led to the development of assisted reproductive techniques (ART) which, along with the evolution of genetics and molecular biology studies, have contributed in a concrete way to the management of infertile couples. Classic in vitro fertilization was initially developed 35 years ago for the treatment of women with tubal blockage, however, it remains inaccessible to a significant proportion of infertile couples around the world. This can be explained by the lack of specialized clinics in some countries and by the high cost of the procedures. Efforts have been employed to increase the number of treatment cycles for assisted reproduction, as for example, the creation of low-cost programs. Even today, infertility remains a problem of global proportions, affecting millions of couples. The estimate of the incidence of infertility is uncertain, mainly because of the criteria used for its definition. This article aims to review the most important aspects, succinctly, regarding the incidence, etiology, and treatment options available to infertile couples.

RESUMO A preocupação com a procriação e a manutenção da espécie humana existe desde as civilizações mais antigas. O progresso no diagnóstico e no tratamento da infertilidade teve como consequência o desenvolvimento de técnicas de reprodução assistida (TRA) que, conjuntamente com a evolução dos estudos em genética e biologia molecular, têm contribuído de maneira real no manejo dos casais inférteis. A fertilização in vitro clássica foi inicialmente desenvolvida há mais de 35 anos para o tratamento de mulheres com obstrução tubária, no entanto, essa terapêutica permanece ainda inacessível para uma considerável parte dos casais inférteis ao redor do mundo. Isso pode ser explicado pela falta de clínicas especializadas em alguns países e pelo alto custo dos procedimentos. Esforços têm sido empregados para aumentar o número de ciclos de tratamento em reprodução assistida, como, por exemplo, a criação de programas de baixo custo. Ainda nos dias atuais, a infertilidade permanece como um problema de proporções mundiais, acometendo milhões de casais. A estimativa da incidência da infertilidade é incerta, principalmente por causa dos critérios utilizados para sua definição. Este artigo tem como objetivo revisar os aspectos mais importantes, de forma sucinta, referentes a incidência, etiologia e alternativas terapêuticas disponíveis para os casais inférteis.

Promise(s) of using mesenchymal stem cells in reproductive disorders.

In recent times, infertility among both man and woman has become a major concern affecting about 20 per cent of the population worldwide and has been attributed in part to several aetiological factors such as changes in lifestyle, which includes sedentary life, dietary habits, sleep anomalies, environmental pollution, etc. Assisted reproductive technologies (ART) have come to the rescue of many such couples, but presence of metabolic disorders such as obesity, diabetes with insulin resistance (IR) and its secondary complications (micro- and macro-vascular complications), become confounders to the outcome of ART. Cell therapies are arising as a new hope in the management of reproductive disorders and currently, the efficacy of mesenchymal stem cells (MSCs) harvested from the adult sources finds wide application in the management of diseases like stroke, neuropathy, nephropathy, myopathy, wounds in diabetes, etc. Given the capacity of MSCs to preferentially home to damaged tissue and modulate the cellular niche/microenvironment to augment tissue repairs and regeneration, the present review outlines the applications of MSCs in the management of infertility/reproductive disorders.

Emergency contraception - Potential for women's health.

Emergency contraception (EC) is a safe and effective method which is used to prevent unwanted pregnancy after unprotected sexual intercourse. Many of the unwanted pregnancies end in unsafe abortions. The search for an ideal contraceptive, which does not interfere with spontaneity or pleasure of the sexual act, yet effectively controls the fertility, is still continuing. Numerous contraceptive techniques are available, yet contraceptive coverage continues to be poor in India. Thus, even when not planning for a pregnancy, exposure to unprotected sex takes place often, necessitating the use of emergency contraception. This need may also arise due to failure of contraceptive method being used (condom rupture, diaphragm slippage, forgotten oral pills) or following sexual assault. Emergency contraception is an intervention that can prevent a large number of unwanted pregnancies resulting from failure of regular contraception or unplanned sexual activity, which in turn helps in reducing the maternal mortality and morbidity due to unsafe abortions. However, a concern has been expressed regarding repeated and indiscriminate usage of e-pill, currently the rational use of emergency contraception is being promoted as it is expected to make a significant dent in reducing the number of unwanted pregnancies and unsafe abortions. In fact, since the introduction of emergency contraception, the contribution of unsafe abortion towards maternal mortality has declined from 13 to 8 per cent.

Propedêutica básica da infertilidade conjugal / Basic propedeutics of conjugal infertility

A infertilidade é um problema que afeta cerca de 10%-20% da população, com incidência variável em todo o mundo. A avaliação do casal infértil é geralmente indicada depois de um ano, tempo em que a maioria dos casais normais teria sido bem sucedida na tentativa de concepção. Algumas investigações são controversas, e, na presença de múltiplos métodos, o custo, a segurança e a conveniência deveriam ajudar a decidir o mais apropriado.

Infertility is a problem affecting approximately 10%-20% of the population with variable incidences across the world. Evaluation of a couple is generally indicated after one year, by which time most normal couples attemptiong conception would have been successful. Some of the investigations are controversial and in the presence of multiple methods of investigating one aspect, the cost, safety, convenience and evidence-base should help in deciding on the appropriate method.

Tratamiento del factor autoinmune en el aborto recurrente y en el retardo de crecimiento intrauterino con anti-agregantes plaquetarios / Treatment of autoimmunity factor in recurrent abortion and in intrauterine growth retardation with platelets anti-aggregation

Objetivo: Describir los resultados del tratamiento anti-agregante plaquetario en un grupo de pacientes con auto-anticuerpos y antecedentes de aborto recurrente (AR) y/o retardo de crecimiento intrauterino (RCIU). Material y Métodos: Diecisiete pacientes que consultaron por AR y/o RCIU, mala historia obstétrica o antecedentes de VDRL falso positivo, en cuyo estudio inmunológico se detectaron autoanticuerpos, constituyen el material del presente trabajo. A las pacientes que tenían como antecedente un RCIU, una vez descartados todos los cuadros clínicos que pudieran ocasionarlo, se les efectuó determinación de anticuerpos. Las parejas que consultaban por AR eran sometidas a estudio para descartar un factor uterino, infeccioso, endocrinológico, metabólico, genético, innmunológico y espermático. En algunas pacientes se realizó una laparoscopia para descartar endometriosis. Todas las pacientes fueron tratadas con Acido Acetilsalicílico (AAS) 80 mg diarios, a partir del momento de la detección de autoanticuerpos. A una sola paciente se le administró además heparina subcutánea durante dos embarazos. Resultados: De las diecisiete pacientes en las que se detectaron autoanticuerpos, catorce embarazaron, algunas de ellas en más de una oportunidad, sumando un total de 24 embarazos. De ellos, 5 concluyeron en aborto espontáneo y dieciocho concluyeron en el tercer trimestre con recién nacido vivo. De éstos, siete presentaron un crecimiento fetal normal, mientras que los once restantes desarrollaron RCIU. La vía de terminación fue vaginal en seis casos y abdominal en los doce restantes. Un embarazo se encuentra en evolución al momento de la presente comunicación

Consenso acerca de la recuperación del ciclo mentrual y fertilidad posterior al uso de anticonceptivos hormonales / A consensus upon menstrual cyclo and fertility restoration after hormonal contraception

Se revisa la frecuencia de amenorrea y esterilidad a la suspención de anticonceptivos hormonales, concluyéndose que ésta es baja. Destaca que la población más susceptible de presentar alteraciones en este sentido es aquella con anteceentes de disfunción hipotálamo-hipofisaria

High prevalence of obesity in a Saudi infertility population

A menstrual history was taken from the female partners of all new infertility couples seen in our clinic between 1988 and 1990. The body mass index [Kg/M[2]] was measured in all females. The ovulatory status was studied using a combination of serial transvaginal ultrasound investigations and progesterone measurements in the second half of the cycle in females with regular menstrual cycles or progesterone measurements one week before the expected onset of menstruation in females with oligomenorrhea. Amenorrheic patients were considered anovulatory if no anatomical abnormality was found. Out of the 1755 patients, only 17% were in the normal weight category [BMI 19-24], 42% were overweight [BMI25-29] and 38% were obese [BMI 30 or more], while the remaining 3% were underweight. With increasing BMI, the percentage of oligomenorrhea increased from 18% to 32%, the percentage of amenorrhea increased from 2% to 13%. The overall percentage of anovulation increased from 32% to 55%

Chlamydia trachomatis como factor de esterilidad en la pareja: proyeccion inicial / Chlamydia trachomatis as a factor in sterility of the couple

El diagnostico y tratamiento de la Chlamydia trachomatis como factor de esterilidad en la pareja humana y como causa de infertilidad en la mujer gestante, es algo mas o menos raro en la nosografia publicada y se constituia, hasta hace unos años, en un poco frecuente hallazgo en la practica de la especialidad. Sin embargo, recientemente con los medios biotecnologicos a nuestro alcance, su frecuencia, investigacion y tratamiento se han convertido en una necesidad en la metodologia de diagnostico, tanto de la pareja que no logra gestaciones, como de aquella en la que el embarazo no culmina afortunadamente. La comunicacion es una proyeccion inicial de un trabajo mayor de proxima publicacion.

Parasitic castration in Fissurella crassa (Archaeogastropoda) due to an adult Digenea, Proctoeces lintoni (Fellodistomidae)

Specimens of Fissurella crassa (Archaeogastropoda) from Ilo, southern Perú, are infected with the adult stage of the digenetic trematode Proctoeces lintoni (Fellodistomidae). The histopatological analysis of the male and female gonads show a strong effect of the parasite on the structure and function of these organs. P. lintoni live unencysted in the gonads, and the main mechanical damage is originated by the action of a well developed acetabulum. Chemical actions of parasitic secretions may also be involved. The infected gonads show altered structure and the gametogenic processes is aborted. There is no evidence of hemocytic response, but leucocite infiltration is evident at least in male infected gonads. An increased content of polysaccarides is evident in infected gonads

Atmospheric temperature & anovulation in south Indian women with primary infertility.

An attempt at correlating atmospheric temperature, humidity and histologically diagnosed anovulatory endometrium has been made. A total of 140 women who had anovulatory endometrium among 1036 patients who had a clinical diagnosis of primary infertility, over a 5 yr period were studied. The principle of Edwards' test was used to analyse the seasonal trends and the seasonal index for the occurrence of anovulatory endometrium, atmospheric temperature and humidity was calculated using the average percentage method. The results suggest that anovulatory cycles in women with infertility tended to occur more during those months in the year when temperature increased (r = 0.63). However, humidity was not related to anovulation.

Glycerylphosphorylcholine levels in the coagulational groups of human ejaculates.

The amount of coagulum present in fresh ejaculates of men (among infertile couple) varied directly with the levels of seminal glycerylphosphorylcholine (GPC; P less than 0.001), which is secreted predominantly by the epididymis. GPC concentrations (mg/ml) of the normally and poorly coagulating ejaculates revealed close similarities with those of the presumably fertile (1.72 +/- 0.10) and infertile semen (1.13 +/- 0.08) respectively. The study suggests that the degree of coagulation of human ejaculates may be correlated with epididymal function.