SARS-COV-2 and Male Reproductive Health.

Critical challenges for the public and private health, research, and medical communities have been posed by the COVID-19 outbreak. Some of these challenges are related to the possible adverse effects of SARS-CoV-2 on male reproductive health, and whether other potential modes of transmission may occur, such as sexual transmission. Moreover, concerns have been raised in terms of whether the COVID-19 outbreak may have an impact on fertility worldwide. In this study, we will discuss the origins of SARS-CoV-2. We will further describe its mechanism of action, diagnosis, symptoms, and potential effects on the male reproductive system.

Expression of PD-L1 in cervical carcinoma and its impact on survival associated with T-cell infiltration and FoxP3 expression.

Background: The PD-1/PD-L1 signaling axis is currently the most elucidated mechanism for tumor evasion of T-cell-mediated immunity. Nevertheless, few data are available regarding its impact on cervical cancer and the relationship with lymphocytic infiltrates. Methods: A retrospective assessment of all cases of cervical neoplasia treated in Caxias do Sul General Hospital, Brazil, between 2012 and 2016 was performed. Clinical and pathological data were collected from electronic records and analyzed. Original slides were independently reviewed by three pathologists to confirm diagnoses and to assess the immunohistochemical expression of PD-L1 and FoxP3 in tumor cells and lymphocytic infiltrates. Results: PD-L1 staining was present in 32.2% of the 59 cervical samples. Median overall survival time of the PD-L1-negative group was 47.8 months, a time point not yet reached by the PD-L1-positive group (p=0.968). Median progression-free survival was 24.3 months for PD-L1-negative and 11.5 months for PD-L1-positive patients (p=0.263). PD-L1 staining was found in 27.1% of the lymphocytic infiltrates, and survival analysis revealed no difference between PD-L1-positive and PD-L1-negative samples. There was no impact on survival related to FoxP3 staining in neither tumor samples nor lymphocytic infiltrates. Conclusion: Although the median progression-free survival times differed, the difference was not statistically significant. Our study corroborates the rationale that PD-L1 expression in cervical neoplasms has no impact on survival. PD-L1 expression in peritumoral lymphocytes revealed no impact on infiltration volume nor survival. Keywords: uterine cervical neoplasms, tumor-infiltrating lymphocytes, cancer, tumor microenvironment, survival.

Improving Sperm Viability After Spinal Cord Injury Using Hyperbaric Therapy.

BACKGROUND: Infertility is one of many complications of spinal cord injury (SCI) in male patients, who are often at the peak of their reproductive life. This study evaluated effects of hyperbaric therapy (HT) on quality of sperm of rats with SCI and correlated the findings with histologic analysis of the testicles. METHODS: This experimental study comprised 18 rats that were submitted to SCI with a MASCIS Impactor and randomly allocated to either a HT or a control group. Testicular biopsies were performed on the first and 28th day of the study; 4 parameters were evaluated: concentration of sperm per mL, number of round cells per field, number of inflammatory cells per field (peroxidase [Endtz] test), and sperm viability (hypo-osmotic swelling test). RESULTS: There was no difference in sperm concentration between the HT group (P = 0.41) and control group (P = 0.74) during 28 days. From day 1 to day 28, sperm viability decreased twice as much in the control group (P = 0.001) compared with the HT group (P = 0.017). There was no difference between the groups in mean sperm concentration and number of round and inflammatory cells. On the first day, there was no difference in sperm viability between groups. There was a significantly higher (P = 0.001) percentage of viable sperm in the HT group (86.8 ± 5.6) compared with the control group (48.8 ± 21.8) on day 28. CONCLUSIONS: SCI increased the number of round and inflammatory cells and diminished sperm viability in both groups. HT promoted greater sperm viability in rats with SCI.

ANDROGEN RECEPTOR EXPRESSION IN TRIPLE NEGATIVE BREAST CANCER AND ITS RELATIONSHIP TO PROGNOSTIC FACTORS / Expressão de receptor de androgênio em câncer de mama triplo negativo e sua relação com fatores prognósticos

Objective: Triple negative breast cancer (TNBC) is a subset of tumors with an aggressive intrinsic biology, resulting in poor prognosis. Androgen receptor (AR) is currently one of the most studied biomarkers in TNBC, playing a role in the genesis and development of breast cancer. Methods: In this cross-sectional study, we retrospectively reviewed the medical records of all patients with TNBC who received care from 2012 to 2014 at a single health center in southern Brazil. Histological material from breast tumors was analyzed by immunohistochemistry for AR expression and related to age, histological grade, tumor-infiltrating lymphocytes (TILs), and Ki-67. Results: Of 34 TNBC cases identified, 23 (67.6%) were AR negative and 11 (32.4%) were AR positive. The average age of the patients was 51.9 years (range: 30­82 years). Among positive cases, AR was weakly expressed in 6 and strongly expressed in 5 cases. Most patients (n=28; 82.0%) had poorly differentiated tumors. Mean Ki-67 expression was 65.0% in AR-negative and 43.6% in AR-positive cases (p<0.05). There was a significant association between age and AR expression (p<0.005), which was associated with mean age 70.8 years in the strongly AR-positive group and 42.3 years in the weakly AR-positive group. The mean percentage of TILs was 38.6% in AR-positive and 39.1% in AR-negative cases (p=0.391). Conclusion: There was no significant association between AR expression and histological grade or TILs. AR positivity in TNBC was associated with older age and tumors with lower Ki-67 expression, indicating two subgroups with distinct phenotypes in patients with TNBC.

Objetivo: O câncer de mama negativo triplo (triple negative breast cancer ­ TNBC) é um subtipo de tumores com biologia intrínseca agressiva, resultando em pior prognóstico. O receptor de andrógeno (androgen receptor ­ AR) é atualmente um dos biomarcadores mais estudados em TNBC, desempenhando papel na gênese e no desenvolvimento do câncer de mama. Métodos: Neste estudo transversal, revisamos retrospectivamente os registros médicos de todos os pacientes com TNBC que receberam atendimento de 2012 a 2014 em um único centro no sul do Brasil. O material histológico dos tumores de mama foi analisado por imuno-histoquímica para a expressão de AR e relacionado a idade, grau histológico, linfócitos infiltrantes de tumores (TILs) e Ki-67. Resultados: Dos 34 casos identificados de TNBC, 23 (67,6%) eram AR negativos e 11 (32,4%), AR positivos. A idade média foi de 51,9 anos (30­82 anos). Entre os casos positivos, AR foi fracamente expresso em 6 e fortemente expresso em 5 casos. A maioria dos pacientes (n=28, 82,0%) apresentou tumores pouco diferenciados. A expressão média de Ki-67 foi de 65,0% em AR-negativo e 43,6% em AR-positivo (p<0,05). Houve associação significativa entre a idade e a expressão de AR (p<0,005), associada à idade média de 70,8 anos no grupo com AR fortemente positivo e de 42,3 anos no grupo com AR fracamente positivo. A porcentagem média de TILs foi de 38,6% em AR-positivo e de 39,1% em AR-negativo (p=0,391). Não houve associação significativa entre expressão AR e grau histológico ou TILs. Conclusão: A positividade de AR em TNBC foi associada com idade mais avançada e tumores com menor expressão de Ki-67, indicando dois subgrupos com fenótipos distintos em pacientes com TNBC.

Occupational exposure to pesticides, reproductive hormone levels and sperm quality in young Brazilian men.

The association of occupational exposure to current-use pesticides with reproductive hormones, semen quality, and genital measures was investigated among young men in the South of Brazil. A cross-sectional study was conducted in 99 rural and 36 urban men aged 18-23 years. Information on pesticide use was obtained through questionnaire. Serum and semen samples were analyzed for sex hormones and sperm parameters, respectively, and measurement of anogenital distance (AGD) and testis volume (TV) were performed. Associations were explored using multivariate linear regression. Rural men had poorer sperm morphology, higher sperm count, and lower LH levels relative to urban subjects. Lifetime use of pesticides, especially herbicides and fungicides, was associated with poorer morphology and reduced LH and prolactin, with evidence of a linear pattern. Maternal farming during pregnancy was associated with larger AGD and TV. Chronic occupational exposure to modern pesticides may affect reproductive outcomes in young men.

Expression analysis of transglutaminase 2 in premalignant lesions of the cervix

Background: The medical management of low-grade squamous intraepithelial lesions (LSIL) is variable, thus a biomarker could assist with the clinical conduct. Type 2 transglutaminase (TG2) has been proposed as a cellular-interfering factor in HPV infection and carcinogenesis. Therefore, this study has the objective of evaluating TG2 expression in LSIL and highgrade squamous intraepithelial lesions (HSIL) and of relating it to the different HPV viral types. Methods: This study included 146 patients with suspected LSIL or HSIL detected in routine conventional Papanicolaou tests. The presence of HPV DNA and viral typing was defined by the polymerase chain reaction method (PCR). TG2 Immunohistochemistry (IHC) was conducted according to the manufacturer's instructions; IHC was carried out in an Autosteiner-Link 48 Dako equipment. IHC quantitation was performed by relative expression and by using the software Image J. Qualitative variables, such as frequencies and proportions, were compared by using the χ2 test for independent samples. For comparison of the qualitative to the quantitative data, nonparametric Mann-Whitney test was used. Results: The association between histopathological examination and TG2 was statistically significant (p <0.05). Results showed that patients with normal cervical histopathology and LSIL are locally associated with TG2 expression levels >50% (p <0.05), and patients with HSIL are associated with no TG2 expression (p <0.05). The analysis of the samples with the Image J software shows a significant (p <0,001) decrease in TG2 immunostaining in HSIL if compared to normal and to LSIL samples. This demonstrates a correlation between the relative quantification and the results provided by Image J. Analysis of HPV types showed a significant association with HPV11 (p = 0.031). This indicates that patients with HPV type 11 had higher TG2 values than patients with different types. Image J analysis showed no significant association between TG2 and HPV viral types. Conclusion: The present data suggest that TG 2 has a high expression in LSIL and normal tissues, and decreased in HSIL. We also observed that its expression is associated with HPV11 (AU)

Spinal cord injury and male infertility: a review / Traumatismo raquimedular e infertilidade masculina: revisão / Lesión de la médula espinal e infertilidad masculina: una revision

Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.

O trauma raquimedular (TRM) é uma importante causa de morbimortalidade na sociedade atual, principalmente por acometer adultos jovens. Dentre as diversas sequelas decorrentes da lesão medular encontram-se as alterações na qualidade de vida sexual e na paternidade. A infertilidade decorre de diversas alterações como: disfunção erétil, anejaculação, alterações bioquímicas no sêmen e estruturais nos espermatozoides. As terapias para a infertilidade pós-TRM, em geral, objetivam o estímulo à ejaculação e posterior inseminação, sendo a baixa qualidade do sêmen o fator determinante para infertilidade. A terapia hiperbárica representa uma possibilidade de atuar diretamente no tecido lesado, seja ele medular ou testicular, diminuindo o dano.

La lesión de la médula espinal sigue siendo una causa importante de morbilidad y mortalidad en la sociedad actual, que afecta principalmente a hombres en la adolescencia a la edad adulta. Entre las varias secuelas resultantes de lesiones de la médula espinal, el deterioro del sistema sexual es de gran relevancia una vez que afectan la calidad de la vida sexual y la paternidad. La infertilidad es secundaria a varios eventos, tales como la disfunción eréctil, aneyaculación, modificación bioquímica seminal y la morfología de los espermatozoides. Los tratamientos para la infertilidad post-TRM, en general, tienen por objeto estimular la eyaculación seguida de inseminación in vitro, siendo la baja calidad seminal el factor determinante de la infertilidad de estos pacientes. En este escenario, la terapia con oxigenación hiperbárica, aún en estudio, representa un tratamiento alternativo ya que actúa sobre el sistema nervioso central lesionado por el trauma y sobre el tejido testicular para reducir el daño espinal y preservar la regulación fisiológica del sistema genital como una forma de evitar la infertilidad.

Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures.

There are many studies in the literature suggesting an acquired, apparently progressive infertility due to varicocele. In fact, varicocelectomy has become the most commonly performed male infertility surgery. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) are also important for couples with male factor infertility associated with varicocele. Therefore, the aim of this study was to evaluate the effect of varicocelectomy on sperm quality and pregnancy rate with ICSI. Data were analyzed from 248 patients who had varicocele or underwent a previous varicocelectomy and were treated with ICSI between 2000 and 2008. Patients with varicocele were divided into two groups: men with clinical varicocele (group 1, n = 79) and men who underwent varicocelectomy before ICSI (group 2, n = 169). In all cases, female infertility was not detected. We evaluated and compared the two groups' semen characteristics as defined by the World Health Organization and Tygerberg's strict criteria: the female partner's age; the number of oocytes retrieved; and the fertilization, implantation, pregnancy, and miscarriage rates. We used the Wilcoxon signed rank test or the Mann-Whitney test for these analyses. No differences were detected in the age of the female partners between group 1 (33.0 ± 0.46 years) and group 2 (33.8 ± 0.38 years; P = .1872). Semen volume was higher in group 1 (3.3 ± 0.3 mL) than it was in group 2 (2.5 ± 0.14; P = .0043). No differences were detected between groups 1 and 2 with regard to sperm concentration (30.08 ± 4.01 million/mL and 24.1 ± 2.42 million/mL, respectively; P = .138), sperm motility (38.2% ± 2.69% and 38.7% ± 2.08%, respectively; P = .881), and morphology according to Tygerberg's strict criteria (2.6% ± 0.44% and 2.4% ± 0.37%, respectively; P = .7202). Also, no differences were detected in the number of oocytes retrieved between group 1 (14.8 ± 1.74) and group 2 (14.9 ± 1.04; P = .9515). The fertilization rate was higher in group 1 (73.2%) than it was in group 2 (64.9%; P = .0377); however, no differences were detected in the pregnancy rates (31.1% vs 30.9%; P = .9806), implantation rates (22.1% vs 17.3%; P = .5882), or miscarriage rates (21.7% vs 23.9%; P = .8401) between groups 1 and 2. Although a varicocelectomy should always be performed before assisted reproduction is pursued, this surgery does not increase pregnancy rates or decrease miscarriage rates following ICSI.

Sintomas depressivos e suas características em pacientes submetidos a hemodiálise / Depressive symptoms and their characteristics in patients undergoing hemodialysis

A depressão é uma condição presente em 20% dos portadores de doenças crônicas, estando associada à incapacitação funcional e comprometimento da saúde física. A doença renal crônica faz parte desse escopo, com prevalência de 405 pacientes por milhão de habitantes submetidos a hemodiálise no Brasil. Objetiva-se avaliar prevalência de sintomatologia depressiva e suas características em pacientes sob tratamento dialítico. Métodos: Estudo transversal, realizado entre junho e agosto de 2010, incluindo os pacientes submetidos a hemodiálise no Hospital Geral de Caxias do Sul, que preencheram os critérios de inclusão. Procedeu-se a aplicação de instrumentos de coleta de dados. O ponto de corte para depressão foi de 16 pontos no Inventário de Depressão de Beck. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: A amostra foi constituída por 64 pacientes. A média de idade foi de 53,66 ± 15,82 anos; 51,7% eram do sexo feminino. A prevalência de depressão foi de 44,8%. Os pacientes com IDB < 16 apresentaram escore médio de 7,23 ± 3,5; já aqueles com IDB > 16 apresentaram média de 26,43 ± 9,35 (p < 0,001). Os pacientes que necessitavam cuidador apresentaram maiores índices de depressão (p< 0,001). Nos pacientes com IDB > 16 os fatores mais influentes foram sono, cansaço e incapacidade de tomar decisões. Conclusão: A prevalência de depressão nos pacientes em hemodiálise é alta. Os pacientes que necessitam de cuidadores apresentam maior escore no IDB. Alterações do sono, cansaço e incapacidade de tomar decisões são os principais fatores para o humor depressivo.

Depression is a condition present in 20% of patients with chronic diseases and is associated with functional disability and impaired physical health. Chronic kidney disease is part of this scope, with an estimated prevalence of 405 patients per million undergoing hemodialysis in Brazil. The objective of this study was to evaluate the prevalence of depressive symptoms and their characteristics in patients on dialysis. Methods: A cross-sectional study conducted between June and August 2010, including patients undergoing hemodialysis at the General Hospital of Caxias do Sul, who met the inclusion criteria. The data collection instruments (questionnaire, Mini Mental State Examination and the Beck Depression Inventory–BDI) were administered individually during a hemodialysis session. The cut-off point for depression was 16 points in the BDI. Results: We studied 64 patients. The mean age was 53.66 ± 15.82 years, 51.7% were females. The prevalence of depression was 44.8. Patients with BDI<16 had a mean score of 7.23 ± 3.5, whereas those with BDI>16 had an average of 26.43 ± 9.35 (p <0.001). Patients who needed caregivers had higher levels of depression (p <0.001). In patients with BDI>16, the most influent factors were sleep, fatigue and inability to make decisions. Conclusion: The prevalence of depression in hemodialysis patients is high. Patients who need caregivers had higher scores on the BDI. Sleep disorders, fatigue and inability to make decisions are the main factors for depressed mood.

Antegrade subinguinal sclerotization with temporary clamping of the spermatic cord: a new surgical technique for varicocele.

OBJECTIVES: The purpose of our study was to evaluate the duration, effectiveness, and complications associated with a new operating technique for varicocele, using a subinguinal surgical approach and antegrade sclerotization of the spermatic veins. METHODS: A total of 756 varicocele patients who came under our care for infertility underwent surgical treatment with our technique. The diagnosis was based on clinical examination and confirmed by color-Doppler ultrasound of the spermatic cord. Only patients with continuous basal reflux inside the left spermatic vein detected in orthostatism underwent operation. The Colpi technique was used, which consists of a subinguinal incision with suspension of the spermatic cord; cord clamping for 8-10 minutes using two elastic bands; and injection of 1.5-3 mL of sclerosing agent during induced ischemia without any intraoperative radiological control. RESULTS: The average operating time was 25 minutes (range: 18-45 minutes). At the 3-month postoperative follow-up, there were 15 cases of persistent reflux (1.9%), 6 cases of hydrocele requiring surgical correction (0.7%), and 50 cases of fibrotic sequelae of penile lymphangiitis (6.6%). CONCLUSIONS: The new technique was more effective than the previous ones, with the exception of the microsurgical technique, which, however, takes 2-3 times longer to perform. The only significant complication was superficial single-vessel lymphangiitis of the penis, which resolved within 3 months with no apparent consequences. In conclusion, this new operating technique for varicocele is simpler to perform and may be effective compared with other techniques.

Effects of resveratrol supplementation on cryopreservation medium of human semen.

OBJECTIVE: To analyze oxidative stress markers and seminal standard parameters after using resveratrol (0.1, 1.0, and 10.0 mM), an important antioxidant, in the cryopreservation of human semen. DESIGN: In vitro prospective study. SETTING: Institutional study. PATIENT(S): Infertile and fertile men. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Levels of thiobarbituric acid-reactive species (TBARS), superoxide dismutase (SOD), and catalase (CAT) activities and spermatozoa concentration, motility, and morphology. RESULT(S): Increased TBARS levels were observed in the post-thawing semen in both fertile and infertile men. Infertile men had lower CAT and SOD activities in prefreezing and post-thawing samples when compared with fertile men. The addition of resveratrol in all the concentrations assayed was able to prevent post-thawing lipoperoxidation in both fertile and infertile men. However, this effect was not dose dependent. The cryopreservation process was not able to change sperm concentration or morphology. However, a decrease in sperm motility was observed in both the fertile and infertile men. The addition of resveratrol was not able to prevent this effect. CONCLUSION(S): Resveratrol avoids oxidative damages induced by the cryopreservation of human semen, but it is not able to restore the decrease in sperm motility.

Assisted reproductive technology outcomes in azoospermic men: 10 years of experience with surgical sperm retrieval.

An azoospermic man suffers from an absence of sperm in the ejaculate and this condition is present in about 10% of infertile men. Obstructive azoospermia (OA) is characterized by an occlusion or partial absence of the reproductive tract with the presence of normal spermatogenesis. On the other hand, non-obstructive azoospermia (NOA) is characterized by impaired spermatogenesis. In these cases, spermatozoa can be obtained by percutaneous epididymal or testicular sperm aspiration (PESA and TESA, respectively) and used for intracytoplasmic injection (ICSI). To compare ICSI outcomes using spermatozoa that were surgically retrieved by PESA and TESA, azoospermic patients were divided into the following categories: (i) TESA-NOA (n = 102), (ii) TESA-OA (n = 103), and (iii) PESA-OA (n = 171). Fertilization, pregnancy, and implantation rates were compared between the groups. We noted a lower normal fertilization rate (p = 0.0017) and a higher abortion rate (p = 0.0387) among men in the TESA group who had OA when compared with men in the PESA group who had OA. On the other hand, a lower normal fertilization rate (p = 0.05) and a lower rate of non-cleaved embryos (p = 0.034) was found in the TESA group of NOA patients as compared to the TESA group of OA patients. No statistically significant differences were detected between the TESA and PESA groups and the OA and NOA groups, respectively. The clinical outcomes of embryos arising from ICSI cycles using spermatozoa harvested via PESA and TESA were similar, regardless of whether the patient had obstructive or non-obstructive azoospermia.

Contribution of in-vitro maturation in ovarian stimulation cycles of poor-responder patients.

This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method to increase the number of embryos available for transfer and whether transfers with RSM-derived embryos would contribute to clinical outcomes of poor-responder patients in ovarian stimulation cycles. The study included 440 patients undergoing intracytoplasmic sperm injection cycles in which fewer than five metaphase II (MII) oocytes and at least one immature oocyte were retrieved after follicle aspiration. Patients were allocated into two groups based on the injected oocytes' nuclear maturation status: MII group (n=330), in which only embryos derived from MII oocytes were transferred, and RSM group (n=110), in which at least one embryo derived from an RSM oocyte was transferred. No differences between the MII and RSM groups were observed for pregnancy (16.7% versus 16.5%) or miscarriage (25.5% versus 29.4%) rates, respectively. The RSM group had a higher number of transferred embryos (1.87+/-1.24 versus 2.35+/-1.22; P<0.001), a lower embryo transfer cancellation rate (14.5% versus 6.36%; P=0.025) and lower implantation rate (15.4+/-31.5% versus 10.5+/-22.3%; not significant). These findings suggest that RSM did not contribute to the outcomes in poor-responder cycles.

Predictive factors of repeat sperm aspiration success.

OBJECTIVES: To evaluate the outcomes of repeated testicular sperm aspirations (TESAs) and to investigate whether the interval between TESA procedures, success in the first attempt, and patient age might influence the results. METHODS: The patient population in the present study consisted of couples undergoing TESA for intracytoplasmic sperm injection. Of these, 189, 46, 42, and 19 male patients underwent 1, 2, 3, and 4 sperm retrievals, respectively. The effects of the interval between TESA procedures, success of the previous attempts, and patient age on sperm recuperation in a repeated procedure were evaluated. RESULTS: Of the patients with nonobstructive azoospermia from whom sperm was not retrieved in the first procedure, 16.6% had successful sperm retrieval at the second procedure. In 57.1% of the patients who did not achieve sperm recuperation for the second attempt, sperm could be retrieved in the third procedure. Finally, of the patients without success in the third attempt, 40.0% had successful sperm retrieval at the fourth attempt. Success in the preceding TESA procedure positively influenced the success of sperm retrieval in a repeated attempt, and a trend for a negative effect of paternal age in the success of a repeated TESA attempt was noted. However, the interval between procedures had no influence on TESA success. CONCLUSIONS: The results of our study have shown that patient age and the success of the first TESA may predict the results of additional attempts. However, TESA may result in sperm recovery even when the first recovery procedure was not successful. Moreover, sperm recovery did not seem to be affected by the interval between procedures.

Resveratrol and ascorbic acid prevent DNA damage induced by cryopreservation in human semen.

Cryopreservation of human semen can cause DNA damages, which compromise the fertilization and normal embryo development. The present study showed that the antioxidant resveratrol prevents these damages both in fertile and infertile men. The addition of ascorbic acid before cryopreservation can reduce DNA damages only in infertile men. Although further studies are needed, the present work showed that resveratrol could be considered in human cryopreservation procedures to avoid/minimize DNA damages and preserve sperm integrity.

Negative influence of paternal age on clinical intracytoplasmic sperm injection cycle outcomes in oligozoospermic patients.

OBJECTIVE: To evaluate the effect of male age on clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles, according to sperm concentration. DESIGN: Retrospective, observational study. SETTING: Assisted reproduction center. PATIENT(S): The study included 1,024 couples undergoing ICSI cycles with fresh spermatozoa. INTERVENTION(S): The influence of paternal age on ICSI outcomes of oligozoospermic and normozoospermic patients was evaluated. MAIN OUTCOME MEASURE(S): Rates of high-quality embryos, pregnancy, implantation, and miscarriage were evaluated through linear logistic regression analyses. RESULT(S): When the sperm concentration was abnormal, paternal age influenced implantation (regression coefficient value = -0.7009) and pregnancy rates (odds ratio = 0.95, 95% confidence interval 0.91-0.99). However, in normozoospermic patients, no influence of paternal age was observed on implantation (regression coefficient value = 0.0566) or pregnancy rates (odds ratio = 1.00, 95% confidence interval 0.97-1.03). CONCLUSION(S): For couples in which the men are oligozoospermic, the implantation rate could be impaired by increased paternal age. In these couples, the chance of pregnancy decreased 5% for each year of paternal age. When men are normozoospermic, this effect is not observed.

Criopreservação de oócitos / Oocytes cryopreservation

criopreservação de oócitos atualmente representa uma grande evolução em Reprodução Humana Assistida. Essa técnica consiste na conservação de células ou tecidos a temperaturas inferiores a -196¨¬C. A criopreservação de oócitos é um dos principais destaques, que surgiu com o objetivo de preservar a fertilidade feminina e, ainda, contornar as questões éticas e legais associadas ao congelamento de embriões. As técnicas de criopreservação vêm sendo aprimoradas, tendo sido observado um avanço notável nas taxas de fertilização obtidas a partir de oócitos congelados. Com base nisto, este estudo teve como objetivo realizar uma revisão bibliográfica sobre dois métodos de criopreservação (congelamento lento e vitrificação). Para isso, realizaram-se leitura e seleção de informações trabalhadas por outros autores em revistas científicas, sites de busca e livros específicos de reprodução humana assistida. Foram analisados: histórico da criopreservação de oócitos; indicações; crioprotetores; métodos de criopreservação e resultados das taxas de fertilização, gravidez e aborto segundo pesquisas já realizadas tanto com congelamento lento quanto com vitrificação de oócitos. Apesar dos resultados favoráveis à criopreservação oocitária, são necessárias mais pesquisas para que haja estabilização dos resultados e estabelecimento de uma técnica de criopreservação de oócitos humanos que seja universal e padronizada, podendo ser aplicada com sucesso nas clínicas de Reprodução Humana Assistida.

Cryopreservation of oocytes currently represents a major evolution in the human assisted reproduction. This technique consists of the conservation of cells or tissues in temperatures less than -196 ¢ªC. In view of the controversy in several cultures on legal and ethical issues associated with the freezing of embryos, the development of techniques that could solve this problem became necessary. The cryopreservation of oocytes is one of the highlights, aiming to preserve the fertility of women. The techniques of cryopreservation have been improving in search of quality and good results. Nowadays, we observe a progress in fertilization rates obtained from frozen oocytes. Our objective was to carry out a bibliographic review of two methods of cryopreservation (slow freezing and vitrification). In order to do that, we read and checked information provided by other authors in scientific journals, search engines and books on human assisted reproduction. We analyzed: history of oocytes cryopreservation; indications; cryoprotectors; methods and results of cryopreservation of fertilization, pregnancy and abortion rates, according to other surveys on slow freezing and oocyte vitrification. Despite the favorable results of oocytes cryopreservation, further studies are necessary to stabilize the results and to establish a technique which be universal for cryopreservation of human oocytes and can be successfully applied in human assisted reproduction clinics.

The role of enzymatic antioxidants detected in the follicular fluid and semen of infertile couples undergoing assisted reproduction.

The follicular fluid environment surrounding the oocytes may play a critical role in fertilization and subsequent embryo development. The goal of our study was to evaluate the oxidative stress markers in the semen, blood serum, and follicular fluid of couples undergoing Intracytoplasmic Sperm Injection (ICSI). Two hundred and eight infertile couples underwent ICSI and the levels of superoxide dismutase (SOD) and catalase and lipid peroxidation (LPO) were evaluated. Semen Catalase was highly correlated with fertilization and cleavage rates, but not with pregnancy rates. Fertilization and cleavage rates were correlated with the levels of SOD and Catalase in the follicular fluid. After adjusting for age, a negative correlation was detected between LPO levels in follicular fluid and pregnancy rates. Follicular fluid LPO levels may be a marker as a metabolic activity within the follicle need for establishing a pregnancy.

Congelamento de espermatozoides para pacientes com câncer e a reprodução assistida: [revisão] / Cryopreservation of sperm before the initiation of cancer therapy and assisted reproductive technics: [review]

Um crescente número de pessoas com câncer é tratado com sucesso e para aqueles com expectativa de sobrevida por longo tempo os efeitos tardios do tratamento são preocupantes. Em muitos pacientes com câncer a qualidade seminal já está reduzida antes mesmo de serem submetidos a qualquer forma de tratamento e deterioração posterior é observada após o tratamento do câncer. Infelizmente, é impossível prever quem irá ter espermatogênese normal ou ficará com azoospermia. Debates têm acontecido à respeito da necessidade de ginecologistas, urologistas, hematologistas, generalistas e oncologistas recomendarem criopreservação de espermatozoides, se o tempo permitir, antes de iniciar a terapia para o câncer. Hoje, criopreservação de sêmen associado a técnicas de reprodução assistida pode fornecer à maioria dos pacientes inférteis com câncer, após a terapia, oportunidade de ter um filho, com excelentes chances de consegui-lo.

Current concepts and future trends in male germ cell cryobanking.

While the idea of freezing human male gametes has been experimented since the late 1700's, it was not until 50 years ago that human sperm were frozen, and later thawed in such a way that they could fertilize an egg and initiate development. In the past several decades the technology of cryopreservation, or maintaining life in a frozen state, has advanced considerably. With the use of modern techniques, cryopreservation of sperm to preserve an individual's ability to reproduce has become successful, safe, and widely available. In the past several decades the technology of cryopreservation, or maintaining life in a frozen state, has advanced considerably preserving the ability of sperm to maintain its fertilizing potential.