Clipping - Clínica Fecondare

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Relatório 09.07.2012 Fecondare Clipping Conteúdo publicado na web: Artigos científicos e
notícias sobre a Reprodução Humana e Andrologia
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Sumário
Artigos Científicos ..................................................................................................................................................... 5 1. Human semen quality in the new millennium: a prospective cross-­‐sectional population-­‐based study of 4867 men……………………………………………………………….…………..5 2. The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan………………………………………………………………………………………………………6 3. A decrease in serum estradiol levels after human chorionic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in in vitro fertilization cycles……………………………………………………………………………………………….6 4. Dietary intake of antioxidant nutrients is associated with semen quality in young university students……………………………………………………………………………………………………...8 5. Two-­‐ and three-­‐dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome: the stromal/ovarian volume ratio as a new diagnostic criterion ………………………………………………………................................................................9 6. Aneuploidy screening for embryo selection………………………………………………….……..10 7. Somatostatin and somatostatin analogues reduce PDGF-­‐induced endometrial cell proliferation and motility…………………………………………………………………………………………...10 8. Are children born after infertility treatment at increased risk of retinoblastoma?...11 9. Methylation levels at imprinting control regions are not altered with ovulation induction or in vitro fertilization in a birth cohort ………………………………………………………12 10. Prevalence of behaviour-­‐related fertility disorders in a clinical sample: results of a pilot study. ………………………………………………………………………………………………………………..14 11. The effects of oxidative stress on female reproduction: a review………………………… 14 Notícias da Web: ..................................................................................................................................................... 15 12. Mulheres sem apêndice têm mais chances de engravidar, diz estudo.............................15 13. Five millionth 'test tube baby'…………………………………………………………………………….16 Clínica
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14. Mediterranean diet can help fertility treatment ………………………………………………….17 Notícias da Clínica e Equipe Fecondare ....................................................................................................... 18 Clínica
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Clipagem - premissas
A clipagem médica tem o objetivo de fornecer aos profissionais da área da saúde atualizações científicas de sua especialidade. Essas atualizações possuem duas funções principais: 1.
Atualizar do corpo clínico, mantendo-­‐o informado das novidades da área; e 2.
Ser base para o desenvolvimento de artigos informativos, que poderão ser veiculados pelo site e mídias sociais da instituição. Para desenvolver o trabalho de clipagem, são feitas pesquisas em bancos de dados renomados no meio científico, bem como notícias sobre os temas definidos em veículos de grande circulação, sites de associações ou blogs, conforme especificado a seguir: Diretórios científicos: Sites temáticos: • Pubmed • Sociedades brasileiras • Portal do Ministério da Saúde • Blogs de profissionais referência na • Bireme -­‐ artigos brasileiros área • Scielo • Cochrane BVS o The Cochrane Library o Biblioteca Cochrane Plus • Resumos de Revisões Sistemáticas em Português Veículos de ampla circulação: Para as pesquisas, são utilizadas as seguintes palavras-­‐chave: • Jornal Estadão • Human reproduction • Jornal Folha de São Paulo • Andrologia • O Globo • Male infertility • Entre outros • Female infertility • Conception 4 Clínica
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Artigos Científicos
TEMA: Atualizações em Infertilidade Masculina, Infertilidade
Feminina e Reprodução Humana
1.
Human semen quality in the new millennium: a prospective cross-­‐sectional population-­‐based study of 4867 men. Veículo: BMJ Open Data: 2 de julho de 2012 Fonte: PubMed Jørgensen N, Joensen UN, Jensen TK, Jensen MB, Almstrup K, Olesen IA, Juul A, Andersson AM, Carlsen E, Petersen JH, Toppari J, Skakkebæk NE. University Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Resumo: OBJECTIVES: Considerable interest and controversy over a possible decline in semen quality during the 20th century raised concern that semen quality could have reached a critically low level where it might affect human reproduction. The authors therefore initiated a study to assess reproductive health in men from the general population and to monitor changes in semen quality over time. DESIGN: Cross-­‐sectional study of men from the general Danish population. Inclusion criteria were place of residence in the Copenhagen area, and both the man and his mother being born and raised in Denmark. Men with severe or chronic diseases were not included. SETTING: Danish one-­‐centre study. PARTICIPANTS: 4867 men, median age 19 years, included from 1996 to 2010. OUTCOME MEASURES: Semen volume, sperm concentration, total sperm count, sperm motility and sperm morphology. RESULTS: Only 23% of participants had optimal sperm concentration and sperm morphology. Comparing with historic data of men attending a Copenhagen infertility clinic in the 1940s and men who recently became fathers, these two groups had significantly better semen quality than our study group from the general population. Over the 15 years, median sperm concentration increased from 43 to 48 million/ml (p=0.02) and total sperm count from 132 to 151 million (p=0.001). The median percentage of motile spermatozoa and abnormal spermatozoa were 68% and 93%, and did not change during the study period. CONCLUSIONS: This large prospective study of semen quality among young men of the 5 Clínica
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general population showed an increasing trend in sperm concentration and total sperm count. However, only one in four men had optimal semen quality. In addition, one in four will most likely face a prolonged waiting time to pregnancy if they in the future want to father a child and another 15% are at risk of the need of fertility treatment. Thus, reduced semen quality seems so frequent that it may impair the fertility rates and further increase the demand for assisted reproduction. 2.
The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan. Veículo: Hum Reprod. Data: 29 de junho de 2012 Fonte:OxforJournal Ghi T, De Musso F, Maroni E, Youssef A, Savelli L, Farina A, Casadio P, Filicori M, Pilu G, Rizzo N. Department of Obstetrics and Gynaecology, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy. Resumo: Artigo original na íntegra disponibilizado pela equipe E-­‐saúde encontra-­‐se no anexo. BACKGROUND Septate uterus seems to be strongly associated with an adverse pregnancy outcome. However, the possible relationship between septate uterus and miscarriage has only been retrospectively ascertained. The aim of our study was to describe the reproductive outcome in women with incidental diagnosis of malformed uterus at first trimester scan. METHODS Women at their first pregnancy attending our centre for a routine viability scan with an incidental suspicion of uterine anomaly at standard sonography were submitted to transvaginal volume ultrasound. All the cases with a 3D diagnosis of septate uterus were prospectively recruited and followed up. RESULTS Overall 24 patients with a single intrauterine pregnancy were included at a median gestational age of 8.2 weeks. The cumulative pregnancy progression rate, as quoted by Kaplan-­‐Meier algorithm, was 33.3% due to the occurrence of early (≤13 weeks) or late miscarriages (14-­‐22 weeks) in 13 and 3 cases, respectively CONCLUSION The pregnancy outcome is poor if a septate uterus is incidentally diagnosed in the early stage of a viable intrauterine pregnancy. 3.
A decrease in serum estradiol levels after human chorionic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in 6 Clínica
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in vitro fertilization cycles. Veículo: Hum Reprod Data: 29 de junho de 2012 Fonte: OxforJournal Kondapalli LA, Molinaro TA, Sammel MD, Dokras A. Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia 19104, PA, USA. Resumo: Artigo original na íntegra disponibilizado pela equipe E-­‐saúde encontra-­‐se no anexo. BACKGROUND Although close observation of serum estradiol (E2) levels remains a mainstay of assessing clinical response to controlled ovarian stimulation, the prognostic value of any change in E2 levels after administration of hCG remains unclear. The objective of this study is to evaluate the relationship between serum E2 response after hCG administration and the clinical pregnancy and live birth rates in fresh IVF cycles. METHODS We conducted a retrospective cohort study of women aged 21-­‐45 years undergoing their first IVF cycle from 1999 to 2008 at a single practice. We compared the post-­‐hCG serum E2 level with values on the day of hCG trigger. IVF cycles were stratified by post-­‐hCG E2 response and appropriate parametric and non-­‐parametric statistics were performed. Clinical intrauterine pregnancy and live births were the primary outcomes of interest. Multivariable logistic regression models were created to identify predictive factors associated with outcomes while adjusting for potential confounders. RESULTS Among the 1712 IVF cycles, 1065 exhibited a >10% increase (Group A), 525 had a plateau (±10%, Group B) and 122 showed a >10% decrease (Group C) in post-­‐hCG E2 levels. While the E2 levels on the day of hCG were similar across groups, Group C had more patients with diminished ovarian reserve, required higher gonadotrophin doses and had the lowest implantation rates. After adjusting for age, total gonadotrophin dose, infertility diagnosis, number of oocytes and number of transferred embryos, the associations between post-­‐hCG E2 decline (Group C) and clinical pregnancy [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.33-­‐0.84, P= 0.007] and live birth (aOR: 0.40; 95% CI: 0.22-­‐0.71, P= 0.002) were significant. We also found significant associations between E2 plateau (Group B) and clinical pregnancy (aOR: 0.73; 95% CI: 0.57-­‐0.94, P= 0.013) and live birth (aOR: 0.74; 95% CI: 0.56-­‐0.97, P= 0.032) when adjusting for the same factors. CONCLUSIONS In our study, >10% decrease in E2 levels after hCG administration was associated with 40-­‐50% reduction in clinical pregnancy and live birth rates. Similarly, post-­‐
hCG E2 plateau (±10%) lowered the clinical pregnancy and live birth rates by >25%. Our study suggests that the change in the post-­‐hCG E2 level is another parameter that can be used by clinicians to counsel patients regarding their likelihood of success with assisted reproductive technologies prior to oocyte retrieval. 7 Clínica
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4.
Dietary intake of antioxidant nutrients is associated with semen quality in young university students. Veículo: Hum Reprod Data: 29 de junho de 2012 Fonte:OxforJournal Mínguez-­‐Alarcón L, Mendiola J, López-­‐Espín JJ, Sarabia-­‐Cos L, Vivero-­‐Salmerón G, Vioque J, Navarrete-­‐Muñoz EM, Torres-­‐Cantero AM. Division of Preventive Medicine and Public Health, Department of Health and Social Sciences, University of Murcia School of Medicine, 30100 Espinardo (Murcia), Spain. Resumo: STUDY QUESTION What are the associations between the dietary intake of antioxidant nutrients and semen parameters in young men? SUMMARY ANSWER Our study suggests that some sperm parameters are sensitive to dietary intake of antioxidant nutrients. WHAT IS KNOWN ALREADY A few reports have suggested that some dietary factors might be related to semen quality. However, the relationship between the intake of antioxidant nutrients and semen quality in young men remains unexplored. STUDY DESIGN, SIZE, DURATION In this cross-­‐sectional study, 215 young men were included between October 2010 and November 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthy university students with complete dietary and semen quality data were analyzed. Dietary intake was recorded using a validated food frequency questionnaire. The associations between the energy-­‐
adjusted nutrient intake of antioxidants in quartiles and the semen volume, sperm concentration, sperm motility, sperm morphology, total sperm count and total motile sperm count were assessed using multivariate linear regression. MAIN RESULTS AND THE ROLE OF CHANCE Out of 240 students who contacted us, 223 (92.9%) were eligible to participate in this study, and 215 attended the clinical appointment. In the multivariate adjusted linear regression models, there was a positive association between dietary intakes of cryptoxanthin (P(trend) = 0.03), vitamin C (P(trend) = 0.04), lycopene (P(trend) = 0.03) and β-­‐carotene (P(trend) = 0.04) and total motile sperm count. The semen volume increased with higher intakes of vitamin C (P(trend) = 0.04). LIMITATIONS, REASONS FOR CAUTION Only one sample of semen was taken for each subject. However, there are indications that one semen sample may be sufficient to characterize the semen quality of the individuals in epidemiological studies. Bias due to measurement errors may also occur since there is no perfect method to assess diet. However, any bias due to measurement error would be non-­‐differential and would 8 Clínica
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reduce, not increase, the strength of the associations. Although selection bias in cross-­‐
sectional studies might not always be ruled out, our subjects were university student volunteers who were rewarded for their participation and the study was not advertised as a fertility study. WIDER IMPLICATIONS OF THE FINDINGS Previous articles in this area have focused mainly on men attending fertility clinics, thus our study brings generalizability to young men of the general population with unknown or untested fertility. Some of our results are in agreement with the previously reported papers. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by 'Fundación Séneca, Región de Murcia, Agencia Regional de Ciencia y Tecnología, grant number: 08808/PI/08', and 'Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III (FIS) grant number: PI10/00985'. The authors have no competing interests to declare. 5.
Two-­‐ and three-­‐dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome: the stromal/ovarian volume ratio as a new diagnostic criterion Veículo: J Ultrasound Med Data: Julho de 2012 Fonte: PubMed Battaglia C, Battaglia B, Morotti E, Paradisi R, Zanetti I, Meriggiola MC, Venturoli S. Department of Gynecology and Patho-­‐physiology of Human Reproduction, Alma Mater Studiorum-­‐University of Bologna, Via Massar-­‐enti 13, 40138 Bologna, Italy., [email protected]. Resumo: OBJECTIVES The purpose of this work was to study the role of 2-­‐dimensional (2D) and 3-­‐
dimensional (3D) sonographic and Doppler techniques in the diagnosis of polycystic ovary syndrome. METHODS A total of 112 young adult lean women with polycystic ovary syndrome and 52 healthy volunteers with regular ovulatory cycles, matched for age and body mass index, underwent a detailed history, medical examination, hormonal assay, and 2D and 3D sonographic and Doppler flow ovarian evaluation during the early follicular phase. RESULTS The Ferriman-­‐Gallwey score, circulating androgen levels, ovarian volume, and mean number of small subcapsular follicles on 2D and 3D sonography were significantly higher in the patients with polycystic ovary syndrome than the controls (P < .001). A stromal score of 1 or 2 was found in all of the patients but none of the controls. The ovarian stromal/total area ratio was 0.32 or higher in 104 of 112 of the patients (93%), which was significantly higher than in the controls (P < .001). On Doppler analysis, the lowest ovarian stromal resistance levels were found in the patients. On 3D sonography, 9 Clínica
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the total ovarian stromal volume, ovarian stroma/total ovarian volume ratio, and stromal mean grayness were significantly higher in the patients than the controls. With 3D power Doppler imaging, ovarian vascularization measurements were significantly lower in the controls than the patients. The ovarian stroma/total ovarian volume ratio was the most accurate predictor of both hyperandrogenemia (area under the curve, 0.915; P < .0001) and hirsutism (area under the curve, 0.891; P < .0001). CONCLUSIONS Our data strongly support the use of 3D sonography with analysis of stromal volume and vascularization in the diagnosis of polycystic ovary syndrome. 6.
Aneuploidy screening for embryo selection Veículo: Semin Reprod Med. Data: 21 de junho de 2012 Fonte: PubMed Fragouli E, Wells D. Reprogenetics UK. Resumo:. Chromosome abnormalities are extremely common in human oocytes and embryos and are associated with a variety of negative outcomes for both natural cycles and those using assisted conception techniques. Embryos containing the wrong number of chromosomes (aneuploidy) may fail to implant in the uterus, miscarry, or lead to children with serious medical problems (e.g., Down syndrome). Preimplantation genetic screening (PGS) is a method that seeks to improve the outcomes of assisted reproductive treatments, such as in vitro fertilization (IVF), by ensuring that the embryos chosen for transfer to the uterus are chromosomally normal. Here we summarize published and novel data concerning the frequency and variety of chromosomal abnormalities seen in oocytes and embryos at the cleavage and blastocyst stages of development. Clinical outcomes of studies using PGS are presented, and the controversy over the use of chromosome screening as a tool for embryo selection is discussed. We describe validation and preliminary clinical data from the new generation of methods being used for PGS, including comparative genomic hybridization (CGH), microarrays (aCGH and single nucleotide polymorphism arrays), and quantitative polymerase chain reaction. These methodologies allow comprehensive chromosomal analysis, provide high accuracy, and have yielded encouraging preliminary clinical data. The combination of advances in genetics and embryology seems poised to usher in a new era in the treatment of infertility. 7.
Somatostatin and somatostatin analogues reduce PDGF-­‐induced endometrial cell proliferation and motility 10 Clínica
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Veículo: Hum Reprod Data: Julho de 2012 Fonte:OxforJournal Annunziata M, Luque RM, Durán-­‐Prado M, Baragli A, Grande C, Volante M, Gahete MD, Deltetto F, Camanni M, Ghigo E, Castaño JP, Granata R. Laboratory of Molecular and Cellular Endocrinology, Department of Internal Medicine, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy. Resumo: Artigo original na íntegra disponibilizado pela equipe E-­‐saúde encontra-­‐se no anexo. BACKGROUND Endometriosis is characterized by ectopic implantation of endometrial cells, which show increased proliferation and migration. Somatostatin (SST) and its analogues inhibit normal and cancer cell growth and motility through the SST receptors, sst1-­‐5. Cortistatin (CST), which displays high structural and functional homology with SST, binds all ssts, as well as MrgX2. Our objective was to investigate the gene expression of the SST/CST system and to determine the effect of SST and its analogues on platelet-­‐
derived growth factor (PDGF)-­‐induced proliferation and motility in telomerase-­‐
immortalized human endometrial stromal cell (T HESC) line and in primary endometrial stromal cell (ESCs) isolated from humanendometriotic tissues. METHODS Ectopic endometrial tissues were collected from women (n= 23) undergoing laparoscopic surgery for endometriosis (Stage III/IV). Gene expression was evaluated by real-­‐time PCR, cell motility by wound healing assay, protein expression and β-­‐actin rearrangement by immunofluorescence, cell proliferation by the Alamar blue assay and ERK1/2 and Akt phosphorylation by western blot. RESULTS Humanendometriotic tissues, primary ESCs and T HESCs expressed SST, CST and ssts. SST, its analogues SOM230 and octreotide, as well as CST, counteracted PDGF-­‐
induced proliferation and migration in both ESCs and T HESCs. SST also inhibited vascular endothelial growth factor and metalloprotease-­‐2 mRNA expression, and reduced basal and PDGF-­‐induced ERK1/2 phosphorylation. CONCLUSION These results indicate that the SST/CST system is expressed in endometriotic tissues and cells. The inhibitory effects of SST and its analogues on PDGF-­‐induced proliferation and motility suggest that these peptides may represent promising tools in the treatment of endometriosis. 8.
Are children born after infertility treatment at increased risk of retinoblastoma? Veículo: Hum Reprod Data: Julho de 2012 11 Clínica
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Fonte:OxforJournal Foix-­‐L'hélias L, Aerts I, Marchand L, Lumbroso-­‐Le Rouic L, Gauthier-­‐Villars M, Labrune P, Bouyer J, Doz F, Kaminski M. INSERM U953 , Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, F-­‐94807 Villejuif, France. Resumo: BACKGROUND Retinoblastoma (RB) is the most frequent eye tumour in children, with an incidence of 1 in 15-­‐20 000 births. It accounts for 11% of all cancers in the first year of life. Except for the hereditary forms, its causes are not well-­‐known. Studies have recently suggested an increased risk of RB among children born after IVF, but the relevant literature is sparse. We assessed the association between infertility treatment, subfertility and RB. METHODS We included all children living in France diagnosed with RB between 1 January 2000 and 31 December 2006 at the Institut Curie, the national reference centre for RB diagnosis and treatment. We used multiple logistic regression to compare them with a national sample of births in France in 1998 and 2003 (n = 28 170). RESULTS The study included 244 non-­‐familial RB cases. The risk of RB increased with maternal age [adjusted odds ratio (adj OR) = 2.07, 95% confidence interval (CI) 1.33-­‐3.22 at 35-­‐39 years compared with younger than 25 years and adj OR = 2.42, 95% CI 1.22-­‐4.81 at 40 years or older], but the associations with IVF (adj OR = 1.37, 95% CI 0.64-­‐2.95) and ovarian stimulation or intrauterine insemination (adj OR = 1.35, 95% CI 0.77-­‐2.38) were not statistically significant after adjustment for maternal age and tobacco use. Among women who had no infertility treatment, the risk of RB was significantly increased when time to pregnancy exceeded 24 months (adj OR = 2.02, 95% CI 1.17-­‐3.48) compared with time to pregnancy ≤24 months. CONCLUSIONS Our study did not observe a significantly increased risk of RB associated with infertility treatment, in particular with IVF. But we did find an increased risk for women for whom time to pregnancy exceeded 24 months. 9.
Methylation levels at imprinting control regions are not altered with ovulation induction or in vitro fertilization in a birth cohort Veículo: Hum Reprod Data: Julho de 2012 Fonte: OxforJournal Rancourt RC, Harris HR, Michels KB. Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, 221 12 Clínica
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Longwood Avenue, Boston, MA 02115, USA. Resumo: STUDY QUESTION Do fertility treatments, including ovulation induction (OI), alter epigenetic mechanisms such as DNA methylation at imprinted loci? SUMMARY ANSWER We observed small but statistically significant differences in certain imprinting control regions (ICRs) based on the method of conception, however, these small changes in methylation did not correlate to the overall transcriptional levels of the genes adjacent to the ICRs (such as KCNQ1 and SNRPN). WHAT IS KNOWN AND WHAT THIS PAPER ADDS Assisted reproductive technology (ART) has been associated with an increase in the risk of rare childhood disorders caused by loss of imprinting (LOI). This study provides novel epigenetic analyses on infants conceived by OI and examines how methylation levels correlate with gene expression. DESIGN Data and biospecimens used in this study were from 147 participants of the Epigenetic Birth Cohort comprising 1941 mother-­‐child dyads recruited between June 2007 and June 2009 at the Department of Obstetrics, Gynecology and Reproductive Biology at Brigham and Women's Hospital (BWH) in Boston, MA, USA. Wilcoxon rank-­‐sum tests were used to examine the differences in median percent methylation at each differentially methylated region (DMR) between the spontaneous conception control group and the fertility treatment groups (OI and IVF). PARTICIPANTS AND SETTING For each woman who reported IVF we selected a woman who conceived spontaneously matched on age (±2 years). To increase efficiency, we matched the same controls from the spontaneously conceived group to participants who reported OI. If an appropriate control was not identified that had been previously matched to an IVF participant, a new control was selected. The final analytic sample consisted of 61 spontaneous, 59 IVF and 27 OI conceptions. MAIN RESULTS AND THE ROLE OF CHANCE No functionally relevant differences in methylation levels were observed across five (out of six) imprinted DMRs in either the placenta or cord blood of infants conceived with OI or IVF compared with infants conceived spontaneously. While KCNQ1, SNRPN and H19 DMRs demonstrated small but statistically significant differences in methylation based on the method of conception, expression levels of the genes related to these control regions only correlated with the methylation levels of H19. BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION Limitations of our study include the limited sample size, lack of information on OI medication used and culture medium for the IVF procedures and underlying reasons for infertility among OI and IVF patients. We did not perform allele-­‐specific expression analyses and therefore cannot make any inferences about LOI. GENERALIZABILITY TO OTHER POPULATIONS These results are likely to be generalizable to non-­‐Hispanic white individuals in populations with similar ART and fertility treatments. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by the Milton Fund, Harvard University (P.I.: K.B.M) and by Public Health Research Grant 5R21CA128382 from the National Cancer Institute, National Institutes of Health (P.I.: K.B.M.). The funders 13 Clínica
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had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. No conflict of interests to declare. Trial registration number N/A. 10.
Prevalence of behaviour-­‐related fertility disorders in a clinical sample: results of a pilot study. Veículo: Arch Gynecol Obstet Data: 3 de julho de 2012 Fonte: PubMed Schilling K, Toth B, Rösner S, Strowitzki T, Wischmann T. Centre for Psychosocial Medicine, Institute of Medical Psychology, University of Heidelberg, Bergheimer Strasse 20, 69115, Heidelberg, Germany. Resumo: INTRODUCTION: There is no doubt that lifestyle factors can be detrimental to fertility. The aim of the present pilot study was to identify initial prevalence rates for behaviour-­‐
related fertility disorders in a clinical sample of couples wanting a child. METHODS: Between February 2010 and August 2010, all patients coming for the first time to Heidelberg University's Women's Hospital for consultation on involuntary childlessness were asked to fill out a questionnaire designed by the authors of this article. The questionnaire was based on a review of the relevant literature, with special reference to the latest research findings on behaviour detrimental to fertility. Of the 156 couples addressed, 110 women and 100 men took part in the study. RESULTS: For behaviour-­‐related infertility, 9 % of the women and 3 % of the men in our sample were classified on the basis of BMI <18.5, sexual disorders, or abuse of anabolic steroids. If we include smokers, these figures increase: 11 % female smokers and 18 % male smokers. A further 19 % of the women practised sport to an excessive degree; and 26 % of the women and 53 % of the men had a BMI ≥25. DISCUSSION: The prevalence of behaviour-­‐related fertility disorders should not be underestimated. For the prevention of behaviour-­‐related fertility disorders, it is important to inform the population about lifestyle-­‐mediated fertility risks. 11.
The effects of oxidative stress on female reproduction: a review Veículo: Reprod Biol Endocrinol. Data: 29 de junho de 2012 14 Clínica
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Fonte: PubMed Agarwal A, Aponte-­‐Mellado A, Premkumar BJ, Shaman A, Gupta S. Resumo: Artigo original na íntegra disponibilizado pela equipe E-­‐saúde encontra-­‐se no anexo. Oxidative stress (OS), a state characterized by an imbalance between pro-­‐oxidant molecules including reactive oxygen and nitrogen species, and antioxidant defenses, has been identified to play a key role in the pathogenesis of subfertility in both males and females. The adverse effects of OS on sperm quality and functions have been well documented. In females, on the other hand, the impact of OS on oocytes and reproductive functions remains unclear. This imbalance between pro-­‐oxidants and antioxidants can lead to a number of reproductive diseases such as endometriosis, polycystic ovary syndrome (PCOS), and unexplained infertility. Pregnancy complications such as spontaneous abortion, recurrent pregnancy loss, and preeclampsia, can also develop in response to OS. Studies have shown that extremes of body weight and lifestyle factors such as cigarette smoking, alcohol use, and recreational drug use can promote excess free radical production, which could affect fertility. Exposures to environmental pollutants are of increasing concern, as they too have been found to trigger oxidative states, possibly contributing to female infertility. This article will review the currently available literature on the roles of reactive species and OS in both normal and abnormal reproductive physiological processes. Antioxidant supplementation may be effective in controlling the production of ROS and continues to be explored as a potential strategy to overcome reproductive disorders associated with infertility. However, investigations conducted to date have been through animal or in vitro studies, which have produced largely conflicting results. The impact of OS on assisted reproductive techniques (ART) will be addressed, in addition to the possible benefits of antioxidant supplementation of ART culture media to increase the likelihood for ART success. Future randomized controlled clinical trials on humans are necessary to elucidate the precise mechanisms through which OS affects female reproductive abilities, and will facilitate further explorations of the possible benefits of antioxidants to treat infertility. Notícias da Web:
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Mulheres sem apêndice têm mais chances de engravidar, diz estudo Veículo: correiodoestado Data: 4 de julho de 2012 Fonte: http://www.correiodoestado.com.br/noticias/mulheres-­‐sem-­‐apendice-­‐tem-­‐mais-­‐
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chances-­‐de-­‐engravidar-­‐diz-­‐est_153737/ Mulheres que retiram o apêndice têm mais chances de engravidar, de acordo com especialistas. De acordo com um estudo publicado no jornal Fertility and Sterility, divulgado nesta quarta-­‐feira (04) pelo jornal britânico Daily Mail, isso vai contra a ideia de que este tipo de operação poderia diminuir as chances de gravidez. O procedimento geralmente é a opção para casos fatais de apendicite. Pesquisadoress da Dundee University analisaram o maior banco de dados de registros médicos do mundo, o UK General Practice Research Database. Eles descobriram que entre as mais de 76 mil mulheres que se submeteram à cirurgia do apêndice, 39% tiveram a primeira gravidez em um período de 10 anos. A taxa das mulheres que não passaram pelo procedimento foi de 28%. A diferença se manteve depois de serem considerados fatores como idade, número de hospitalizações anteriores e controle de natalidade. Os especialistas afirmam que os resultados pedem mais estudos para identificar o que as mulheres que retiraram o apêndice têm de "especial". Sami Shimi, cirurgião envolvido na pesquisa, ressaltou que as mulheres não devem se apressar para fazer a cirurigia e ver suas chances de gravidez aumentarem. "Mas os resultaodos mostram que as mulheres que precisam da cirurgia não devem se preocupar com problemas de fertilidade. Os medos relacionados à infertilidade depois da apendicectomia ão infundados". O cirurgião afirmou ainda que a iniciativa para se fazer um grande estudo acerca do tema se originou dos inúmeros relatos de pacientes sobre o medo da cirurgia e da possível infertilidade. 13. Five millionth 'test tube baby' Veículo: BBC news Data: 2 de julho de 2012 Fonte: http://www.bbc.co.uk/news/health-­‐18649582 Five million "test tube babies" have now been born around the world, according to research presented at a conference of fertility experts. Delegates hailed it as a "remarkable milestone" for fertility treatments. The first test tube baby, Louise Brown, was born in the UK in July 1978. Her mother Leslie Brown died last month. However, delegates at the conference in Turkey warned couples not to use fertility treatment as an "insurance policy" if they delayed parenthood. The International Committee for Monitoring Assisted Reproductive Technologies (Icmart) presented its latest data on children born to infertile parents at the European Society of 16 Clínica
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Human Reproduction and Embryology conference. It said official figures up to 2008, plus three years of estimates, put the total number of test tube babies born at five million. Milestone Icmart chairman Dr David Adamson said: "This technology has been highly successful in treating infertile patients. Millions of families with children have been created, thereby reducing the burden of infertility. "The technology has improved greatly over the years to increase pregnancy rates." About 1.5 million cycles of IVF, and similar techniques, are performed every year, resulting in 350,000 babies, Icmart said. Stuart Lavery, a consultant gynaecologist and director of IVF at Hammersmith Hospital, said: "IVF is now part of the mainstream, it is no longer something couples are ashamed of." However, he cautioned that the great success of assisted reproduction techniques should not lull people into thinking they could wait to have children. "The subtext is that if people delay childbirth they may view IVF as an insurance policy that they can access at any stage. "Unfortunately the facts still suggest that IVF success rates in women as they get older are not fantastic." Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, said: "I think it's significant that we've got to five million. It's far more socially acceptable than it has been over the last 10 or 20 years. "One word of warning, we should make sure that couples understand that IVF isn't a guaranteed solution and if they're in a position to have their children earlier in life then they should try and do that. "IVF really is something that should be preserved for those people who really need it." 14.
Mediterranean diet can help fertility treatment Veículo: TIMES live Data: 4 de julho de 2012 17 Clínica
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Fonte: http://www.timeslive.co.za/thetimes/2012/07/04/mediterranean-­‐diet-­‐can-­‐help-­‐
fertility-­‐treatment New research indicates that a diet containing lots of monounsaturated fat can as much as triple the chance of success in women resorting to fertility treatment. Specialists believe such a diet could help most women wanting to get pregnant naturally as well. But eating lots of saturated fat, found in meat and dairy, appears to damage women's fertility . Dr Jorge Chavarro and colleagues at the Harvard School of Public Health in the US, looked at how intake of different types of fats affected success of IVF treatment in 147 women, mostly in their 30s. They found the women who ate the most monounsaturated fat had up to three times the chance of giving birth by IVF as those who ate the least. Specifically the top third, who derived on average 25% of their kilojoules from monounsaturated fat, has three times the chance of success compared to the bottom third, who derived on average 9% of their kilojoules from it. Those who ate the most saturated fat produced two fewer eggs suitable for test-­‐tube fertilisation than those who ate the least . Chavarro said: "As far as the best fat profile is concerned, this is the fat profile you would find in a Mediterranean diet." However, he cautioned that the study was very small and the findings needed to be replicated in larger numbers before firm advice could be issued. The Harvard study also looked at the role of polyunsaturated fats, commonly thought to be healthy. It found that women with higher intake of polyunsaturated fats tended to have lower quality eggs. But Chavarro, a nutritionist and epidemiologist, said there were different types of polyunsaturated fats -­‐ some that could hinder fertility and others that could help. Notícias da Clínica e Equipe Fecondare
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