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The interaction between human spermatozoa and its homologous zona pellucida : scientific advances and clinical significanceOehninger, Sergio C. 12 1900 (has links)
Thesis (PhD)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: Infertility is a very common problem worldwide. Recent data have shown that disorders of the
male represent the most common single defined cause of infertility. This proposal examines
the clinical significance and fundamental physiological aspects of human gamete interaction.
These studies are focused on the assessment of the cellular-molecular mechanisms involved in
human sperm binding to its homologous zona pellucida resulting in the physiologic induction
of the acrosome reaction. We have developed and validated in vitro bioassays that assess
specific steps of the fertilization process that are critical for early embryo development. The
results of our translational research have already had a significant impact on the overall
evaluation of male infertility and on the clinical management of the infertile man in the
assisted reproduction arena. Furthermore, the unveiling of the basic mechanisms involved in
human gamete interaction will ultimately allow for both (i) the development of new male
reproductive diagnostic capabilities and (ii) the design of improved and safer therapies aiding
conception in childless couples suffering from male infertility. / AFRIKAANSE OPSOMMING: Menslike onvrugbaarheid is 'n algemene wêreldwye probleem en onlangse data toon aan dat
die manlike factor die grootste enkel bydraende factor tot hierdie toestand is. Die werk loods
'n intensiewe ondersoek na die kliniese betekenis en basiese fisiologiese aspekte wat 'n rol
tydens spermsel en eisel interaksie speel. Hoofstuk 3 fokus op die sellulêre en molekulêre
meganismes wat betrokke is tydens spermsel en eisel binding wat gevolglik lei tot
akrosoomreaksie van die spermsel. Die werk verteenwoordig die resultate van 10 jaar se
navorsing tussen die kandidaat en die promoter. Dit gee oorsprong aan 'n reeks bio-toetse wat
die bevrugtingsproses koriografiese ontleed en verskaf dus 'n stap-vir-stap uiteenseting van
menslike bevrugting en gevolglike embrio ontwikkeling. Die resultate in Hoostuk 4 bring
vernuwing in die begrippe van die manlike faktor en die rol in die kinderlose huwelik. Die
resulate soos in Hoofstuk 3 en 4 uiteengesit, vorm nie net die basis vir die moontlike
ontwikkeling van nuwe diagnostiese benaderings tot die hantering van die man nies maar
speel oojk 'n rol die daarstelling van verbeterde terapeutiese hantering van die kinderlose
egpaar. Hoofstuk 5 gee kortliks riglyne en aanbevelings tot opsigte van die gebruik van die
spermsel-zona pellucida bindingstoets en akrosomreaksie. Die kandidaat bevel aan dat die
genoemde twee bio-toetse deel van die laboratorium ondersoeke van die man gebruik moet
word.
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Desenvolvimento de uma técnica para seleção de espermatozoides em amostra seminal não processada para utilização na injeção intracitoplasmática de espermatozoides / Development of a technique for selection of spermatozoa for use in intracytoplasmic sperm injection without previous semen processingMartim, Hamilton de 27 June 2017 (has links)
Durante a injeção intracitoplasmática de espermatozoides (ICSI) seleciona-se um espermatozoide móvel e morfologicamente normal para injeção em ovócito maduro. Evidências recentes indicam que mesmo espermatozoides aparentemente normais podem ocultar defeitos em nível molecular. O principal objetivo deste trabalho foi a descrição de um novo método capaz de selecionar espermatozoides maduros a partir de amostras não processadas em procedimento de ICSI. Em um estudo comparativo e prospectivo testou-se uma gota estendida modificada. A \"gota estendida com mecanismo contracorrente\" - GEMC foi montada em uma placa de ICSI padrão a partir de seis gotas de meio de cultivo (10 ?L). O posicionamento e união precisa das gotas deram origem a dois reservatórios e um canal, resultando em um fluxo de líquido através do canal. A adição de uma solução de PVP (polivinilpirrolidona) gerou um gradiente de viscosidade no final do circuito. Amostras seminais foram obtidas de 40 pacientes inférteis. Cada amostra seminal foi dividida em 4 alíquotas: uma alíquota para o processamento por centrifugação em gradiente de densidade (CGD), uma alíquota para a GEMC utilizando amostras não processadas, uma alíquota para a GEMC utilizando amostras processadas e uma alíquota para controle. Nos grupos GEMC uma média de 200 espermatozoides foram consecutivamente coletados, sem seleção, no reservatório de captura utilizando-se uma micropipeta de injeção como no procedimento convencional de ICSI. A morfologia espermática foi avaliada e demonstrou melhora, comparando-se com os controles, em todos os tratamentos utilizados. A imaturidade da cromatina foi avaliada utilizando-se o teste do azul de anilina. Em relação à imaturidade, 100% dos homens obtiveram melhores resultados tanto após o preparo por CGD quanto utilizando o método GEMC. Isto se refletiu em uma redução das formas imaturas de 28.65 ± 8.97% no sêmen fresco para 17.29 ± 7.72% após processamento por CGD (P < 0.01). Uma redução ainda maior nas formas imaturas foi obtida após o método GEMC quando comparado com o processamento por CGD: 0.89 ± 1.31% (P < 0.01) utilizando-se sêmen fresco e 1.05 ± 1.63% (P < 0.01) utilizando-se amostras processadas. Um novo método unindo seleção e captura de espermatozoides em um mesmo procedimento de ICSI foi descrito e testado. O método GEMC seleciona espermatozoides de forma fácil e permite o uso direto de amostras não processadas em procedimentos de ICSI. Este método seleciona espermatozoides maduros com mais eficiência do que o processamento por CGD. Novos estudos são necessários para se analisar o impacto do método nas taxas de fertilização, desenvolvimento embrionário, gravidez, implantação e abortamento / During intracytoplasmic sperm injection (ICSI) a motile spermatozoon with normal morphology is visually selected for insemination of an oocyte. Recent evidence indicates that even though the sperm appears morphologically normal, a possibility of defects at the molecular level still exists. The main objective of this work was to describe a novel approach capable of selecting mature spermatozoa from unprocessed semen sample in a one-step ICSI procedure. A modified extended drop was tested in a prospective comparative study. The \"Gota Estendida com Mecanismo Contracorrente - GEMC\" (Positive Rheotaxis Extended Drop - PRED) was assembled on a standard ICSI dish and consisted of six culture medium droplets (10 ?L). The precise merging of the drops created two reservoirs and a channel therefore the fluid flew through the channel. The addition of a PVP solution created a viscosity gradient in the final sector of the circuit. Semen samples were taken from 40 subfertile men. Each semen sample was divided into four aliquots: one aliquot for density gradient centrifugation (DGC), one aliquot for GEMC using fresh semen, one aliquot for GEMC using processed semen and one aliquot for the control. In GEMC a mean of 200 spermatozoa were collected consecutively, without selection, from the outlet reservoir with an injecting pipette as for conventional ICSI procedure. Sperm morphology was assessed and resulted in improvement compared to controls in all treatments. Chromatin immaturity was assessed using aniline blue assay. Regarding to chromatin immaturity, 100% of men had better results after DGC preparation and GEMC approach. This was reflected in a mean reduction from 28.65 ± 8.97% uncondensed chromatin in the native ejaculates to 17.29 ± 7.72% in DGC processed semen (P < 0.01). An even greater reduction was achieved after GEMC approach showing a mean of 0.89 ± 1.31% uncondensed chromatin compared to DGC processed sample (P < 0.01). A novel one-step ICSI approach joining sperm selection and recovery was developed and tested. This GEMC approach can select sperm easily and permits the direct use of native semen in ICSI. This approach can select sperm with lower chromatin immaturity than DGC method. Further studies need to access its relation to fertilization, embryo development, pregnancy, implantation and miscarriage rates
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The effect of whole body heating on testis morphology and fertility of male miceJakrit Yaeram. January 2002 (has links) (PDF)
"April 2002" Includes bibliographical references (leaves 200-249)
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The effect of whole body heating on testis morphology and fertility of male mice / by Jakrit Yaeram.Jakrit Yaeram January 2002 (has links)
"April 2002" / Includes bibliographical references (leaves 200-249) / xv, 249 leaves : ill., plates (some col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Science, 2003
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Psychosocial responses of women and men to in-vitro fertilizationCheung, Wai-man, 張惠敏 January 2003 (has links)
published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice
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The effect of whole body heating on testis morphology and fertility of male mice / by Jakrit Yaeram.Jakrit Yaeram January 2002 (has links)
"April 2002" / Includes bibliographical references (leaves 200-249) / xv, 249 leaves : ill., plates (some col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Science, 2003
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Desenvolvimento de uma técnica para seleção de espermatozoides em amostra seminal não processada para utilização na injeção intracitoplasmática de espermatozoides / Development of a technique for selection of spermatozoa for use in intracytoplasmic sperm injection without previous semen processingHamilton de Martim 27 June 2017 (has links)
Durante a injeção intracitoplasmática de espermatozoides (ICSI) seleciona-se um espermatozoide móvel e morfologicamente normal para injeção em ovócito maduro. Evidências recentes indicam que mesmo espermatozoides aparentemente normais podem ocultar defeitos em nível molecular. O principal objetivo deste trabalho foi a descrição de um novo método capaz de selecionar espermatozoides maduros a partir de amostras não processadas em procedimento de ICSI. Em um estudo comparativo e prospectivo testou-se uma gota estendida modificada. A \"gota estendida com mecanismo contracorrente\" - GEMC foi montada em uma placa de ICSI padrão a partir de seis gotas de meio de cultivo (10 ?L). O posicionamento e união precisa das gotas deram origem a dois reservatórios e um canal, resultando em um fluxo de líquido através do canal. A adição de uma solução de PVP (polivinilpirrolidona) gerou um gradiente de viscosidade no final do circuito. Amostras seminais foram obtidas de 40 pacientes inférteis. Cada amostra seminal foi dividida em 4 alíquotas: uma alíquota para o processamento por centrifugação em gradiente de densidade (CGD), uma alíquota para a GEMC utilizando amostras não processadas, uma alíquota para a GEMC utilizando amostras processadas e uma alíquota para controle. Nos grupos GEMC uma média de 200 espermatozoides foram consecutivamente coletados, sem seleção, no reservatório de captura utilizando-se uma micropipeta de injeção como no procedimento convencional de ICSI. A morfologia espermática foi avaliada e demonstrou melhora, comparando-se com os controles, em todos os tratamentos utilizados. A imaturidade da cromatina foi avaliada utilizando-se o teste do azul de anilina. Em relação à imaturidade, 100% dos homens obtiveram melhores resultados tanto após o preparo por CGD quanto utilizando o método GEMC. Isto se refletiu em uma redução das formas imaturas de 28.65 ± 8.97% no sêmen fresco para 17.29 ± 7.72% após processamento por CGD (P < 0.01). Uma redução ainda maior nas formas imaturas foi obtida após o método GEMC quando comparado com o processamento por CGD: 0.89 ± 1.31% (P < 0.01) utilizando-se sêmen fresco e 1.05 ± 1.63% (P < 0.01) utilizando-se amostras processadas. Um novo método unindo seleção e captura de espermatozoides em um mesmo procedimento de ICSI foi descrito e testado. O método GEMC seleciona espermatozoides de forma fácil e permite o uso direto de amostras não processadas em procedimentos de ICSI. Este método seleciona espermatozoides maduros com mais eficiência do que o processamento por CGD. Novos estudos são necessários para se analisar o impacto do método nas taxas de fertilização, desenvolvimento embrionário, gravidez, implantação e abortamento / During intracytoplasmic sperm injection (ICSI) a motile spermatozoon with normal morphology is visually selected for insemination of an oocyte. Recent evidence indicates that even though the sperm appears morphologically normal, a possibility of defects at the molecular level still exists. The main objective of this work was to describe a novel approach capable of selecting mature spermatozoa from unprocessed semen sample in a one-step ICSI procedure. A modified extended drop was tested in a prospective comparative study. The \"Gota Estendida com Mecanismo Contracorrente - GEMC\" (Positive Rheotaxis Extended Drop - PRED) was assembled on a standard ICSI dish and consisted of six culture medium droplets (10 ?L). The precise merging of the drops created two reservoirs and a channel therefore the fluid flew through the channel. The addition of a PVP solution created a viscosity gradient in the final sector of the circuit. Semen samples were taken from 40 subfertile men. Each semen sample was divided into four aliquots: one aliquot for density gradient centrifugation (DGC), one aliquot for GEMC using fresh semen, one aliquot for GEMC using processed semen and one aliquot for the control. In GEMC a mean of 200 spermatozoa were collected consecutively, without selection, from the outlet reservoir with an injecting pipette as for conventional ICSI procedure. Sperm morphology was assessed and resulted in improvement compared to controls in all treatments. Chromatin immaturity was assessed using aniline blue assay. Regarding to chromatin immaturity, 100% of men had better results after DGC preparation and GEMC approach. This was reflected in a mean reduction from 28.65 ± 8.97% uncondensed chromatin in the native ejaculates to 17.29 ± 7.72% in DGC processed semen (P < 0.01). An even greater reduction was achieved after GEMC approach showing a mean of 0.89 ± 1.31% uncondensed chromatin compared to DGC processed sample (P < 0.01). A novel one-step ICSI approach joining sperm selection and recovery was developed and tested. This GEMC approach can select sperm easily and permits the direct use of native semen in ICSI. This approach can select sperm with lower chromatin immaturity than DGC method. Further studies need to access its relation to fertilization, embryo development, pregnancy, implantation and miscarriage rates
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In vitro effects of aqueous leaf extracts of moringa oleifera on human spermMoichela, Faith Tebatso January 2021 (has links)
Thesis (M.Sc. (Medical Sciences)) -- University of Limpopo, 2020 / Infertility affects nearly 186 million couples globally, with male factors contributing to half of the cases. Oxidative stress is an established cause of declining semen quality. Moringa oleifera has proven antioxidants. This study aimed to investigate in vitro effects of aqueous leaf extract of M. oleifera on human sperm functions. Semen samples from donors (n = 40) and patients (n = 30) were washed with HTF-bovine serum albumin (BSA), and then incubated with various concentrations of M. oleifera (0, 0.625, 6.25, 62.5, and 625 μg/ml) at 37°C for 1 hour. Sperm motility, vitality, mitochondrial membrane potential (MMP), reactive oxygen species (ROS), DNA fragmentation, capacitation, and acrosome reaction were assessed. Sperm motility, vitality, MMP, and capacitation were enhanced, while ROS production, and DNA fragmentation decreased after M. oleifera treatment. Uncapacitated spermatozoa increased significantly with a reduction in acrosome reaction in donors. M. oleifera antioxidant compounds suppressed excessive ROS, preserved mitochondrial membrane, DNA and acrosome integrity, while enhancing sperm motility and viability. / National Research Foundation (NRF)
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Human gamete micromanipulation and intracytoplasmic sperm injection (ICI) : its impact on severe male infertilityWindt, Marie-Lena 12 1900 (has links)
Thesis (PhD)--Stellenbosch Uni versity, 2000. / ENGLISH ABSTRACT: Intracytoplasmic sperm injection (ICSI) introduced a revolutionary way of treatment for male
factor infertility. With the exception of some cases of non-obstructive azoospermia, all other
male factor infertility cases have the potential to be successfully treated with ICS!. The only
prerequisite seems to be the presence of a motile or viable immotile sperm cell for each oocyte.
In this study we report on our own experience with the development and implementation of the
ICSI method in the Reproductive Biology Unit at Tygerberg Hospita!. An analysis of 5 years of
ICSI experience showed that semen parameters, sperm morphology, motility and concentration
did not influence fertilization and pregnancy rates adversely. In most cases, patients who could
not be treated with in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), due to poor
semen parameters or fertilization failure, were treated successfully with ICS!. Even a case of
globozoospermia was treated successfully with ICS!.
Testicular spermatozoa, fresh or frozen-thawed, also resulted in excellent fertilization and
pregnancy rates. Cryopreservation of testicular samples facilitated the management of the
infertile couple, aiding the coordination of the recovery of vital gametes from both partners and
also limiting the repetition of testicular biopsies. Incubation (maturation) of testicular spermatozoa
also induced an enhancement in pregnancy rates.
It can be concluded that ICSI proved to be a treatment method with success similar to that of in
vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), in spite of a severe male factor.
The study also indicated transfer route and embryo quality (viability) to be very important factors
in the success of ICS!. The tubal transfer route was shown to be a significant contributor to the
pregnancy success (compared to uterine transfer) as was the transfer of embryos that showed
early division to the 2-cell stage, 26 hours post injection. The transfer of early dividing embryos
into the fallopian tube resulted in a pregnancy rate of almost 40%, a result similar to that of GIFT
with a mild male factor.
The role of the oocyte in fertilization and pregnancy success was also revealed indirectly by the
introduction of ICS!. Visual observation of denuded oocytes was possible and many
morphological features, normal and abnormal, can be observed. Immature oocytes can also be
identified and it was shown that they could be successfully matured in vitro before injection.
In this study transmission electron microscopy (TEM) was used to study abnormalities in oocyte
morphology. The standard method was adapted and modified for single cell TEM. The
abnormalities observed included lysosomal and non-lysosomal degeneration (yellowish or darkly
coloured oocytes), degeneration and vacuole formation (vacuolated oocytes), large secondary
lysosomes filled with multiple small lipid droplets - lipofuscin body (refractile body) and a
fragmented oocyte. It was also possible to study at ultrastructural level, possible reasons for
fertilization failure in ICS!. Different stages of oocyte activation failure, cytoplasmic immaturity,
sperm cell extrusion, abnormal sperm cell decondensation, female spindle abnormalities and
technique related factors were observed. TEM was also successfully implemented to elucidate the reason for infertility in a patient with a
longstanding, unexplained history of infertility. TEM evaluation of two of the patient's unfertilized
oocytes revealed a spindle abnormality with contributing cytoskeletal anomalies at ultrastructural
level. The modified TEM technique offers a valuable tool to study this small, but important group
of patients with unexplained infertility. ThisTEM study opened up a new, valuable and interesting
avenue of research with both diagnostic and prognostic value for patients with unexplained
infertility.
ICSI is therefore a valuable method in the treatment of especially male factor infertility. It is the
most advanced fertilization technique developed in the last decade in this field. Not only can
almost all male factor patients be treated, but unexplained female infertility can also be exposed,
studied and hopefully in future also be treated with micromanipulation methods. / AFRIKAANSE OPSOMMING: Die ontwikkeling van die mikromanipulasie tegniek "Intracytoplasmic sperm injection" (ICSI)
het die behandeling van die manlike faktor in infertiliteit, revolusionêr verander. Met die
uitsondering van sommige gevalle van nie-obstruktiewe asoospermia, kan potensieel alle
ander manlike infertiliteits faktore suksesvol met ICSI behandel word. Die enigste voorvereiste
blyk "n bewegende of "n nie-bewegende, maar bewese lewende spermsel te wees.
In hierdie studie word verslag gedoen oor die ontwikkeling en toepassing van die ICSI metode in
die Eenhed vir Reproduktiewe Biologie by Tygerberg Hospitaal. 'n Analise van 5 jaar se resultate
na die implementering van die ICSI metode het gewys dat die semen parameters, sperm
morfologie, motiliteit en konsentrasie, nie "n effek op bevrugting- en swangerskapsyfers gehad
het nie. Pasiënte wat, as gevolg van ontoereikende semen parameters, nie met die klassieke
metodes, in vitro bevrugting (IVB) of gameet intrafallopiusbuis terugplasing (GIFT) behandel kon
word nie, kon suksesvol met ICSI behandel word. Daar was selfs "n geval van manlike infertiliteit
as gevolg van globosoospermie, wat suksesvol met ICS behandel is.
Die ICSI metode het dit ook moontlik gemaak om uitstekende bevrugting- en swangerskap
resultate met testikulêre spermatosoa .(vars en gevries) te bereik. Die bevriesing van
testisweefsel het ook bygedra tot beter hantering van sulke pasiënte. Herhaalde testisbiopsies
word uitgeskakel en die koórdinasie van die verkryging van die manlike en vroulike gamete, word
ook vergemaklik wanneer testisweefsel in gevriesde vorm beskikbaar is. Die studie het verder
getoon dat wanneer testikulêre weefsel geïnkubeer word (om spermatosoa te laat matureer), die
swangerskapsyfers verhoog was.
Dit is dus duidelik dat die ICSI metode net so suksesvol soos die IVB en GIFT metodes toegepas
kan word, selfs en veral in gevalle van erge manlike faktor infertiliteit.
Die studie het ook verder getoon dat die plek waar embrios teruggeplaas word, asook die
embriokwalitiet van teruggeplaasde embrios, belangrike bydraende faktore in die ICSI
swangerskapsukses was. Embrioterugplasing in die buis van fallopius en terugplasing van
embrios wat vroeë 2-sel deling, 26 uur na ICSI getoon het, is uitgewys as faktore wat ICSI
swangerskap betekenisvol verbeter het. Dit was moontlik om "n swangerskapsyfer van ongeveer
40%, sootgelyk aan die van GIFT sonder "n erge manlike faktor, te bereik met die terugplasing
van ten minste een vroeë deler embrio in die fallopiese buis.
Die ICSI tegniek het ook indirek bygedra tot nuwe insigte met betrekking tot die rol wat die
vroulike eiersel (oësief in ICSI bevrugting speel. Oósiete word gestroop van hulomringende selle
vir die ICSI proses en kan dan maklik vir hul normale en abnormale morfologiese eienskappe
evalueer word. Oësiete wat immatuur is kan ook so geïdentifiseer word en dit is moontlik om hulle
suksesvol te matureer voor mikro-inspuiting.
Transmissie-elektronmikroskopie (TEM) is in die studie gebruik om die ultrastruktuur van
onbevrugde en abnormale oësiete te bestudeer. Hiervoor is "n bestaande tegniek gemodifiseer vir die hantering van "n enkele sel, in hierdie geval die oosiet. Lisasomale en nie-lisosomale degenerasie (oósiete wat geelof donker van kleur voorkom), degeneratiewe tekens en vakuole
(oësiete met vakuole), groot sekondêre lisosome gevul met klein lipieddruppels ('refractile body')
en 'n gefragmenteerde oosiet was van die morfologies abnormale eienskappe wat ultrastruktureel
geïdentifiseer is. Moontlike faktore wat 'n rol kan speel in nie-bevrugting na ICSI kon ook op
ultrastrukturele vlak met die tegniek geïdentifiseer word. Hierdie faktore het die volgende
ingesluit: die onvermoë van verskillende stadiums van oosiet aktivering, sitoplasmatiese
immaturiteit, uitwerping van die spermsel na die periviteliene spasie, abnormale spermsel
dekondensasie, vroulike spoelvormings abnormaliteite en tegniekgekoppelde faktore.
Die TEM tegniek is ook suksesvol aangewend om die infertiliteitsprobleem van 'n pasiënt wat vir
etlike jare aan onverklaarbare infertiliteit gely het, te identifiseer. TEM het op die ultrastrukturele
vlak gewys dat daar 'n spoel abnormaliteit in twee van haar onbevrugde oëslete was. TEM kan
dus baie vrugbaar gebruik word in hierdie groep pasiënte om onverklaarbare infertiliteit, wat
andersins ongeïdentifiseerd sou bly, te verklaar.
Die ICSI metode is die mees revolusionêre tegniek wat die afgelope dekade vir die behandeling
van veral manlike infertiliteit ontwikkel en baie suksesvol toegepas is. Die metode ook kan 'n
bydraende rol speel in die hantering van onverklaarbare infertiliteit veral ten opsigte van die
vroulike gameet. In die toekoms is dit moontlik dat selfs hierdie probleem met nuwe
mikromanipulasietegnieke opgelos sal kan word.
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Impacto da obesidade e da cirurgia bariátrica na função erétil, hormônios reprodutivos, função testicular e fragmentação do DNA espermático / Impact of obesity and bariatric surgery on erectile function, reproductive hormones, testicular function, and sperm DNA fragmentationWood, Guilherme Jacom Abdulmassih 25 February 2019 (has links)
INTRODUÇÃO: A prevalência global da obesidade duplicou desde 1980, alcançando mais de 600 milhões de adultos obesos em 2014. Em paralelo a este aumento, alguns autores relataram uma tendência mundial de declínio da concentração de espermatozoides no ejaculado nas últimas décadas. Consequentemente, surge a hipótese da relação entre esses dois fatos temporais. Dentre todas as formas de tratamento da obesidade, a cirurgia bariátrica é a que apresenta melhores resultados em termos de perda de peso e melhor efetividade a longo-prazo. Há evidências na literatura que sugerem que a obesidade é capaz de alterar os níveis dos hormônios reprodutivos e função erétil. No entanto, seus efeitos sobre os parâmetros seminais clássicos e no índice de fragmentação do DNA espermático (IFD) são pouco estabelecidos. Além disso, o impacto da cirurgia bariátrica sobre estas alterações ainda não foi devidamente esclarecido. OBJETIVO: Identificar os efeitos da obesidade sobre a função erétil, hormônios reprodutivos, função testicular e IFD de homens obesos. Adicionalmente, avaliar se a cirurgia bariátrica é capaz de afetar estes mesmos parâmetros. MÉTODOS: Este estudo foi organizado em duas fases. Na primeira fase, indivíduos com índice de massa corpórea (IMC) menor que 30 kg/m2 e fertilidade comprovada foram comparados a pacientes obesos em programação para cirurgia bariátrica, com IMC maior que 35 kg/m2. Todos os pacientes foram submetidos a dosagem de hormônios reprodutivos, análise seminal e aferição do IFD pelo método do cometa alcalino. O questionário do Índice Internacional de Função Erétil (IIEF-5) foi aplicado. Na segunda fase, parte dos indivíduos obesos foi submetida à cirurgia bariátrica e todos foram convocados para reavaliação em 6 meses. RESULTADOS: Homens obesos apresentam maiores níveis séricos de estradiol, LH e FSH, e menores níveis séricos de testosterona total (TT) quando comparados com homens férteis eutróficos. Além disso, apresentam piores parâmetros seminais, com redução do volume ejaculado, concentração seminal, número total de espermatozoides no ejaculado, motilidade total, motilidade progressiva e percentual de espermatozoides com morfologia normal, e elevação do IFD. Na fase 2, homens obesos submetido a cirurgia bariátrica apresentaram elevação dos valores de FSH, SHBG, TT e testosterona livre (TL), e redução dos níveis de prolactina sérica. Além disso, apresentam queda da concentração seminal e do número total de espermatozoides no ejaculado, e queda na fragmentação do DNA espermático. Controles obesos, por outro lado, não apresentaram alterações nas variáveis estudadas. Além disso, maior intensidade da perda de peso esteve associada com alterações mais importantes do número total de espermatozoides no ejaculado, e dos níveis séricos de TT, TL, SHBG e FSH. CONCLUSÕES: A obesidade é capaz de induzir alterações importantes dos hormônios reprodutivos, parâmetros seminais e IFD. A cirurgia bariátrica, entretanto, pode reverter os efeitos deletérios sobre os hormônios reprodutivos e fragmentação do DNA, mas pode trazer piora de parâmetros seminais em 6 meses de seguimento / INTRODUCTION: Worldwide obesity prevalence has duplicated since 1980, reaching more than 600 million obese adults in 2014. Parallel to this increase, several authors have reported a global tendency of ejaculated sperm concentration decline in the last decades. Therefore, comes to light the hypothesis that these two temporal trends are related. Among all forms of obesity treatments, the one that reaches the best results and long-term effectiveness is the bariatric surgery. Growing evidence in the literature suggests that obesity is capable of altering reproductive hormones levels and erectile function. Effects on classic semen parameters and DNA fragmentation index (DFI), however, have not been properly established. OBJECTIVE: Determine the effects of obesity over erectile function, reproductive hormones, testicular function, and DFI in obese men. Additionally, evaluate if bariatric surgery can also impact those parameters. METHODS: This study was divided into two phases. On the first phase, individuals with body mass index (BMI) lower than 30 kg/m2 and proven fertility were compared to obese men, with BMI higher than 35 kg/m2, waiting to be submitted to bariatric surgery. Reproductive hormones evaluation, semen analysis and evaluation of DFI by the alkaline comet assay were performed in all patients. The International Index of Erectile Function (IIEF-5) was used to assess erectile function. On phase two, part of the obese patients was submitted to bariatric surgery, and all were invited to 6-month revaluation. RESULTS: Obese men have higher blood levels of estradiol, LH and FSH, and lower levels of total testosterone (TT) when compared to eutrophic fertile men. Additionally, they present worse semen parameters, with a reduction in ejaculated volume, sperm concentration, total number of sperm in the ejaculate, total motility, progressive motility, and percentage of normal sperm, and higher sperm DFI. On phase two, obese men submitted to bariatric surgery showed higher FSH, SHBG, TT, and free testosterone (FT) levels, and reduction of blood prolactin levels. Moreover, they exhibited a reduction in sperm concentration and total ejaculated sperm count, and a reduction in sperm DNA fragmentation. Obese controls, however, did not experience changes in the studied variables. Finally, the intensity of weight loss was associated with greater changes in total ejaculated sperm count and in TT, TL, SHBG and FSH blood levels. CONCLUSIONS: Obesity can induce important changes in reproductive hormones, semen parameters, and DFI. Bariatric surgery, however, can revert the deleterious effects in reproductive hormones and DFI, but can result in worsening of semen parameters on 6-month follow-up
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