A impossibilidade de engravidar pode desencadear consequências psíquicas importantes, visto que barra a mulher no momento em que ela sente-se pronta para vivenciar a experiência da maternidade. Nesse sentido, a reprodução assistida vem possibilitando a maternidade para aquelas que não conseguiam conceber uma criança naturalmente. Contudo, percebe-se que os impactos emocionais não estão restritos à descoberta da infertilidade, estando presentes durante o processo do tratamento. Assim, para aquelas que obtiverem sucesso no tratamento, questiona-se a configuração da experiência de maternidade em meio a este contexto, que muitas vezes está atravessado por outro aspecto: a gravidez múltipla. Para abordar este fenômeno de forma ampla, foram realizados dois estudos. O Estudo 1 tinha como objetivo investigar a experiência da implantação de múltiplos embriões em mulheres que se submeteram à técnica FIV. Para tanto, foram analisadas entrevistas de mulheres que se submeteram à FIV e que mencionaram esta questão de implantação de múltiplos embriões espontaneamente. As entrevistas ocorreram no 3º trimestre gestacional destas participantes, contando inicialmente com 21 mulheres, restando após a seleção que discriminou as que não haviam trazido este tema 14 participantes. Percebeu-se que o tema da experiência da implantação em si foi comum estando presente nos relatos das 14 mulheres. Contudo, a gravidez múltipla despertara vivências distintas em relação à gravidez singular, pois na gravidez singular fantasias quanto à implantação de múltiplos embriões foram vivenciadas, mas nas mulheres que conceberam uma gravidez múltipla estas tinham se tornado concretas, de forma que estas mulheres pareciam estar se preparando para maternidade com mais de um bebê. O Estudo 2 tinha como objetivo investigar a experiência da maternidade de uma gravidez múltipla nesse contexto. Para tanto, contou com três mulheres que estavam no seu 3º trimestre gestacional. Neste estudo, ficou evidenciado o sofrimento destas mulheres ao se defrontarem com a infertilidade conjugal e ao se submeterem a tratamentos invasivos. Contudo, verificou-se que a experiência da gravidez pode reprimir este sofrimento para que estas mulheres vivenciem integralmente a experiência da maternidade. Neste sentido, este estudo levantou a discussão de que as TRA se configuram como uma forma distinta de concepção, entretanto, não levam a uma forma distinta de maternidade. / The impossibility of getting pregnant can lead to significant psychological effects, because it represents an obstacle for a woman at a time when she feels ready to go through the experience of motherhood. In this sense, assisted reproduction has enabled the experience of motherhood for those who could not conceive a child naturally. However, the emotional impact is not restricted to the discovery of infertility, being present, often, during the treatment process. Besides, for those who are successful in treatment, it is wondered how is the experience of motherhood in this context, that can still be influenced by another aspect: multiple pregnancy. Two studies were carried out. The first study was aimed to investigate the experience of implantation of multiple embryos into women who underwent IVF technique. To this end, interviews of women who underwent IVF and who mentioned the issue of implantation of multiple embryos spontaneously were analyzed. The interviews took place in the third trimester of pregnancy, with 14 women. It was noticed that the theme of the experience of implantation itself was common to all these women. However, multiple pregnancy revealed different experiences in singular as compared to singular pregnancy. Whereas in singular pregnancy the implantation of multiple embryos was only a ´possibility which was not later confirmed, in women who conceived a multiple pregnancy the fantasy became reality, so these woman seemed to be preparing for motherhood with more than one baby. The second study was designed to investigate the experience of motherhood in the context of multiple pregnancy. This involved three women who were in their third trimester of pregnancy. In this study, it became evident the suffering of these women when they were confronted with the couple’s infertility and had to undergo invasive treatments. However, it was found that the experience of pregnancy can suppress this suffering so that these women can experience the full experience of motherhood. Thus, this study raised the discussion that although TRA involves a distinct form of conception, it does not imply a distinct form of maternity.

Orientador: Wilma de Grava Kempinas / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-10T14:12:01Z (GMT). No. of bitstreams: 1 Pontes_DaviAbeid_M.pdf: 1952879 bytes, checksum: ba9688c1750c742fa3f40d3d422ed3eb (MD5) Previous issue date: 2008 / Resumo: O Diabetes mellitus geralmente se associa a algum tipo de disfunção sexual, provocando infertilidade, tanto em seres humanos, quanto em animais experimentais. Em trabalho anterior realizado em nosso laboratório, ratos machos que tiveram hiperglicemia induzida quimicamente pela administração de streptozotocin apresentaram diminuição da fertilidade através de múltiplos parâmetros analisados. O presente estudo teve como objetivo investigar os mecanismos envolvidos e o papel da testosterona no processo. Para tanto, ratos machos foram divididos em 3 grupos experimentais: normoglicêmico (controle), hiperglicêmico (streptozotocin), e hiperglicêmico com reposição hormonal (streptozotocin+testosterona) e foram avaliados parâmetros reprodutivos e espermáticos, níveis hormonais, a contratilidade do ducto deferente isolado in vitro, comportamento sexual e o número de espermatozóides ejaculados no útero. O ducto deferente de animais diabéticos apresentou um quadro de hipersensibilidade à metoxamina, um agonista sintético de adrenoceptores _1. Estes mesmos animais apresentaram os seguintes resultados: alteração de comportamento sexual e ausência de espermatozóides ejaculados, redução dos níveis plasmáticos de testosterona, perda de peso corpóreo e de órgãos como epidídimo, ducto deferente, vesículas seminais e próstata ventral, perda de células germinativas na luz e desorganização epitelial aparente em túbulos seminíferos, além da aceleração do tempo de trânsito dos espermatozóides pelo epidídimo. Os dados apresentados neste trabalho indicam que os mecanismos responsáveis pela perda de fertilidade natural de ratos diabéticos envolvem comprometimento do processo espermatogênico, assim como desregulação do eixo reprodutivo masculino, juntamente com evidências para problemas no processo de maturação espermática, tendo como fator complicante o prejuízo da função ejaculatória, dependente da contratilidade da musculatura lisa dos ductos deferentes. A reposição de andrógeno não foi totalmente capaz de reverter os danos causados pelo diabetes no sistema reprodutivo masculino de ratos adultos / Abstract: Diabetes mellitus is usually related with some kind of sexual dysfunction, promoting infertility in humans as well as in experimental models. In a prior work from our laboratory, male rats, which had a diabetic-induced state of hyperglycemia caused by streptozotocin administration, demonstrated reduced fertility through several parameters analyzed. The present study aimed at investigating the mechanisms involved and the role of testosterone in the process. Male rats were randomly allocated in 3 experimental groups: control, hyperglycemic (streptozotocin), and hyperglycemic with hormone replacement (streptozotocin+testosterone) and the following parameters were analyzed: reproductive and spermatic parameters, hormone levels, sexual behavior, contractility of vas deferens in vitro, sexual behavior parameters and the number of sperm ejaculated in utero. The vas deferens of diabetic animals was hypersensitive to methoxamine, a synthetic agonist of _1 adrenoceptors. The same animals showed the following results: alterations in sexual behavior and lack of sperm ejaculated, reduction in plasma testosterone levels, decreased body weight and epididymis, seminal vesicles, ventral prostate and vas deferens weights, loss of germ cells in the lumen and apparent epithelial disarrange in seminiferous tubules, and accelerated sperm transit time in the epididymis. The data presented herein indicate that the mechanisms underlying the reduced fertility through natural mating observed in diabetic rats involve impairment of the spermatogenic process, as well as a dysregulation of the male reproductive axis, together with evidence for problems in the sperm maturation process, which has as a complicant factor the impairment of the ejaculatory function, dependent on the vas deferens smooth muscle contractility. Androgen replacement was not totally capable of reversing the damage caused by diabetes on the male reproductive system of adult rats / Mestrado / Biologia Celular / Mestre em Biologia Celular e Estrutural

A impossibilidade de engravidar pode desencadear consequências psíquicas importantes, visto que barra a mulher no momento em que ela sente-se pronta para vivenciar a experiência da maternidade. Nesse sentido, a reprodução assistida vem possibilitando a maternidade para aquelas que não conseguiam conceber uma criança naturalmente. Contudo, percebe-se que os impactos emocionais não estão restritos à descoberta da infertilidade, estando presentes durante o processo do tratamento. Assim, para aquelas que obtiverem sucesso no tratamento, questiona-se a configuração da experiência de maternidade em meio a este contexto, que muitas vezes está atravessado por outro aspecto: a gravidez múltipla. Para abordar este fenômeno de forma ampla, foram realizados dois estudos. O Estudo 1 tinha como objetivo investigar a experiência da implantação de múltiplos embriões em mulheres que se submeteram à técnica FIV. Para tanto, foram analisadas entrevistas de mulheres que se submeteram à FIV e que mencionaram esta questão de implantação de múltiplos embriões espontaneamente. As entrevistas ocorreram no 3º trimestre gestacional destas participantes, contando inicialmente com 21 mulheres, restando após a seleção que discriminou as que não haviam trazido este tema 14 participantes. Percebeu-se que o tema da experiência da implantação em si foi comum estando presente nos relatos das 14 mulheres. Contudo, a gravidez múltipla despertara vivências distintas em relação à gravidez singular, pois na gravidez singular fantasias quanto à implantação de múltiplos embriões foram vivenciadas, mas nas mulheres que conceberam uma gravidez múltipla estas tinham se tornado concretas, de forma que estas mulheres pareciam estar se preparando para maternidade com mais de um bebê. O Estudo 2 tinha como objetivo investigar a experiência da maternidade de uma gravidez múltipla nesse contexto. Para tanto, contou com três mulheres que estavam no seu 3º trimestre gestacional. Neste estudo, ficou evidenciado o sofrimento destas mulheres ao se defrontarem com a infertilidade conjugal e ao se submeterem a tratamentos invasivos. Contudo, verificou-se que a experiência da gravidez pode reprimir este sofrimento para que estas mulheres vivenciem integralmente a experiência da maternidade. Neste sentido, este estudo levantou a discussão de que as TRA se configuram como uma forma distinta de concepção, entretanto, não levam a uma forma distinta de maternidade. / The impossibility of getting pregnant can lead to significant psychological effects, because it represents an obstacle for a woman at a time when she feels ready to go through the experience of motherhood. In this sense, assisted reproduction has enabled the experience of motherhood for those who could not conceive a child naturally. However, the emotional impact is not restricted to the discovery of infertility, being present, often, during the treatment process. Besides, for those who are successful in treatment, it is wondered how is the experience of motherhood in this context, that can still be influenced by another aspect: multiple pregnancy. Two studies were carried out. The first study was aimed to investigate the experience of implantation of multiple embryos into women who underwent IVF technique. To this end, interviews of women who underwent IVF and who mentioned the issue of implantation of multiple embryos spontaneously were analyzed. The interviews took place in the third trimester of pregnancy, with 14 women. It was noticed that the theme of the experience of implantation itself was common to all these women. However, multiple pregnancy revealed different experiences in singular as compared to singular pregnancy. Whereas in singular pregnancy the implantation of multiple embryos was only a ´possibility which was not later confirmed, in women who conceived a multiple pregnancy the fantasy became reality, so these woman seemed to be preparing for motherhood with more than one baby. The second study was designed to investigate the experience of motherhood in the context of multiple pregnancy. This involved three women who were in their third trimester of pregnancy. In this study, it became evident the suffering of these women when they were confronted with the couple’s infertility and had to undergo invasive treatments. However, it was found that the experience of pregnancy can suppress this suffering so that these women can experience the full experience of motherhood. Thus, this study raised the discussion that although TRA involves a distinct form of conception, it does not imply a distinct form of maternity.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A vasectomia, como mÃtodo de contracepÃÃo, poderà ser revertida em situaÃÃes especiais, atravÃs dos procedimentos cirÃrgicos; porÃm, o desenvolvimento de respostas humorais auto-imunes pÃs-vasectomia, em alguns, poderà ser um impeditivo para restaurar a fertilidade. Neste contexto, investigaÃÃes sobre a incidÃncia e evoluÃÃo das respostas auto-imunes em vasectomizados poderÃo oferecer subsÃdios, tanto para a compreensÃo da infertilidade auto-imune associada à vasectomia, quanto para avaliaÃÃo do sucesso nos esforÃos para restauraÃÃo da fertilidade nestes indivÃduos. Foram selecionados 20 voluntÃrios com desejo manifesto de se submeterem à vasectomia; encaminhados, na sua maioria, pela Maternidade Escola Assis Chateaubriand. As vasectomias foram realizadas pelo autor da pesquisa, no AmbulatÃrio de Cirurgia da Faculdade de Medicina. Amostras de sangue e sÃmen foram colhidas antes e 30, 90 e 180 dias apÃs a vasectomia, e a presenÃa das IgG e IgA, avaliada no Centro de ReproduÃÃo Assistida do Cearà (CONCEPTUS), atravÃs do Imunobead Test (IBT), com o mÃtodo direto para amostras prÃ-cirÃrgicas de sÃmen e o mÃtodo indireto para as amostras seminais posteriores e as de soro. Os anticorpos foram detectados nos soro e/ou sÃmen, nas positividades de >0% (todas as reaÃÃes positivas) e ≥ 20% de espermatozÃides ligados Ãs imunoglobulinas. Foram estudadas: i) avaliaÃÃes comparativas das incidÃncias das IgG e/ou IgA , ii) evoluÃÃes dos tÃtulos dos anticorpos em funÃÃo do tempo, e iii) anÃlises dos sÃtios de ligaÃÃo dos anticorpos nos espermatozÃides de voluntÃrios. Nenhuma das amostras prÃ-vasectomia revelou presenÃa de anticorpos antiespermatozÃides; porÃm IgG e IGA estavam presentes no soro e sÃmen simultaneamente nas amostras pÃs-vasectomia da maioria dos indivÃduos, revelando crescimento progressivo de 30 atà 180 dias. A presenÃa conjunta dos anticorpos sempre se mostrou predominante. Na positividade de >0%, 25% dos vasectomizados eram positivos em 30 dias, com IgG ou IgA presentes, individualmente, em poucos. Em 90 dias, 60% dos vasectomizados revelou presenÃa dos anticorpos, o que aumentou para 85% em 180 dias. A positividade de ≥ 20% nÃo foi encontrada em nenhum dos indivÃduos. Em exames de soro, isoladamente, a positividade de ≥ 20% aumentou de um indivÃduo em 30 dias, para trÃs em 90 dias, e para quatro (25%) em 180 dias. No sÃmen, esta positividade nÃo foi detectada em nenhum indivÃduo. AvaliaÃÃes dos tÃtulos de anticorpos (% de espermatozÃides ligados aos anticorpos), revelaram que as IgG e IgA aumentaram progressivamente com tempo, tanto no soro quanto no sÃmen, com a IgG sempre na dianteira; atingindo, aos 180 dias, os valores mÃdios de 7,90% (mediana â 5%) e 6,35% (mediana - 4,50%); respectivamente para IgG e IgA. A peÃa intermediÃria (PI) e cauda do espermatozÃide, nesta ordem, foram os principais sÃtios de ligaÃÃo das IgG e IgA. Esses resultados mostram que um nÃmero significativo de atà 85% dos vasectomizados desenvolve as IgG e IgA antiespermatozÃides nos primeiros 180 dias; com a positividade crescente que alcanÃa ≥ 20% em alguns; o que poderÃ, em tese, comprometer as tentativas futuras de restauraÃÃo da fertilidade nestes indivÃduos. / The contraceptive method of vasectomy can be reversed, in certain circumstances, through surgical procedures; but the incidence of autoimmune antisperm humoral responses in some vasectomized individuals may impede attempts to restore fertility. In this context, investigations on the incidence and evolution of autoimmune responses in vasectomized individuals may contribute for the understanding of autoimmune infertility associated with vasectomy, as also for the assessment of viability of restorative surgeries for fertility. Twenty individuals who have requested voluntary vasectomy for contraception, most referred by the Assis Chateaubriand School of Maternity of the Federal University of CearÃ, were selected for the study. Surgical vasectomy was performed by the author, in the Ambulatory ward of the Faculty of Medicine. Blood and semen samples were collected from the individuals prior to, and 30, 90 and 180 days after vasectomy. Antisperm IgG and IgA were evaluated in the Center for Assisted Reproduction of Cearà (CONCEPTUS), by âImmunobeadâ technique (IBT), using the direct method for the detection of antibodies in pre-vasectomy seminal samples, and the indirect IBT for evaluation of antibodies in semen samples after vasectomy, and for sera. Antibody presence was measured as >0% (all positive results) and ≥ 20% of spermatozoa bound to antibodies. The parameters studied were: i) comparative evaluations of the incidences of IgG and/or IgA in serum and/or semen; ii) evolution of the titers of these antibodies with time; and iii) the sites of binding of the antibodies in the spermatozoa of volunteers. All the pre-vasectomy serum and semen samples were devoid of antisperm antibodies; however, IgG and/or IgA were present in post-vasectomy serum and semen samples in a majority of individuals, in increasing numbers from 30 to 180 days. The simultaneous presence of IgG and IgA was always predominant. At >0% positivity, 25% of the individuals were positive in 30 days, with IgG or IgA individually present in very few. In 90 days, 60% of the vasectomized were positive, rising to 85% in 180 days. No positive reactivity was detected for ≥ 20%. Evaluation of antibodies in serum individually showed that positive results at ≥ 20% increased from one (30 days) to three in 90days, and to four in 180 days. In semen, this positivity was not detected. The evaluation of antibody titers (% of spermatozoa bound to antibodies) revealed increase of IgG and IgA with time both in serum and semen, with the former always ahead of IgA, and reaching mean values at 180 days of 7,9% (median â 5%) and 6,35% (4,5%); respectively for IgG and IgA. The midpiece and the tail of spermatozoa were the principal binding sites, in that order, for both IgG and IgA. These results show that up to 85% of individuals develop antisperm antibodies in 180 days after vasectomy, with a steadily increasing level of positivity reaching ≥ 20% in some; which may potentially compromise efforts to restore fertility in them.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-24T13:22:43Z No. of bitstreams: 2 Tese - Rita de Cássia Pereira da Costa e Silva - 2017.pdf: 1886601 bytes, checksum: 1bc3d00228ab4b2618ed1cfc39a2ac4e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-24T13:23:08Z (GMT) No. of bitstreams: 2 Tese - Rita de Cássia Pereira da Costa e Silva - 2017.pdf: 1886601 bytes, checksum: 1bc3d00228ab4b2618ed1cfc39a2ac4e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-03-24T13:23:08Z (GMT). No. of bitstreams: 2 Tese - Rita de Cássia Pereira da Costa e Silva - 2017.pdf: 1886601 bytes, checksum: 1bc3d00228ab4b2618ed1cfc39a2ac4e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-14 / Endometriosis is defined by the emergence of foci of endometrial tissue with glandular and stromal or characteristics identical to those of the uterine cavity in other locations than the endometrium and focuses primarily on women of reproductive age. It is present in 10% of the general population and in 50% of cases of infertility, showing a strong genetic component by correlating the disease with various polymorphisms. One of them, G894T of eNOS gene of the enzyme endothelial nitric oxide synthase (eNOS) has been studied by have implications with infertility. The present study examined the allele frequency and genotype of this polymorphism in women with endometriosis storied in fertile and infertile. Blood samples were used 47 women with endometriosis from a center of reference in laparoscopy and infertility of the city of Goiânia, Goiás. The DNA was extracted and measured for genotypic analysis (PCR/RFLP) with primers and controls to enlarge the gene eNOS G894T. In the statistical analysis we used the Chi square tests and/or Fisher and Mann-Whitney. The patients had an average age 32.5 ± 2.9 years. Was demonstrated difference in average age between fertile and infertile patients p = 0.034, fertile was demonstrated 39,9± 3,0 anos, and infertile 37,3 ± 5,6 anos. Genotype polymorphism frequencies in study were: GG 59.6% 29.8% and GT TT 10.6%; to split into sub-groups of fertile and infertile met respectively: 70% and 50% GG; GT 30% and 29.2%; TT was null between fertile and infertile 20.8%. The allele frequency between the fertile and infertile, was, respectively: G 85% and 15% T; G 64.6% and 35.4% T, p = 0.04 (95% CI 3.0 OR = 1.12-8.29). In the frequency analysis of genotypic heritage models, codominant and recessive were respectively: (GG vs. TT) 59.6% (28/47) vs. 10.6% (5/47) p = 0.044 and recessive (TT vs. GT + GG) was 10.6% (5/47) vs. 89.4% (42%) p = 0.049. The study showed that the presence of the T allele of eNOS gene G894T polymorphism of endothelial nitric oxide synthase enzyme in fertile and infertile patients have an important role in the increase of endometriosis and in homozygous T allele confers risk for the infertility in endometriosis in women in the city of Goiânia-Goiás. / A endometriose é definida pelo aparecimento de focos de tecido endometrial com características glandulares e/ou estromais idênticas às da cavidade uterina em outras localizações, que não o endométrio e incide principalmente em mulheres em idade reprodutiva. Está presente em 10% da população geral e em 50% dos casos de infertilidade, apresentando um forte componente genético correlacionando a doença com diversos polimorfismos. Um deles, G894T do gene eNOS da enzima óxido nítrico sintase endotelial (eNOS) tem sido estudado por ter implicações com a infertilidade. O presente estudo analisou a frequência alélica e genotípica desse polimorfismo, em mulheres com endometriose estratificadas em férteis e inférteis. Foram utilizadas amostras de sangue de 47 mulheres com endometriose provenientes de um centro de referência em videolaparoscopia e infertilidade na cidade de Goiânia, Goiás. O DNA foi extraído e quantificado para a análise genotípica (PCR/RFLP) com primers e controles para ampliar o gene eNOS G894T. Na análise estatística foram utilizados os testes qui quadrado e/ou Fisher e Mann-Whitney. As pacientes apresentaram média de idade 32,5±2,9 anos. Foi demonstrada diferença nas médias de idade entre pacientes férteis e inférteis p = 0,034, as férteis apresentaram média de 39,9 ± 3,0 anos, enquanto as inférteis 37,3 ± 5,6 anos. As frequências genotípicas do polimorfismo em estudo foram: GG 59,6%, GT 29,8% e TT 10,6%; ao dividir em subgrupos de férteis e inférteis encontrou-se respectivamente: GG 70% e 50%; GT 30% e 29,2%; TT foi nulo entre as férteis e 20,8% nas inférteis. A frequência alélica entre as férteis e inférteis, foi, respectivamente: G 85% e T 15%; G 64,6% e T 35,4%, p = 0,04 (OR = 3,0 IC 95% 1,12 – 8,29). Na análise dos modelos de herança genotípica, codominante e recessivo as frequências observadas foram respectivamente: (GG vs. TT) 59,6% (28/47) vs 10,6% (5/47) p = 0,044 e recessivo (TT vs. GT +GG) foi de 10,6% (5/47) vs 89,4% (42%) p= 0,049. O estudo demonstrou que a presença do alelo T do polimorfismo G894T do gene eNOS da enzima do óxido nítrico sintase endotelial em pacientes férteis e inférteis tem um importante papel no agravamento da endometriose e em homozigose o alelo T confere risco para infertilidade na endometriose em mulheres na cidade de Goiânia - Goiás.

O período entre a investigação da causa da infertilidade até o procedimento de fertilização assistida (FA) tem sido caracterizado como responsável por um estresse crônico. Também, a infertilidade altera o relacionamento conjugal e causa transformações sociais e sexuais,podendo o casal apresentar depressão e ansiedade. Para avaliar o casal infértil, foi desenvolvido o Fertility Problem Inventory (FPI), que mensura aspectos relacionados a preocupações sociais, sexuais, com relacionamentos, rejeição à vida sem filhos e necessidade de ter um filho. No Brasil, não foi encontrado nenhum instrumento que avaliasse casais inférteis. O objetivo deste estudo foi adaptar para a língua portuguesa o FPI. Para a adaptação, solicitou-se que quatro juízes analisassem a tradução e realizou-se um consenso quanto aos melhores termos a serem utilizados em língua portuguesa. Foi realizada a retroversão por tradutor profissional, verificando-se que o FPI não sofreu alterações na tradução. Para a análise semântica, participaram 30 casais anteriormente submetidos a procedimentos de FA com sucesso. Era solicitado que cada participante indicasse dificuldades na compreensão do inventário e 73,3% das mulheres e 66,7% dos homens afirmaram que gostariam de mudar alguma questão, sendo que 55% mudariam a classificação de respostas e 58,3% retirariam a negativa de uma questão. A partir de então, o FPI passou a ser denominado Inventário de Problemas de Fertilidade (IPF). Para a verificação da validade do IPF, participaram 122 homens e 197 mulheres que estavam no primeiro dia de FA. Estes respondiam ao IPF, Inventário de Ansiedade Traço-Estado, Inventário de Depressão de Beck e Escala Modos de Enfrentamento de Problemas. Na análise fatorial foram obtidos quatro fatores referentes a relacionamentos sociais (fator 1), conjugal e sexual (fator 2), vida sem filhos (fator 3) e maternidade/paternidade (fator 4). Obteve-se também fatores de segunda ordem que agrupavam os fatores relatados acima. Na validade de critério, o fator 1 correlacionou-se positivamente com o Idate-Estado e Traço, BDI, enfrentamento focalizado na emoção e religiosidade/ pensamento fantasioso. O fator 3 correlacionou-se positivamente com o Idate Estado e Traço, BDI e enfrentamento focalizado na emoção. O fator 4 correlacionou-se positivamente com o Idate-Traço e religiosidade/pensamento fantasioso. Para a avaliação da estabilidade do IPF, participaram 30 homens e 30 mulheres. O IPF foi respondido na primeira consulta médica e reaplicado 30 dias depois. O índice de correlação de Pearson variou de 0,86 a 0,78 nos quatro escores fatoriais. Com relação à consistência interna, o coeficiente Lambda variou entre 0,72 e 0,87. Observou-se que o Idate-Estado, Idate-Traço, enfrentamento focalizado na emoção e religiosidade/pensamento fantasioso foram as variáveis mais associadas com os escores fatoriais do IPF, sendo que estes dados foram confirmados na regressão linear, na correlação canônica e no modelo de interações proposto. Constata-se, portanto, que o IPF tornou-se um instrumento independente do original e apresentou qualidades psicométricas adequadas para a aplicação na população de casais inférteis de Ribeirão Preto e região. Assim, o IPF pode se tornar um meio de avaliação objetivo dos casais inférteis, tanto em triagens quanto em futuras pesquisas com esta população. / The period between the investigation of infertility and the assisted-fertilization procedure (FA) has been characterized as responsible for chronic stress. Additionally, infertility alters the marital relationship and causes social and sexual transformations, and the couple may come to present depression and anxiety. To asses the infertile couple, the Fertility Problem Inventory (FPI) was developed, which measure aspects related to social, sexual concerns, as well as those with relationships, rejection of life without children and the need to have a child. In Brazil , no instrument was found to evaluate infertile couples. The aim of this study was to adapt the FPI to the Portuguese language. For the adaptation, four judges were asked to analyze the translation and a consensus was reached in regards to the best terms to be used in the Portuguese language. The back translation was done by a professional translator, verifying that the FPI did not suffer alterations in the translation. The semantic analysis counted on the participation of 30 couples that had previously been successively submitted to FA procedures. Each participant was asked to indicate difficulties in the understanding of the inventory and 73.3% of the women and 66.7% of the men stated they would like to change some question, 55% would change the response rating and 58.3% would remove the negative from one question. From that moment, the FPI was called Inventário de Problemas de Fertilidade (IPF). The verification of the IPF validity counted on the participation of 122 men and 197 women that were in the first day of FA. They would answer the IPF, State-Trait Anxiety Inventory (STAI), Beck-Depression Inventory (BDI) and the Ways of Coping Scale. In the factorial analysis, four factors referring to social (factor 1), marital and sexual (factor 2) relationships, life without children (factor 3) and maternity/paternity (factor 4) were obtained. Second-order factors that grouped the above-mention factors were also obtained. In the criterion validity, factor 1 correlated positively with the STAI-State and Trait, BDI, facing the problem focused on emotion and religiousness/fantasized thoughts. Factor 3 correlated positively with the STAI State and Trait, BDI and facing the problem focused on emotion. Factor 4 correlated positively with the STAI-Trait and religiousness/fantasized thoughts. To assess the stability of the IPF, 30 men and 30 women participated. The IPF was answered in the first medical consultation and replicated 30 days later. The Pearson correlation index varied between 0.86 and 0.78 in the four factorial scores. In regards to the internal consistency, the Lambda coefficient varied between 0.72 and 0.87. It was observed that the STAI-State, STAI-Trait, facing of the problem focused on emotion and religiousness/ fantasized thought were the variables most associated with the IPF factorial scores, and these data were confirmed in the linear regression, in the canonic correlation and the proposed interaction model. Therefore, it was verified that the IPF became an instrument independent of the original and presented adequate psychometric qualities to be applied in the population of infertile couples in Ribeirão Preto and the region. Thus, the IPF may become an objective means of evaluating infertile couples, both in screenings and future researches among this population.

Orientador: Egle Cristina Couto de Carvalho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T11:06:18Z (GMT). No. of bitstreams: 1 Guimaraes_JoaoAgripino_M.pdf: 1627287 bytes, checksum: b5aedfb0c0a3b2d807c0d3324ae57317 (MD5) Previous issue date: 2012 / Resumo: Contexto e objetivo: Alterações imunológicas podem estar associadas à infertilidade e endometriose. O objetivo deste estudo foi avaliar se, na infertilidade inexplicada e na infertilidade associada à endometriose, ocorre polarização da resposta imunológica Th1ou Th2. Tipo de estudo e local: Foi realizado um estudo de corte transversal no Centro de Atenção Integral a Saúde da Mulher (CAISM), Universidade de Campinas (Unicamp), Campinas, São Paulo, Brasil, de janeiro a junho de 2010. Métodos: 142 mulheres foram alocadas em três grupos (52 com infertilidade inexplicada, 38 inférteis com endometriose e 52 férteis) para dosagem de citocinas Th1 (interleucina 2, fator de necrose tumoral-ALFA' e do interferon-y ) e citocinas Th2 (interleucinas 4 e 10). Os dados foram descritos através de média, desvio-padrão e mediana, e através de frequências absolutas e relativas. Os grupos foram comparados em relação às variáveis através dos testes de qui-quadrado ou exato de Fisher. As citocinas foram comparadas entre os grupos através do teste de Kruskal-Wallis; em caso de diferença significativa, foram feitas comparações dois a dois através do teste de Mann-Whitney e aceitou-se nível de significância 5%. Resultados: As mulheres com infertilidade inexplicada apresentaram menores níveis de interferon-y (p = 0,0012) e maiores níveis de interleucina-4 (p < 0,0001) do que as mulheres férteis, e maiores níveis de interferon-y (p = 0,0001) e de interleucina-4 (p = 0,0005) do que as mulheres inférteis com endometriose. Aquelas com infertilidade primária apresentaram menores níveis de interferon-y e maiores de interleucina-4 que as mulheres férteis. Conclusão: Não foi detectado qualquer tipo de polarização da resposta imunológica Th1 ou Th2 nas mulheres com infertilidade inexplicada ou com endometriose, quando comparadas com mulheres férteis / Abstract: Context and objective: Immunological alterations may be associated with infertility and endometriosis. The aim of this study was to evaluate the polarization of Th1 and Th2 immune response in women with unexplained infertility and infertility associated with endometriosis. Design and setting: A cross-sectional study was performed at the Center for Integral Attention to Women's Health (CAISM) from University of Campinas (UNICAMP), SP, Brazil, from January to June 2010. Methods: 142 women were allocated into three groups (52 with unexplained infertility, 38 infertile women with endometriosis and 52 fertile women) for measurement of Th1 (interleukin 2, tumor necrosis factor-? and interferon-?) and Th2 cytokines (interleukins 4 and 10). Data were reported as mean, standard deviation, median, and by absolute and relative frequencies. The groups were compared with respect to variables using the chi-square or Fisher exact test. Cytokines were compared between groups using the Kruskall-Wallis test and, if significant differences were noted, comparisons were made in pairs by Mann-Whitney test, with 5% significance level. Results: Women with unexplained infertility showed lower levels of interferon-? (p = 0.0012) and increased levels of interleukin-4 (p <0.0001) than fertile women, and higher levels of interferon-? (p = 0.0001) and interleukin-4 (p = 0.0005) than infertile women with endometriosis. Those with primary infertility had lower levels of interferon-? and interleukin-4 over than fertile women. Conclusion: We could not detect any polarization of Th1 or Th2 immune response in women with unexplained infertility or infertility with endometriosis, when compared with fertile women / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Introduction: Mondia whitei commonly known as "White Ginger" is a highly acclaimed medicinal plant that is extensively used across Africa. M. whitei is used as treatment for sexual dysfunction and is considered to be an aphrodisiac by traditional medicine practitioners. Yet, scientific evidence to support these claims are minimal and those that are published possess ambiguity. To date, only one study reporting the in vitro effect of the aqueous rhizome extract of M. whitei on human sperm motility is available. Therefore, the aim of the study was to determine the in vitro effects of M. whitei in human sperm functions. Materials and Methods: Roots of Mondia whitei obtained from the tropical Kakamega rain forest, located in the Western Province of Kenya, were cleaned and chopped into smaller segments. These pieces were ovendried at 25℃ for 3 days and milled to form a powdery substance which was infused with hot (about 70℃) distilled water for 1 hour. After cooling and filtration, the extract was frozen at -20℃ and subsequently freeze-dried. The dried extract was then stored at 4℃ in a closed container until experimentation. A total of 60 semen samples were collected: 28 of them represented healthy sperm donors and 32 infertile patients. Among these subjects, oligozoospermic and asthenozoospermic semen samples were identified and analysed separately. Sperm were washed using human tubular fluid medium supplemented with bovine serum albumin (HTF-BSA) and incubated for 1 hour at 37℃ with different concentrations of M. whitei (0.0185, 0.185, 1.85, 18.5 and 185 μg/ml). A sample without M. whitei served as control. Sperm cell motility, vitality, reactive oxygen species (ROS) production, mitochondrial membrane potential (MMP), capacitation, acrosome reaction and DNA fragmentation were assessed. Results: Total motility and the percentage of sperm with intact MMP showed significant dose-dependent increases in both groups (patient and donor), while, the percentages of progressively motile sperm only revealed significant increases in the patient group. Besides, the percentage of ROS-positive spermatozoa showed significant trend towards higher concentrations in the patient group only. Conversely, a trend towards reduced sperm DNA-fragmentation could be observed in the patient, but not the donor group. Similar tendencies were noted in oligozoospermic and asthenozoospermic, but not for normozoospermic subjects. Yet, sperm vitality, capacitation, acrosome reaction and kinematic parameters were not affected. Conclusions: Phytochemicals present in M. whitei root extract maintains spermatozoa total motility, progressive motility and intact-MMP and DNA integrity. However, at therapeutic concentration (<1.85 μg/ml) it does not trigger sperm intrinsic superoxide production nor increase ROS by causing oxidative stress, that leads to DNA fragmentation. / National Research Foundation (NRF)

Magister Scientiae - MSc / Male infertility in humans has increased in the last few decades and could be as high as 40%, while up to 50% of these men have ''unexplained'' (idiopathic) infertility. Although newly developed molecular techniques have great value in detecting subtle causes of male infertility, more detailed sperm functional tests are required to identify compromised fertility, especially in a clinical set-up. Since ethical constraints often preclude the pursuit of many basic research questions in humans, non-human primates (NHPs) have been identified as key models in human-related studies. NHPs are often used in studies on male fertility/infertility, IVF or assisted reproductive technology (ART) procedures, male contraception and reproductive toxicology. However, comparing results of NHP and human studies require that techniques used for assessment must be objective, standardized and sensitive to recognize compromised sperm function. The aim of this study was to evaluate standard sperm functional tests and develop new functional tests using NHP sperm, specifically from vervet monkeys (Chlorocebus aethiops), chacma baboons (Papio ursinus) and rhesus monkeys (Macaca mulatta), for application in human and NHP studies and to ultimately develop a basic primate model. The sperm functions investigated included sperm motility, longevity, vitality, DNA integrity, acrosome reaction, and hyperactivation. The sperm functional tests evaluated were: CASA motility analysis; Sperm Longevity test; Eosin-Nigrosin and Hoechst and Propidium Iodide staining, as well as the use of WST-1 cytotoxicity assay for vitality; the TUNEL assay for DNA integrity; Acrosome Intactness Test; and induction of hyperactivation via stimulants. The validity of each test was investigated by inhibiting sperm function through the use of copper sulphate and cadmium chloride. All functional tests were successfully performed across all three species, except the TUNEL assay for DNA integrity, and was further used for validation testing. Validation testing proved that all sperm functional parameters were significantly affected by the highest concentrations of the chemicals (250 µg/ml CuSO4 and 500 µg/ml CdCl2) and if not significant, trends of reduction were seen. The tests employed were therefore sensitive to the inhibitory effect of the metals. By evaluating these established sperm functional tests we found that primates would serve as good models for research study. Furthermore, we optimized and modified techniques for sperm and functional analysis in these three primate species and this study will standardize protocols for use in future studies on male infertility. Additionally, comparing human and NHP sperm function can possibly reveal or explain the high infertility rates in humans.

Abstract The effectiveness of intrauterine insemination (IUI) combined with controlled ovarian hyperstimulation (COH) in the treatment of subfertility was investigated in the present study. For this purpose the prognostic factors associated with success of clomiphene citrate (CC)/human menopausal gonadotrophin (HMG)/IUI were identified in 811 treatment cycles. Furthermore, a long gonadotrophin-releasing hormone agonist (GnRHa)/HMG stimulation protocol was compared with a standard CC/HMG protocol. In addition, the usefulness of alternative insemination techniques including fallopian tube sperm perfusion (FSP) and intrafollicular insemination (IFI) was investigated. Finally, the obstetric and perinatal outcome of pregnancies after COH/IUI was examined and compared with those of matched spontaneous and in vitro fertilization(IVF) pregnancies. Female age, duration of infertility, aetiology of infertility, number of large preovulatory follicles and number of the treatment cycle were predictive as regards pregnancy after CC/HMG/IUI. The highest pregnancy rate (PR) was obtained in women of &lt; 40 years of age with infertility duration ≤ 6 years, who did not suffer from endometriosis. A multifollicular ovarian response to CC/HMG resulted in better treatment success than a monofollicular response, indicating the necessity of COH combined with IUI. A significantly higher PR was achieved in the first treatment cycles compared with the others, and 97% of the pregnancies were obtained in the first four treatment cycles. The PR per cycle did not differ significantly between a long GnRHa/HMG and a standard CC/HMG protocol, but the average medication expense of GnRHa/HMG stimulation was four times the cost of CC/HMG stimulation. Therefore, the routine use of a long GnRHa/HMG protocol in IUI treatment remains questionable. The FSP procedure was easy to perform by using a paediatric Foley catheter. The success rate in couples with either FSP or standard IUI did not differ significantly, although there was a trend towards a lower PR in the FSP group. The FSP technique should not replace the simpler and less time-consuming IUI technique in routine use. The IFI technique was also simple to perform and convenient for patients. However, only one normal singleton intrauterine pregnancy resulted in 50 IFI-treated women, indicating that IFI is inefficacious for treating subfertility. The IUI parturients differed from average Finnish parturients in respect to higher maternal age, more frequent primiparity and a higher incidence of multiple pregnancies. The use of antenatal care services was significantly lower in IUI singleton pregnancies compared with IVF singletons, although there were no more complications in IVF pregnancies. The hospitalization and Caesarean section rates were generally high in all pregnancies. The mean birthweight of IUI singletons was significantly lower than that in spontaneous pregnancies, but comparable to that in IVF pregnancies. However, the incidence of preterm birth, low birth weight and other variables describing the outcome of infants were similar in IUI, IVF and spontaneous pregnancies. In summary, the IUI procedure itself does not seem to affect adversely the obstetric and perinatal outcome of pregnancy, and patient characteristics and multiplicity may be more important in this respect.