Influência dos fatores de agravo à fertilidade masculina nas taxas de recuperação de espermatozoides após processamento seminal
Data
2020-04-17
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Dissertação de mestrado
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Introdução: A infertilidade conjugal é definida como incapacidade em alcançar a gestação após doze meses de relações sexuais, sem o uso de métodos contraceptivos. Estima-se que esta condição acomete 15% de casais em idade reprodutiva. Nas últimas décadas as tecnologias de reprodução assistida ofereceram a muitos casais inférteis a oportunidade de terem um filho. Para a realização de qualquer técnica de reprodução assistida, os espermatozoides ejaculados devem ser separados do plasma seminal de forma rápida e eficiente. Uma das técnicas de separação mais utilizadas é o gradiente de densidade descontínuo, que separa os melhores espermatozoides com base em sua densidade. Após a realização da técnica, deve-se calcular a porcentagem de sucesso, por meio da taxa de recuperação. Esta é a proporção de espermatozoides progressivamente móveis que está presente na preparação final, e pode ser influenciada pela qualidade seminal do homem. Acredita-se também que o sucesso da técnica pode estar ligado aos fatores de agravo a fertilidade masculina, como a varicocele e a obesidade. O sucesso, ou não, da técnica é capaz de determinar a conduta médica, e qual a complexidade da técnica de reprodução assistida pelo qual o casal será submetido. Desta forma, torna-se importante verificar de qual forma as taxas de recuperação de espermatozoides são influênciadas. Objetivo: Analisar se os fatores de agravo da fertilidade masculina influenciam as taxas de recuperação de espermatozoides pós-processamento seminal. Métodos: Foi realizado um estudo retrospectivo, no qual foram utilizadas informações de um banco de dados de casais que buscaram o Setor Integrado de Reprodução Humana da UNIFESP, entre janeiro de 2006 e dezembro de 2018 para tratamento de infertilidade conjugal. Foram analisados dados clínicos masculinos, de análise seminal e de taxa de recuperação dos espermatozoides após o processamento seminal. Então este estudo foi dividido em dois subestudos: (i) para verificar o efeito da varicocele nas taxas de recuperação de espermatozoides; e (ii) para verificar o efeito dos índices de massa corpórea nas taxas de recuperação de espermatozoides. Para a análise estatística, em ambos os subestudos, foi realizado o teste ANOVA, seguido pelo post-hoc LSD. Ainda, foi calculado o coeficiente d de Cohen para verificar o tamanho do efeito. Foi considerado α = 5%. Resultados e Conclusão: Por meio dos nossos resultados, podemos observar que a varicocele, e a obesidade, quando fatores isolados de infertilidade, não alteram a taxa de recuperação de espermatozoides, entretanto, foi possível verificar um efeito sinérgico dos fatores de infertilidade, pois quando estes estão associados um ao outro, há uma diminuição nas taxas de recuperação de espermatozoides desses homens.
Introduction: Marital infertility is defined as the inability to reach pregnancy after twelve months of sexual intercourse, without the use of any contraceptive method. It is estimated that this condition affects about 15% of couples of reproductive age. In the recent decades, assisted reproductive technologies have offered to many infertile couples the opportunity to conceive a child. To perform any assisted reproduction technique, the ejaculated sperm must be separated from the seminal plasma quickly and efficiently. One of the most used separation techniques is the discontinuous density gradient, which separates the best sperm based on their density. After performing the technique, it is calculated the success percentage using the recovery rate, which is the proportion of progressively mobile sperm that is present in the final preparation and can be influenced by man's seminal quality. It is also believed that the success of the technique may be linked to factors that aggravate male fertility, such as varicocele and obesity. The success, or not, of the technique is able to determine the medical conduct, and what is the complexity of the assisted reproduction technique to which the couple will be submitted. Thus, it is important to verify how sperm recovery rates are influenced. Objective: to analyze whether the factors that impair male fertility influence the sperm recovery rates after seminal processing. Methods: a retrospective study was performed, in which information from a database of couples who sought the Integrated Human Reproduction Sector of UNIFESP, from January 2006 to December 2018, for the treatment of marital infertility. Male clinical data, seminal analysis and sperm recovery rate after seminal processing were analyzed. This study was then divided into two sub-studies: (i) to verify the effect of varicocele on sperm recovery rates; and (ii) to verify the effect of body mass index on sperm recovery rates. For statistical analysis, in both sub-studies, the ANOVA test was performed, followed by the post-hoc LSD. In addition, Cohen's d coefficient was calculated to verify the effect size, α = 5% was considered. Results and Conclusion: Through our results, we can observe that varicocele and obesity, when isolated factors of infertility, do not alter the rate of recovery of sperm, however, it was possible to verify a synergistic effect of infertility factors because when they are associated with another factor, there is a decrease in the sperm recovery rates of those men.
Introduction: Marital infertility is defined as the inability to reach pregnancy after twelve months of sexual intercourse, without the use of any contraceptive method. It is estimated that this condition affects about 15% of couples of reproductive age. In the recent decades, assisted reproductive technologies have offered to many infertile couples the opportunity to conceive a child. To perform any assisted reproduction technique, the ejaculated sperm must be separated from the seminal plasma quickly and efficiently. One of the most used separation techniques is the discontinuous density gradient, which separates the best sperm based on their density. After performing the technique, it is calculated the success percentage using the recovery rate, which is the proportion of progressively mobile sperm that is present in the final preparation and can be influenced by man's seminal quality. It is also believed that the success of the technique may be linked to factors that aggravate male fertility, such as varicocele and obesity. The success, or not, of the technique is able to determine the medical conduct, and what is the complexity of the assisted reproduction technique to which the couple will be submitted. Thus, it is important to verify how sperm recovery rates are influenced. Objective: to analyze whether the factors that impair male fertility influence the sperm recovery rates after seminal processing. Methods: a retrospective study was performed, in which information from a database of couples who sought the Integrated Human Reproduction Sector of UNIFESP, from January 2006 to December 2018, for the treatment of marital infertility. Male clinical data, seminal analysis and sperm recovery rate after seminal processing were analyzed. This study was then divided into two sub-studies: (i) to verify the effect of varicocele on sperm recovery rates; and (ii) to verify the effect of body mass index on sperm recovery rates. For statistical analysis, in both sub-studies, the ANOVA test was performed, followed by the post-hoc LSD. In addition, Cohen's d coefficient was calculated to verify the effect size, α = 5% was considered. Results and Conclusion: Through our results, we can observe that varicocele and obesity, when isolated factors of infertility, do not alter the rate of recovery of sperm, however, it was possible to verify a synergistic effect of infertility factors because when they are associated with another factor, there is a decrease in the sperm recovery rates of those men.
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Homsi C.