Análise retrospectiva da qualidade seminal de pacientes que procuraram tratamento para infertilidade
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Data
2024-03-19
Autores
Vieira, Henrique Cunha [UNIFESP]
Orientadores
Fraietta, Renato [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
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Resumo
Objetivo: Avaliar a qualidade seminal de pacientes que procuraram Setor Integrado de Reprodução Humana e os fatores de agravo ao seu potencial fértil. Métodos: Estudo retrospectivo dos homens que passaram no Ambulatório da Unifesp e Hospital São Paulo, entre os anos de 2006 e 2020. Coleta de dados anonimizados de prontuários médicos, como informações gerais (idade, altura e peso); dados clínicos (comorbidades, cirurgias prévias, fatores ocupacionais, presença e grau de varicocele, uso de medicamentos, volume testicular e hábitos de vida); e avaliação dos dados provenientes da análise de uma ou duas amostras seminais que foram avaliadas de acordo com os padrões do manual da Organização Mundial de Saúde (WHO). Foram realizados o teste de Kolmogorov-Smirnov, a análise descritiva, modelos lineares generalizados (GLM) e teste de correlação. Os resultados foram considerados estatisticamente significantes quando p<0,05 e intervalo de confiança de 95%. Resultados: Foram avaliados 1853 homens membros de um casal com infertilidade primária. A frequência de normozoospermia foi de 42,57%, azoospermia de 8,85% e oligozoospermia de 28,55%. Analisando-se os fatores de agravo, a presença de ao menos um fator na avaliação inicial ocorreu em cerca de 77,66%. Os fatores mais prevalentes foram varicocele grau 2 e 3 (48,84%), etilismo (36,1%) e obesidade (23,85%). Entre os parâmetros seminais, destaca-se a morfologia que quando na presença de um fator de agravo, teve seu valor mais próximo ao percentil 5% dos homens férteis, valor este determinado pelo manual da WHO, além de ter uma correlação com todos os outros parâmetros: concentração de espermatozoides (R = 0,480 p < 0,0001), contagem (R = 0,495 p < 0,0001), motilidade progressiva (R = 0,467 p < 0,0001), motilidade total (R = 0,460 p < 0,0001), imóveis (R = -0,461 p < 0,0001) e vitalidade (R = 0,323 p < 0,0001). A concentração de espermatozoides foi inferior para orquite (p = 0,012), caxumba sem orquite (p = 0,037), terapias gonadotóxicas (radioterapia e quimioterapia), varicocele grau 2 e 3 (p <0,0001) e obesidade (p = 0,003). Conclusões: Homens componentes de casais que procuraram tratamento para infertilidade têm uma predominância de alterações nos parâmetros seminais. Os fatores de agravo à fertilidade influenciam em diferentes graus os parâmetros seminais e com diversos mecanismos.
Objective: To evaluate the seminal quality of patients who sought the Human Reproduction service and the factors affecting their fertility potential. Methods: Retrospective study of men who attended the Unifesp Outpatient Clinic and Hospital São Paulo between the years 2006 and 2020. Collection of anonymized data from medical records, including general information (age, height, and weight); clinical data (comorbidities, previous surgeries, occupational factors, presence and grade of varicocele, medication use, testicular volume, and lifestyle habits); and assessment of data from the analysis of one or two semen samples carried out according to the World Health Organization (WHO) manual standards. For statistical analysis, the Kolmogorov-Smirnov test was done, descriptive analysis, generalized linear models (GLM), and correlation tests. Results were considered statistically significant at p < 0.05 with a 95% confidence interval. Results: 1,853 male members of a couple with primary infertility were evaluated. The frequency of normozoospermia was 42.57%, azoospermia was 8.85%, and oligozoospermia was 28.55%. Regarding the aggravating factors to reproduction potencial, the presence of at least one during the initial assessment occurred in approximately 77.66%. The most prevalent were grade 2 and 3 varicocele (48.84%), alcohol consumption (36.1%), and obesity (23.85%). Among the seminal parameters, it's noteworthy that when an aggravating factor was present, morphology approached values closer to the 5th percentile of fertile men according to the WHO manual. It also exhibited correlation with all other parameters: sperm concentration (R = 0.480, p < 0.0001), sperm count (R = 0.495, p < 0.0001), progressive motility (R = 0.467, p < 0.0001), total motility (R = 0.460, p < 0.0001), immotile sperm (R = -0.461, p < 0.0001), and vitality (R = 0.323, p < 0.0001). Sperm concentration was lower for orchitis (p = 0.012), mumps without orchitis (p = 0.037), gonadotoxic therapies (radiation therapy and chemotherapy), varicocele grade 2 and 3 (p < 0.0001) and obesity (p = 0.003). Conclusions: Men seeking treatment for infertility within a couple predominantly exhibit alterations in seminal parameters. Reproductive potential can be impaired by aggravating factors that reduce male reproductive capacity, reflecting in seminal parameters to varying degrees through different mechanisms.
Objective: To evaluate the seminal quality of patients who sought the Human Reproduction service and the factors affecting their fertility potential. Methods: Retrospective study of men who attended the Unifesp Outpatient Clinic and Hospital São Paulo between the years 2006 and 2020. Collection of anonymized data from medical records, including general information (age, height, and weight); clinical data (comorbidities, previous surgeries, occupational factors, presence and grade of varicocele, medication use, testicular volume, and lifestyle habits); and assessment of data from the analysis of one or two semen samples carried out according to the World Health Organization (WHO) manual standards. For statistical analysis, the Kolmogorov-Smirnov test was done, descriptive analysis, generalized linear models (GLM), and correlation tests. Results were considered statistically significant at p < 0.05 with a 95% confidence interval. Results: 1,853 male members of a couple with primary infertility were evaluated. The frequency of normozoospermia was 42.57%, azoospermia was 8.85%, and oligozoospermia was 28.55%. Regarding the aggravating factors to reproduction potencial, the presence of at least one during the initial assessment occurred in approximately 77.66%. The most prevalent were grade 2 and 3 varicocele (48.84%), alcohol consumption (36.1%), and obesity (23.85%). Among the seminal parameters, it's noteworthy that when an aggravating factor was present, morphology approached values closer to the 5th percentile of fertile men according to the WHO manual. It also exhibited correlation with all other parameters: sperm concentration (R = 0.480, p < 0.0001), sperm count (R = 0.495, p < 0.0001), progressive motility (R = 0.467, p < 0.0001), total motility (R = 0.460, p < 0.0001), immotile sperm (R = -0.461, p < 0.0001), and vitality (R = 0.323, p < 0.0001). Sperm concentration was lower for orchitis (p = 0.012), mumps without orchitis (p = 0.037), gonadotoxic therapies (radiation therapy and chemotherapy), varicocele grade 2 and 3 (p < 0.0001) and obesity (p = 0.003). Conclusions: Men seeking treatment for infertility within a couple predominantly exhibit alterations in seminal parameters. Reproductive potential can be impaired by aggravating factors that reduce male reproductive capacity, reflecting in seminal parameters to varying degrees through different mechanisms.
Descrição
Citação
VIEIRA, Henrique Cunha. Análise retrospectiva da qualidade seminal de pacientes que procuraram tratamento para infertilidade. 2024. 123 f. Dissertação (Mestrado em Urologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024