F.F. Pasqualotto

Female sexual dysfunction: the important points to remember

Media exposure regarding male sexual dysfunction and the growing number of viable treatment alternatives for erectile dysfunction has resulted in increasing numbers of men seeking clinical appointments and treatment for the condition, which has previously been considered taboo. Because these problems usually arise within the context of relationships, some investigators have alluded to increased rates of sexual dysfunction among the partners of these men. Also, since general practitioners, gynaecologists, geriatrists, and urologists are also seeing female patients for evaluation of various types of dysfunction, certain groups of these women with underlying chronic conditions have been noted to have high rates of concomitant sexual dysfunction. Physicians who have good rapport with these patients are in a privileged position to help with these intimate problems, which are often difficult for patients to discuss. Therefore, it is of extreme importance that these professionals become knowledgeable about and comfortable with the initial evaluation and possible treatment of female sexual dysfunction.

Measuring male infertility: epidemiological aspects

Evidence suggests that human semen quality may have been deteriorating in recent years. Most of the evidence is retrospective, based on analysis of data sets collected for other purposes. Measures of male infertility are needed if we want to monitor the biological capacity for males to reproduce over time or between different populations. We also need these measures in analytical epidemiology if we want to identify risk indicators, risk factors, or even causes of an impaired male fecundity-that is, the male component in the biological ability to reproduce. The most direct evaluation of fecundity is to measure the time it takes to conceive. Since the time of conception may be missed in the case of an early abortion, time to get pregnant is often measured as the time it takes to obtain a conception that survives until a clinically recognized pregnancy or even a pregnancy that ends with a live born child occurs. A prolonged time required to produce pregnancy may therefore be due to a failure to conceive or a failure to maintain a pregnancy until clinical recognition. Studies that focus on quantitative changes in fecundity (that does not cause sterility) should in principle be possible in a pregnancy sample. The most important limitation in fertility studies is that the design requires equal persistency in trying to become pregnant and rather similar fertility desires and family planning methods in the groups to be compared. This design is probably achievable in exposure studies that make comparisons with reasonable comparable groups concerning social conditions and use of contraceptive methods.

Pronuclear and Morphological Features as a Cumulative Score to Select Embryos in ICSI (Intracytoplasmic Sperm Injection) Cycles According to Sperm Origin

AbstractPurpose: To analyze best parameter to select embryos according to sperm origin in ICSI cycles. Methods: One hundred seventy-two ICSI cycles were divided among three different groups: A (ejaculated spermatozoa from nonmale factor infertility), B (ejaculated spermatozoa from oligospermia), and C (spermatozoa from azoospermia). Embryos were divided on Day 1 into two patterns: S0 (pronuclei (PN) aligned and close with normal arrangement of nucleoli) and S1 (when these characteristics were absent) and also on transfer day according to morphological features. Results: Relationships of PN patterns related to sperm origin were noted. More S0 embryos were detected with better sperm quality. Higher number of good quality embryos was obtained when male factor was absent. Ejaculated and epididymal spermatozoa provide better quality embryos than do testicular spermatozoa. Conclusions: PN classification associated with transfer day morphology is valuable additional noninvasive criterion for elective embryo transfer, mainly in the cases with severe male factor.

Testicular sperm results in elevated miscarriage rates compared to epididymal sperm in azoospermic patients

CONTEXT Several sperm retrieval techniques are available for use on azoospeermic men. Comparisons between spermatozoa retrieved from the testicles and epididymis in relation to pregnancy and miscarriage rates are not well established. OBJECTIVE To compare pregnancy and miscarriage rates using sperm retrieved from the testes and epididymis using intracytoplasmic sperm injection. Furthermore, we evaluated the fertilization and pregnancy rates according to the status of the spermatozoa retrieved (motile or immotile). DESIGN Retrospective study. SETTING A private center for assisted fertilization. PARTICIPANTS One hundred and eight consecutive patients who presented with azoospermia were included in our study, on whom a total of 144 retrieval procedures were performed. PROCEDURES Of the 144 retrieval procedures, 104 were testicular sperm aspirations (TESA) and 40 were epididymal sperm aspirations (PESA). PESA was the first approach in obstructive patients (n = 68), whereas TESA was used when the former failed. For non-obstructive patients (n = 40), TESA was the method of retrieval. MAIN MEASUREMENTS Pregnancy and miscarriage rates according to spermatozoa characteristics (motile or immotile). RESULTS The number of cycles performed using spermatozoa retrieved from the testicles and epididymis was 81 and 30, respectively. Motile spermatozoa had higher fertilization (2PN) and pregnancy rates compared to immotile spermatozoa (p < 0.05). Also, motile spermatozoa had lower miscarriage rates compared to immotile spermatozoa (p < 0.0001). No differences were seen in pregnancy rates with testicular spermatozoa (n = 28) compared to epididymal spermatozoa (n = 13) (p = 0.1). However, the miscarriages rates were higher in spermatozoa retrieved from the testicles (n = 12) compared to epididymis retrievals (n = 1) (p = 0.01). CONCLUSIONS Although pregnancy rates were similar when the intracytoplasmic sperm injection was performed with spermatozoa retrieved from the testicles and epididymis, the use of testicular spermatozoa yields a significantly higher miscarriage rate. It is possible that the higher miscarriage rate seen in patients using spermatozoa retrieved from the testicles is linked to high genetic sperm abnormalities.

Different Intervals Between Vasectomy and Sperm Retrieval Interfere in the Reproductive Capacity from Vasectomized Men

AbstractPurpose: To evaluate the relationship between the postvasectomy period and sperm reproductive capacity after ICSI. Methods: Seventy-seven ICSI cycles with percutaneous epididymal sperm aspiration (PESA) were reviewed. Patients were divided into 4 groups according to the interval after vasectomy: 0 – 5 years (G1); 6 – 8 years (G2); 9 – 14 years (G3), and >15 years (G4). Results: Clinical and ongoing pregnancy rates did not correlate significantly with the time period of vasectomy until 14 years. Although the higher implantation rate observed in G1, no significant differences were noted among Groups 1–3. The miscarriage rates increased from G1 to G4, reaching a statistical significance among G1, G2, and G3 compared with G4. When groups were also divided according to the maternal age, the same results were obtained. Conclusions: The interval between the vasectomy and the sperm retrieval procedure has no effect on the outcome until the interval of 14 years.

Trends in male contraception

Methods that are available for male contraception, namely coitus interruptus, condoms, and vasectomy, have been used since the 19th century. With the exceptions of a few improvements of these methods, no major progress has been made with respect to introducing new male contraceptives since then. It is extremely urgent to develop new, safe, effective, and reversible male contraceptive methods. Among all male contraceptive methods that are being investigated, the hormonal approach is the closest to clinical application. Hormonal contraception provides pregnancy protection by means of spermatogenic suppression. Androgen-progestin regimens currently represent the best available hormonal combination for induction of a profound suppression of spermatogenesis. Further development of new steroids is mandatory for increasing the choices of available contraceptive formulations and to optimize long-term safety of these regimens.

Risks and benefits of hormone replacement therapy in older men

The use of testosterone in older men, known as male hormonal replacement therapy or androgen replacement therapy, has become of increasing interest to both the medical and lay communities over the past decade. Even though the knowledge of the potential benefits and risks of male Androgen Replacement Therapy has increased dramatically, there is still much that needs to be determined. Although there are a number of potential benefits of male Androgen Replacement Therapy and data concerning clinical effects of such replacement have accumulated, as yet there have not been any large multicenter randomized controlled trials of this therapy. It is the purpose of this article to review what is currently known about the possible risks and benefits of male Androgen Replacement Therapy by discussing the clinical trials to date.

Spinal cord injury and male infertility: a review

O trauma raquimedular (TRM) e uma importante causa de morbimortalidade na sociedade atual, principalmente por acometer adultos jovens. Dentre as diversas sequelas decorrentes da lesao medular encontram-se as alteracoes na qualidade de vida sexual e na paternidade. A infertilidade decorre de diversas alteracoes como: disfuncao eretil, anejaculacao, alteracoes bioquimicas no semen e estruturais nos espermatozoides. As terapias para a infertilidade pos-TRM, em geral, objetivam o estimulo a ejaculacao e posterior inseminacao, sendo a baixa qualidade do semen o fator determinante para infertilidade. A terapia hiperbarica representa uma possibilidade de atuar diretamente no tecido lesado, seja ele medular ou testicular, diminuindo o dano.Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.La lesion de la medula espinal sigue siendo una causa importante de morbilidad y mortalidad en la sociedad actual, que afecta principalmente a hombres en la adolescencia a la edad adulta. Entre las varias secuelas resultantes de lesiones de la medula espinal, el deterioro del sistema sexual es de gran relevancia una vez que afectan la calidad de la vida sexual y la paternidad. La infertilidad es secundaria a varios eventos, tales como la disfuncion erectil, aneyaculacion, modificacion bioquimica seminal y la morfologia de los espermatozoides. Los tratamientos para la infertilidad post-TRM, en general, tienen por objeto estimular la eyaculacion seguida de inseminacion in vitro, siendo la baja calidad seminal el factor determinante de la infertilidad de estos pacientes. En este escenario, la terapia con oxigenacion hiperbarica, aun en estudio, representa un tratamiento alternativo ya que actua sobre el sistema nervioso central lesionado por el trauma y sobre el tejido testicular para reducir el dano espinal y preservar la regulacion fisiologica del sistema genital como una forma de evitar la infertilidad.

Lesión de la médula espinal e infertilidad masculina: una revision

O trauma raquimedular (TRM) e uma importante causa de morbimortalidade na sociedade atual, principalmente por acometer adultos jovens. Dentre as diversas sequelas decorrentes da lesao medular encontram-se as alteracoes na qualidade de vida sexual e na paternidade. A infertilidade decorre de diversas alteracoes como: disfuncao eretil, anejaculacao, alteracoes bioquimicas no semen e estruturais nos espermatozoides. As terapias para a infertilidade pos-TRM, em geral, objetivam o estimulo a ejaculacao e posterior inseminacao, sendo a baixa qualidade do semen o fator determinante para infertilidade. A terapia hiperbarica representa uma possibilidade de atuar diretamente no tecido lesado, seja ele medular ou testicular, diminuindo o dano.Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.La lesion de la medula espinal sigue siendo una causa importante de morbilidad y mortalidad en la sociedad actual, que afecta principalmente a hombres en la adolescencia a la edad adulta. Entre las varias secuelas resultantes de lesiones de la medula espinal, el deterioro del sistema sexual es de gran relevancia una vez que afectan la calidad de la vida sexual y la paternidad. La infertilidad es secundaria a varios eventos, tales como la disfuncion erectil, aneyaculacion, modificacion bioquimica seminal y la morfologia de los espermatozoides. Los tratamientos para la infertilidad post-TRM, en general, tienen por objeto estimular la eyaculacion seguida de inseminacion in vitro, siendo la baja calidad seminal el factor determinante de la infertilidad de estos pacientes. En este escenario, la terapia con oxigenacion hiperbarica, aun en estudio, representa un tratamiento alternativo ya que actua sobre el sistema nervioso central lesionado por el trauma y sobre el tejido testicular para reducir el dano espinal y preservar la regulacion fisiologica del sistema genital como una forma de evitar la infertilidad.

Traumatismo raquimedular e infertilidade masculina: revisão

O trauma raquimedular (TRM) e uma importante causa de morbimortalidade na sociedade atual, principalmente por acometer adultos jovens. Dentre as diversas sequelas decorrentes da lesao medular encontram-se as alteracoes na qualidade de vida sexual e na paternidade. A infertilidade decorre de diversas alteracoes como: disfuncao eretil, anejaculacao, alteracoes bioquimicas no semen e estruturais nos espermatozoides. As terapias para a infertilidade pos-TRM, em geral, objetivam o estimulo a ejaculacao e posterior inseminacao, sendo a baixa qualidade do semen o fator determinante para infertilidade. A terapia hiperbarica representa uma possibilidade de atuar diretamente no tecido lesado, seja ele medular ou testicular, diminuindo o dano.Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.La lesion de la medula espinal sigue siendo una causa importante de morbilidad y mortalidad en la sociedad actual, que afecta principalmente a hombres en la adolescencia a la edad adulta. Entre las varias secuelas resultantes de lesiones de la medula espinal, el deterioro del sistema sexual es de gran relevancia una vez que afectan la calidad de la vida sexual y la paternidad. La infertilidad es secundaria a varios eventos, tales como la disfuncion erectil, aneyaculacion, modificacion bioquimica seminal y la morfologia de los espermatozoides. Los tratamientos para la infertilidad post-TRM, en general, tienen por objeto estimular la eyaculacion seguida de inseminacion in vitro, siendo la baja calidad seminal el factor determinante de la infertilidad de estos pacientes. En este escenario, la terapia con oxigenacion hiperbarica, aun en estudio, representa un tratamiento alternativo ya que actua sobre el sistema nervioso central lesionado por el trauma y sobre el tejido testicular para reducir el dano espinal y preservar la regulacion fisiologica del sistema genital como una forma de evitar la infertilidad.