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Highlights ASMR 2015: infertilidade masculina
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Fator Masculino and ART Outcomes Highlights ASRM 2015 - Baltimore
Conrado AlvarengaHospital das Clínicas da FMUSP
Responsável Andrologia Clinica Vida Bem Vinda - SP
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ICSI VERSUS IMSI – COCHRANE
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ICSI VERSUS IMSI – COCHRANE
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2014 – NOVA REVISAO
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Oncofertilidade
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FERTILIDADE – TOP PRIORITY NO CANCER
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Recomendações ASCO
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40% nem discutem com paciente
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Futuro
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Investigar a Influência da aneuploidia no gameta masculino nas alterações cromossômicas do embrião
de oócitos doados Sabe-se que taxa de Aneuploidias em Embriões gerados de doação é mais alta
A contribuição de cada fator para isso ainda é pouco claraESTUDO RETROSPECTIVO
Does the male factor influence in the embryo aneuploidy rate?
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Does the male factor influence in the embryo aneuploidy rate?
Todos ESPG normais – SPERM FISH X, Y, 13, 16, 18, 21 e 22 Array CGH de 103 POLAR BODIES ( de oócitos doados ) e 56
biópsias de embriões no quinto dia Idade média 25 anos – doadoras
Main outcome measures foram = aneuploidia, alterações cromossômicas, monossomias e trissomias rates
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Investigar a Influência da aneuploidia no gameta masculino nas alterações cromossômicas do embrião
de oócitos doados Sabe-se que taxa de Aneuploidias em Embriões gerados de doação é mais alta
A contribuição de cada fator para isso ainda é pouco claraESTUDO RETROSPECTIVO
Does the male factor influence in the embryo aneuploidy rate?
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Instituto Bernabeu – Spain Alicante
Todos ESPG normais – SPERM FISH X, Y, 13, 16, 18, 21 e 22 Array CGH de 103 POLAR BODIES ( de oócitos doados ) e 56
biópsias de embriões no quinto dia Idade média 25 anos – doadoras
Main outcome measures foram = aneuploidia, alterações cromossômicas, monossomias e trissomias rates
Does the male factor influence in the embryo aneuploidy rate?
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TAXA DE ANEUPLOIDA POLAR BODIES – 20%
CROMOSSOMOS MAIS ALTERADOS 16 e 22 LEMBRAR QUE TODOS NORMOZOOSPERMIA
Does the male factor influence in the embryo aneuploidy rate?
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Instituto Bernabeu – Spain Alicante
MENSAGENS
• Alta porcentagem de aneuploidias nos embriões provenientes de oócitos doados deve-se tb a fator
masculino • Seleção mais criteriosa para SET ?
• Comprehensive Cromossome Screening (CCS) nos embriões de oócitos doados
Does the male factor influence in the embryo aneuploidy rate?
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Estilo de vida, fatores ambientais e psico-sociaisPalavras chave relacionadas
Pubmed , Cochrane and relacionados1295 – 256 com critérios de relevância
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• ALCOOL – Motilidade – reversível • ACRILAMIDA – frituras ( gordura ) 3 parâmetros
• DROGAS RECREATIVAS – reversíveis • BANHOS QUENTES – estudos fracos
• ESTRESSE FISICO – Ruim atividade física alto impacto - Triathlon• TABAGISMO - Passivo – mutações de novo em Ratos com oligospermia
• LUBRIFICANTES VAGINAIS – sem alterações • IMC
• DISRUPTORES ENDOCRINOS • CONDICOES PSICOLOGICAS • USO DE MEDICAMENTOS
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Queda da fertilidade masculina pelo mundo
Hipóteses Principais -Aumento do IMC e ingesta de gordura saturada ( frituras – acrilamida ) -Aumento do sedentarismo -Aumento dos níveis de estresse-Piora qualidade do sono -Aumento dos disruptores Endócrinos -Poluentes Ambientais
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Endocrine disruptors and timing of human exposure.
*A gradual decline in human fertility coincides with intensive industrial and agricultural development and the concomitant release of chemical waste into the
environment. – ATENCAO PARA HIDROCARBONETOS
*Among these chemicals are endocrine disruptors (EDs) which, in minute doses, have detrimental effects on reproductive health.
*Adults are exposed mainly through the ingestion of contaminated drinking water, meat, fat-dairy products and breathing polluted air.
* Infants are exposed to EDs through breast milk, baby products, and polluted air
*To create a healthier environment, scientific research must be translated into preventive policy legislation.
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Can You Treat Sperm DNA Fragmentation????
Reducing the amount of sperm DNA fragmentation includes such things as "having a urologist evaluate the man to determine if a varicocele is present and, if
large, surgically repair it. Several studies have shown this not only brings down the DFI but increases pregnancy success,” .
Keep the testes cool Stop smoking
Eat a diet rich in antioxidants because oxidative stress is the primary culprit for breaking DNA
Avoid some medications such as cortisone and SSRIs
Ask your doctor about supplementary vitamins and antioxidants such as vitamins C and E, co-enzyme Q-10 and supplements containing carnitine.
Fragmentação DNA
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BACKGROUND – IIU X CUTOFFS SEMEN
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SOP > Inexplicada > masculino >>> Endometriose
9.000.000
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Resultados pós congelamento de amostras graves – Pôster – ASRM 2015
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Resultados pós congelamento de amostras graves – Pôster – ASRM 2015
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Caso graves masculinos – Elevada IFDNA
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MESSAGE TO TAKE HOME
1- Inicial caso obesidade, tabagismo,
oligo grave,varicoce
lepós QT….
2- Após primeira falha
caso sem alterações
masculinas
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FNA MICROTESE
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PROMESSAS DO FNA MAPPING – PAUL TUREK – NAO PUBLICADAS
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OBRIGADO [email protected]
Conrado AlvarengaHospital das Clínicas da FMUSP
Responsável Andrologia Clinica Vida Bem Vinda - SP