Desenvolvimento e Estudo da Validade Facial do Questionário de Motivações para Revelar/Não Revelar a Parentalidade Não-Genética por Doação de Gâmetas

Introdução: A parentalidade é um papel muito valorizado socialmente. No entanto, para casais com infertilidade o desempenho deste papel pode implicar tratamentos de fertilidade, alguns deles com recurso a gâmetas de dador. Para os casais que recorrem a gâmetas de dador, surge uma outra preocupação: contar à criança a origem da sua conceção ou manter segredo. Ainda que as motivações que influenciam este processo de decisão tenham sido alvo de estudo, em Portugal a investigação relativa a este tema é escassa. Objetivos: A presente investigação pretendeu desenvolver e estudar a validade facial do Questionário de Motivações para Revelar/Não Revelar a Parentalidade não Genética por Doação de Gâmetas (QMRDG), o qual se destina a avaliar as principais motivações que influenciam o processo de tomada de decisão dos pais que recorrem a gâmetas de dador relativamente a contar ou não contar ao/à seu/sua filho/a a origem da sua conceção. Pretendeu-se ainda explorar a relação entre os sintomas emocionais negativos e o sentido de competência parental nos diferentes grupos em estudo (pais que já contaram à criança, pais que decidiram não contar e pais que ainda não contaram). Metodologia: Estudo exploratório conduzido numa amostra de 21 participantes que recorrem a tratamento de fertilidade com recurso a gâmetas de dador, tendo tido filhos resultantes desse mesmo tratamento, com idades compreendidas entre os 30 e 49 anos. Os participantes preencheram um conjunto de questionários numa plataforma online, tendo o estudo sido divulgado pela Associação Portuguesa de Fertilidade. Resultados: Os dados obtidos indicam que a maioria dos pais ainda não contou ao/à seu/sua filho/a sua origem genética devido ao facto de a criança ser ainda muito pequena, encontrando-se estes com intenção de revelar à criança. Dos pais que já contaram, as motivações que mais influenciaram a decisão basearam-se na falta de motivos para omitir, na importância dada à honestidade, no direito do conhecimento das origens genéticas e na transparência no seio familiar. Face às motivações para não contar, das que mais influenciaram os pais salienta-se a pouca importância dada à genética. O QMRDG revelou possuir validade facial não tendo sido reportada a existência de itens ambíguos ou de difícil compreensão. Discussão: A tendência dos pais no presente estudo foi de contar ao/à seu/sua filho/a a origem da sua conceção, sendo também esta a tendência reportada em estudos mais recentes. Verificou-se a existência de algumas limitações no estudo, nomeadamente o tamanho da amostra. No entanto, o QMRDG mostrou possuir validade facial, podendo constituir-se como um instrumento útil na prática clínica e na investigação com pessoas que estejam a realizar tratamento de fertilidade com recurso a gâmetas de dador. / Introduction: Parenting is a highly valued social role. However, for couples dealing with infertility this role can involve fertility treatments, and for some of them donorassisted reproduction. For couples who use third party reproduction, another concern can emerge: tell the child about the donor conception, or preserve secrecy. Although arguments for decision making have been studied, in Portugal research on this topic is scanty. Objectives: The current study sought out to develop and study the facial validity of Motivations for Disclosing/Not Disclosing Non-genetic Parenthood through Gamete Donation (QMRDG), which is designed to assess motivations that influence the decision-making process of parents who use gamete donation regarding tell or not to tell to his/her son/daughter his/her conception. The existence of differences concerning emotional negative symptoms and parenting sense of competence in three groups (parents that already disclosed, parents that decided not to disclose and parents that did not decide what to do) was also explored. Methods: This exploratory study was conducted in sample of 21 participants who undergone third-party reproduction treatment and became parents. Participants´ age ranged from 30 to 49 years. Participants completed a set of questionnaires through an online platform. The study was advertised by Associação Portuguesa de Fertilidade. Results: Data showed that most parents did not disclose to their child their donor conception due to the fact that the child is still very young, but their intention seems to be to disclose in the future. For parents who have disclosed, core motivations for that decision are based on the lack of reasons for omitting, on the importance of honesty, on the right to know genetic origins and on transparency in the family. Concerning motivations for not disclosing the little importance given to genetics emerges as one of the most important ones. QMRDG revealed good facial validity. The existence of ambiguous or difficult to understand items has not been reported. Discussion: In our study parent’s tendency was to disclose to his/her son/daughter his/her donor conception and this is also the trend reported in recent studies. There are some methodological limitations that should be considered mainly due to the sample size. However, the QMRDG proved to be an instrument showing facial validity, and it can be a useful tool in clinical practice and research with people who are pursuing fertility treatment with gamete donation.

Cancer and fertility preservation: International recommendations from an expert meeting

In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should be addressed by both patients and their treating physicians. In April 2015, physicians with expertise in the field of fertility preservation in cancer patients from several European countries were invited in Genova (Italy) to participate in a workshop on the topic of "cancer and fertility preservation". A total of ten controversial issues were discussed at the conference. Experts were asked to present an up-to-date review of the literature published on these topics and the presentation of own unpublished data was encouraged. On the basis of the data presented, as well as the expertise of the invited speakers, a total of ten recommendations were discussed and prepared with the aim to help physicians in counseling their young patients interested in fertility preservation. Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field. The participation to the ongoing registries and prospective studies is crucial to acquire more robust information in order to provide evidence-based recommendations.

Analysis of the role of the transcription factor C/EBPβ in controlling uterine functions during early pregnancy

Embryo implantation into the endometrium is a complex biological process involving the integration of steroid hormone signaling, endometrial tissue remodeling and maternal- fetal communications. A successful pregnancy is the outcome of the timely integration of these events during the early stages of implantation. The involvement of ovarian steroid hormones, estrogen (E) and progesterone (P), acting through their cognate receptors, is essential for uterine functions during pregnancy. The molecular mechanisms that control the process of implantation are undergoing active exploration. Through our recent efforts, we identified the transcription factor, CCAAT Enhancer Binding Protein Beta (C/EBPb) as a prominent target of estrogen and progesterone signaling in the uterus. The development of a C/EBPb-null mouse model, which is infertile, presented us with an opportunity to analyze the role of this molecule in uterine function. We discovered that C/EBPb functions in two distinct manners: (i) by acting as a mediator of E-induced proliferation of the uterine epithelium and (ii) by controlling uterine stromal cell differentiation, a process known as decidualization, during pregnancy. My studies have delineated important mechanisms by which E regulates C/EBPb expression to induce DNA replication and prevent apoptosis of uterine epithelial cells during E-induced epithelial growth. In subsequent studies, I analyzed the role of C/EBPb in decidualization and uncovered a unique mechanism by which C/EBPb regulates the synthesis of a unique laminin-containing extracellular matrix (ECM) that supports stromal cell differentiation and embryo invasion. In order to better define the role of laminin in implantation, we developed a laminin gamma 1-conditional knockout mouse model. This is currently an area of ongoing investigation. The information gained from our analysis of C/EBPb function in the uterus provides new insights into the mechanisms of steroid hormone action during early pregnancy. Ultimately, our findings may aid in the understanding of dysregulation of hormone-controlled pathways that underlie early pregnancy loss and infertility in women.

Rastreio de Infeções Sexualmente Transmissíveis não víricas nos adolescentes: qual o estado da arte

As infeções sexualmente transmissíveis (IST) constituem um problema persistente de saúde pública, sendo os adolescentes e adultos jovens os que apresentam as taxas de prevalência mais elevadas para algumas IST. As IST não víricas nos países desenvolvidos incluem a Chlamydia Trachomatis, a Neisseria gonorrhoeae, o Treponema pallidume a Trichomonas vaginalis. A deteção precoce das IST não víricas tem impacto positivo a nível individual e na saúde pública: permite instituição atem- pada de tratamento adequado, a redução de transmissão entre parceiros, bem como reduzir as complicações a longo prazo, nomeadamente doença inflamatória pélvica, dor pélvica crónica, gravidez ectópica e infertilidade. Várias sociedades médicas internacionais publicaram recomendações para o rastreio de algumas IST não víricas em de- terminados grupos. Em Portugal, a Direção Geral de Saúde (DGS) atualizou em 2014 a norma sobre a notificação obrigatória de doenças transmissíveis, que inclui a gonorreia, a sífilis e a infeção por Chlamydia Trachomatis. Não obstante, os estudos sobre a epidemiologia de IST são parcos em Portugal e apenas recentemente foi contemplado o rastreio oportunístico de infeção genital por Chlamydia Trachomatis no Plano Nacional de Saúde 2011-2016. O médico de família através da sua abordagem holística centrada na pessoa, no seu contexto familiar e social (focando antecedentes pessoais / comportamentos de risco) tem necessariamente um papel determinante na prevenção primária e no rastreio das IST.

Ochrona prawna zdolności do życia zarodka w ustawie o leczeniu niepłodności z uwzględnieniem dorobku konstytucyjnego

Od wielu lat niepłodność pozostaje przedmiotem dyskusji medycznych, jak i prawnych. Choroba ta jest problemem o szerokim zasięgu społecznym, dotyka bowiem coraz większej liczby osób starających się o potomstwo. Uznanie niepłodności za chorobę a procedurę zapłodnienia pozaustrojowego za jedną z metod jej leczenia ma swoje doniosłe konsekwencje prawne. Z jednej strony mamy do czynienia z konstytucyjną ochroną prawa do ochrony zdrowia niepłodnej pary, ale z drugiej strony jawi się kolejna konstytucyjna wartość wymagająca ochrony – życie mającego się urodzić dziecka. Ustawodawca dostrzegł potrzebę uregulowania metod leczenia niepłodności, czego konsekwencją jest ustawa z dnia 25 czerwca 2015 r. o leczeniu niepłodności. Tematem artykułu jest ocena, na ile i czy w ogóle ustawodawca w przedmiotowej ustawie zapewnia ochronę prawną zdolności do życia zarodka.

Endometrial tuberculosis simulating an ovarian cancer

Female genital tuberculosis remains a major health problem in developing countries and is an important cause of infertility. As symptoms, laboratory data and physical fndings are non-specifc, its diagnosis can be diffcult. We describe a case of a 39-year-old woman suffering from peri-umbilical pain and increased abdominal size for one year, anorexia, asthenia, weight loss, occasionally dysuria and dyspareunia, and four months amenorrhea. Laboratory data revealed cancer antigen 125 (CA-125) level of 132.3 U/mL, erythrocyte sedimentation rate of 42 mm/h, and gamma-globulins of 2.66 g/dL. Computer Tomography scan showed loculated ascites. It was initially suspected a carcinomatous origin, but ascites evaluation was negative for malignant cells. Magnetic Resonance Imaging from another hospital showed endometrial heterogeneity. Therefore, an endometrial biopsy was performed demonstrating an infammatory infltrate with giant cells of type Langhans and bacteriological culture identifed Mycobacterium tuberculosis

Doença, inflamatória pélvica: o que o radiologista precisa saber?

O diagnóstico da doença inflamatória pélvica é clínico, baseando-se numa combinação de sintomas e sinais, que incluem dor pélvica e febre. A referenciação ao médico radiologista ocorre na fase aguda da doença, quando é necessário excluir diagnósticos diferenciais (ginecológicos, gastrointestinais ou urinários) ou em doentes que tiveram um episódio agudo prévio, por vezes assintomático, que recorrem ao médico assistente por complicações, como dor pélvica crónica, gravidez ectópica e infertilidade. Neste contexto, é fundamental que o médico radiologista reconheça as manifestações radiológicas dos diferentes estádios da doença inflamatória pélvica, com especial ênfase para o abcesso tuboovárico, cujas características radiológicas colocam diagnóstico diferencial com carcinoma do ovário.

The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes.

Objective: The aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes. Method: This study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples’ state anxiety scores were re-evaluated after embryo transfer (ET). Results: A significant relationship was found between the depression score of women and pregnancy outcome (p < 0.05). It was determined that anxiety scores for both men and women were higher before the ART procedure, but their anxiety scores decreased after ET (p < 0.05). Spouses of women with a negative pregnancy outcome had higher trait and state anxiety mean scores (p > 0.05) and lower depression scores (p <0.05) than spouses of women with a positive pregnancy outcome. Conclusion: Study results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.

Candidaemia or Candidasis: Controversy of Staphylococcus Sexually Transmitted Infection?

Herbal medications are becoming increasingly popular but a most-extraordinary claim by traditional/herbal medical practitioners relates to a Gram-positive bacterium, Staphylococcus , which has been depicted as a deadly sexually transmitted disease that manifest in the form of worms and other symptoms; with contributory roles including infertility, sexual dysfunction and impotency. They further boasted that they are the only ones that possessed the remedy (herbal) for the Staphylococcus sexually transmitted scourge. In the absence of distinguishing phenotypic taxonomic tools, Staphylococcus and Candida spp. may be confused for each other. However, Staphylococcus is a bacterium and not an infection; therefore, there must be more to the traditional medical practitioners’ boasts in ability to cure an infection that was not an infection in the first place. In conclusion, the common sense is that candiaemia or candidiasis is most likely the misdiagnosed sexually transmitted Staphylococcus disease, which is of significant human clinical health issue.

Infertilidade na síndrome do ovário poliquístico : evidências sobre o tratamento

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Levels of dioxin-like PCBs in low-volume serum samples of male patients attending fertility clinics

An accurate and easy method for the extraction, cleanup, and HRGC-HRMS analysis of dioxin-like PCBs (DL-PCBs) in low-volume serum samples (1 mL) was developed. Serum samples were extracted several times using n-hexane and purified by acid washing. Recovery rates of labeled congeners ranged from 70 to 110 % and the limits of detection were below 1 pg/g on lipid basis. Although human studies are limited and contradictory, several studies have shown that DL-PCBs can have adverse effects on the male reproductive system. In this way, the present method was applied to 21 serum samples of male patients attending fertility clinics. The total levels obtained for the patients ranged from 6.90 to 84.1 pg WHO-TEQ/g lipid, with a mean value of 20.3 pg WHO-TEQ/g lipid. The predominant PCBs (the sum of PCB 118, 156, and 105) contributed 67 % to the mean concentration of total DL-PCBs in the samples analyzed.

Miomatosis uterina: frecuencia y características clínico-ecográficas en el Hospital Vicente Corral Moscoso, periodo 2010-2014

Antecedentes: La miomatosis es la neoplasia benigna más común en ginecología, presentándose en 20-30% en mujeres en edad fértil, es indicación frecuente de histerectomía entre los 35 y 54 años y puede producir infertilidad, coexistir con un embarazo y causar complicaciones en el mismo. Son tumores de fibras musculares lisas y tejido conectivo con manifestaciones clínicas variables dependiendo del tamaño, posición y número, aunque la mayoría son asintomáticos, es un diagnóstico común en ginecología y generan importantes gastos en salud. Objetivo: Determinar la frecuencia y las características clínico-ecográficas de la miomatosis uterina en las pacientes atendidas en el Hospital Vicente Corral Moscoso, periodo 2010- 2014 Metodología: Se realizó un estudio descriptivo, retrospectivo. El universo de estudio estuvo conformado por las historias clínicas de pacientes hospitalizadas en el departamento de ginecología del Hospital Vicente Corral Moscoso, periodo 2010-2014, los datos fueron analizados en la base de datos Excel 2010 y SPSS 20, los resultados fueron presentados en cuadros y gráficos, para las variables cualitativas se utilizó medidas de frecuencia absolutas y relativas; y para las variables cuantitativas medidas de tendencia central y dispersión. Resultados: Se obtuvieron 303 casos, se observó que el mayor número de casos (90.1%) se presentó en mujeres que tenían una edad mayor a 35 años con una media de 43.31 años y DS de 6.96. Los miomas más frecuentes fueron los intramurales (50.8 %); El síntoma de consulta más frecuente fue el sangrado transvaginal (74.6%)

The frequency of follicle stimulating hormone receptor gene polymorphisms in Iranian infertile men with azoospermia

Background: Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. Follicle stimulating hormone (FSH) is a member of the glycoprotein hormone family that plays an important role in human reproduction because of its essential role in normal spermatogenesis. Various Single Nucleotide Polymorphisms (SNPs) have been reported within FSH receptor (FSHR) gene that may affect the receptor function. Objective: The present study aimed to investigate the correlation between two FSHR SNPs at positions A919G, A2039G, and susceptibility to azoospermia in a group of Iranian azoospermic men. The association between FSH levels within the sera and A919G and A2039G alleles and genotypes were also investigated. Materials and Methods: This case control study was performed on 212 men with azoospermia (126 non-obstructive and 86 obstructive) and 200 healthy Iranian men. Two FSHR gene SNPs were genotyped using PCR-RFLP method. The relationship between FSH levels within the sera and A919G and A2039G alleles and genotypes were also investigated. Results: Statistical analysis indicated that at A919G position, AA genotype and A allele were more frequent in obstructive azoospermia cases compared to non- obstructive or normal men (p=0.001). Regarding A2039G polymorphisms, no significant difference was observed between both azoospermia groups and the controls. The mean level of serum FSH was higher in the non-obstructive men compared to the obstructive patients (23.8 versus 13.8, respectively, p= 0.04). Conclusion: The results of the present study indicated that the genetic polymorphisms in the FSHR gene might increase the susceptibility to azoospermia in Iranian men.

The interaction between Sertoli cells and luekemia inhibitory factor on the propagation and differentiation of spermatogonial stem cells in vitro

Background: Sertoli cells play a pivotal role in creating microenvironments essential for spermatogonial stem cells (SSCs) self-renewal and commitment to differentiation. Maintenance of SSCs and or induction of in vitro spermiogenesis may provide a therapeutic strategy to treat male infertility. Objective: This study investigated the role of luekemia inhibitory factor (LIF) on the propagation of SSCs and both functions of Sertoli cells on the proliferation and differentiation of these cells. Materials and Methods: SSCs were sorted from the testes of adult male mice by magnetic activated cell sorting and thymus cell antigen 1 antibody. On the other hand, isolated Sertoli cells were enriched using lectin coated plates. SSCs were cultured on Sertoli cells for 7 days in the absence or presence of LIF. The effects of these conditions were evaluated by microscopy and expression of meiotic and post meiotic transcripts by reverse transcriptase polymerase chain reaction. Results: Our data showed that SSCs co-cultured with Sertoli cells in the presence of LIF formed colonies on top of the Sertoli cells. These colonies had alkaline phosphatesase activity and expressed SSCs specific genes. SSCs were enjoyed limited development after the mere removal of LIF, and exhibiting expression of meiotic and postmeiotic transcript and loss of SSCs specific gene expression (p< 0.05). Conclusion: Our findings represent co-culture of SSCs with Sertoli cells provides conditions that may allow efficient proliferation and differentiation of SSCs for male infertility treatment.

The effects of vitamin D supplementation on maternal and neonatal outcome: A randomized clinical trial

Background: Vitamin D supplementation during pregnancy has been supposed to defend against adverse gestational outcomes. Objective: This randomized clinical trial study was conducted to assess the effects of 50,000 IU of vitamin D every two weeks supplementation on the incidence of gestational diabetes (GDM), gestational hypertension, preeclampsia and preterm labor, vitamin D status at term and neonatal outcomes contrasted with pregnant women that received 400 IU vitamin D daily. Materials and Methods: 500 women with gestational age 12-16 weeks and serum 25 hydroxy vitamin D (25 (OH) D ) less than 30 ng/ml randomly categorized in two groups. Group A received 400 IU vitamin D daily and group B 50,000 IU vitamin D every 2 weeks orally until delivery. Maternal and Neonatal outcomes were assessed in two groups. Results: The incidence of GDM in group B was significantly lower than group A (6.7% versus 13.4%) and odds ratio (95% Confidence interval) was 0.46 (0.24-0.87) (P=0.01). The mean ± SD level of 25 (OH) D at the time of delivery in mothers in group B was significantly higher than A (37.9 ± 19.8 versus 27.2 ± 18.8 ng/ml, respectively) (P=0.001). There were no differences in the incidence of preeclampsia, gestational hypertension, preterm labor, and low birth weight between two groups. The mean level of 25 (OH) D in cord blood of group B was significantly higher than group A (37.9 ± 18 versus 29.7 ± 19ng/ml, respectively). Anthropometric measures between neonates were not significantly different. Conclusion: Our study showed 50,000 IU vitamin D every 2 weeks decreased the incidence of GDM.