Socioeconomic profile of couples seeking the public healthcare system (SUS) for infertility treatment

Protective Relational Factors of Lesbian Couples Navigating the Fertility Process

Little research about lesbian couples' experiences with fertility treatment exists in the counseling literature. While there is an increase in lesbian couples exploring fertility options to expand their families, it is important to understand their experiences during this stressful process. This research seeks to understand these experiences using Moustakas' Imaginative Variation method with seven lesbian couples. Results include feelings of isolation, psychological and physical stress. Despite myriad difficulties associated with assisted reproductive technology, participants' experiences show the presence of strong relationship factors, divided into three categories: connectedness, mutuality, and resilience. The use of Relational Cultural Theory may be helpful to lesbian couples looking to expand their families through reproductive methods.

Fertility Does not Quarantine: Coronavirus Disease 2019 Pandemic Impacts on in Vitro Fertilization Clinical Pregnancy Rates

OBJECTIVE

 To understand the impact of the coronavirus disease 2019 pandemic on in vitro fertilization (IVF) clinical pregnancy rates and analyze factors that may have influenced their outcome.

METHODS

 This was a retrospective observational study conducted at a tertiary-care Brazilian fertility center. All fresh IVF and embryo warming cycles performed from March 11 to December 31, 2018-2021 were analyzed, and their data were used to calculate fertilization, embryo cleavage, cycle cancellation, embryo transfer (ET), and clinical pregnancy rates. Statistical tests were used to evaluate the alterations found. Logistic regression models were used to explore the association of the categorical variables with the observed clinical pregnancy rates. Data from 2018 and 2019 (prepandemic) and 2020 and 2021 (pandemic) were grouped.

RESULTS

 A total of 756 cycles were analyzed (n = 360 prepandemic and n = 396 pandemic). The age group of the patients, fertilization rates, and cleavage rates did not have significant differences (p > 0.05). There was a reduction in the percentage of fresh IVF and an increase in embryo warming cycles (p = 0.005) during the pandemic. There was also an increase in fresh cycle cancellations (p < 0.001) and a reduction in ET rates (p < 0.001). The pandemic had a negative impact on clinical pregnancy rates (p < 0.001) especially due to the increase in fresh cycle cancellations (p < 0.001).

CONCLUSION

 Embryo warming cycles with subsequent frozen-thawed ET were presented as a viable alternative to continue assisted reproductive treatments against pandemic restrictions on fresh cycles, ensuring clinical pregnancy, albeit at a lower rate than that of the prepandemic period.

Echinacoside Protects Against Dysfunction of Spermatogenesis Through the MAPK Signaling Pathway

Dysfunction at various levels of spermatogenesis (SD) is one of the important causes of infertility in men of reproductive age and requires advanced treatment strategies. Increasing evidence suggests that the therapeutic effects of echinacoside (ECH) mainly depend on their capacity to inhibit cell death. This study aimed to explore the therapeutic potential of ECH in SD rat models. Treatment with ECH reverted the morphological changes observed in testes with spermatogenesis dysfunction. It improved total sperm number, decreased the sperm deformity rate, and increased the sperm forward motility rate. The level of glutathione (GSH) was significantly higher in ECH-treated mice, whereas the lactate dehydrogenase (LDH) and SOD activities were improved compared with those in the spermatogenesis dysfunction model. Moreover, the increased expression of p38 and JNK was partially reversed by ECH. The number of normal TM3 cells increased gradually in an Echinacea dosage-dependent manner, suggesting that ECH promoted the proliferation of TM3 cells. In addition, treatment with ECH partially reversed the increased expression of p38 and JNK in TM3 cells. ECH protects against oxidative stress damage by activating antioxidant enzymes and MAPK signaling-related factors (p38 and JNK). It suggested that treatment with ECH alleviated spermatogenetic dysfunction of testes in male mice and it could be a promising strategy for patients suffering severe SD.

Assisted Reproductive Technologies in Brazil: characterization of centers and profiles from patients treated

OBJECTIVE

The aim of this study was to analyze the application of assisted reproductive technologies (ART) in Brazil from the active clinics and the population served considering the changes in the last resolutions of the Federal Council of Medicine (CFM), which enabled the use of the techniques for anyone, regardless of their health insurance system, gender or marital status.

METHODS

This paper was based on the analysis from the "Reproductive Technologies and (in) fertility study: regulation, market and rights". We used quantitative and qualitative methodologies. In this paper, we used the empirical data produced in the quantitative study. The quantitative online survey was carried out in 2016-2018, answered by 81 fertility clinics in Brazil about their performance in 2015-2016. We opted to use the REDCap Program, a web-based application for the construction and management of online surveys and databases. The questionnaire addressed the characteristics of services, practices performed, population served and existing forms of funding.

RESULTS

The questionnaires returned corresponded to 63.1% of the clinics in the southeast region. ART is mainly offered by 90.1% private clinics. We report that 63.8% of establishments have up to 20 employees; 44.5% have been in operation between 11 and 20 years. 85.1% of the clinics reported having treated non-Brazilian residents.

CONCLUSIONS

There has been a significant increase in the provision of ART in Brazil. Access remains thoroughly dependent on its own financial resources. The new CFM resolutions have shifted from the prevailing concept of "health care" to "assisting with new family configurations".

Twin Peaks: A spatial and temporal study of twinning rates in Brazil

Twin births are an important public health issue due to health complications for both mother and children. While it is known that contemporary factors have drastically changed the epidemiology of twins in certain developed countries, in Brazil, relevant data are still scarce. Thus, we carried out a population-based study of live births in spatial and temporal dimensions using data from Brazil's Live Birth Information System, which covers the entire country. Over 41 million births registered between 2001 and 2014 were classified as singleton, twin or multiple. Twinning rates (TR) averaged 9.41 per 1,000 for the study period and a first-order autoregressive model of time-series analysis revealed a global upward trend over time; however, there were important regional differences. In fact, a Cluster and Outlier Analysis (Anselin Local Moran's I) was performed and identified clusters of high TR in an area stretching from the south of Brazil's Northeast Region to the South Region (Global Moran Index = 0.062, P < 0.001). Spearman's correlation coefficient and a Wilcoxon matched pairs test revealed a positive association between Human Development Index (HDI) and TRs in different scenarios, suggesting that the HDI might be an important indicator of childbearing age and assisted reproduction techniques in Brazil. Furthermore, there was a sharp increase of 26.42% in TR in women aged 45 and over during study period. The upward temporal trend in TRs is in line with recent observations from other countries, while the spatial analysis has revealed two very different realities within the same country. Our approach to TR using HDI as a proxy for underlying socioeconomic changes can be applied to other developing countries with regional inequalities resembling those found in Brazil.