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O572 Infertility services: low level of priority in the public health sector in Brazil
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
recurrent fetal loss syndrome in 66%; 96% pts were delivered after 37 weeks. Patients had not recurrence of placental abruption or VTE. Conclusions: Thrombophilia might be the main pathogenetic mechanism of recurrent pregnancy complications. Due to thrombophilia involvement in trophoblast invasion and placentation early treatment is essential. O572 Infertility services: low level of priority in the public health sector in Brazil M. Makuch1 , M. Osis1 , K. Simˆonia de Padua1 , C. Petta2 . 1 Center for Research on Reproductive Health of Campinas, Cemicamp, Campinas, S˜ ao Paulo, Brazil, 2 Department of Obstetrics an Gynecology, Faculty of Medicine, State University of Campinas, Campinas, S˜ ao Paulo, Brazil Objective: To study access of infertile couples and service offered, including assisted reproductive technology (ART) in the public sector in Brazil. Subjects and Methods: A descriptive cross-sectional study conducted with health authorities of the 29 states, Federal District, state capitals, and cities with more than 500.000 inhabitants. Telephone questionnaires were utilized to interview policy makers. Results: Sixty-eight interviews were conducted. Eight (32%) out of the 29 states offer infertility services, the most common reasons for the inexistence of these services were lack of political decision (76%) and of human resources (53%). Sixteen (40%) out of 40 cities offered infertility services, the main reasons for the inexistence of these services were lack of funds (52%), of political decision (43%) and of interest among providers (16%). Four state policy makers referred that ART were available. Two states that offered ART reported a long waiting list. Almost two thirds (64%) of the states responded that there were no plans to implement these services, being the main reason given lack of political decision (69%). Only one municipal policy maker referred providing intrauterine insemination and 84% having no plans to implement infertility or RTA services. In the majority of cases couples were referred to university services that were not free of charge. Conclusions: Our findings showed an inequity in the access to infertility services including RTA for low-income couples and reflect the low political commitment with this kind of attention. Financial Support: Fundac˜ ¸ ao de Amparo a Pesquisa do Estado de S˜ao Paulo – FAPESP O573 Are herbal male contraceptives a better option to control human population P. Mali. University of Rajasthan, Jaipur Objective: Since, unchecked and uncontrolled human population growth pose a serious threatens to sustainable development and mankind existence, fertility regulation has therefore become the major global concern of people of all walks of life. While millions women are motivated to avoid unwanted pregnancy, difficulties in using methods consistently, varying side effects and a wide range of failure rates may create obstacles to contraceptive use. It is estimated that 210 million pregnancies that occur worldwide each year, 40% are of unplanned. Although, several types of contraceptives, includes chemical and mechanical barrier methods, hormonal methods, trans-cervical sterilization and immunocontraceptives, an injection, skin patch, implant, condoms, cervical barrier methods for women, or natural methods are available and has been used to control human population in developed and developing countries. However, hormonal contraceptives are easy to use and have highly effective. But, there are numerous side-effects and health risks involving hormonal contraceptives. Hormonal contraceptives may increase risk of breast cancer and cervical cancer, fatigue and tiredness, headaches, high blood pressure, high cholesterol, insulin resistance, constipation,
vaginal discharge and decreased libido etc, but reduce the risk of uterine or ovarian cancer. Many novel compounds that have antifertility and possible antimicrobial effects are currently being developed and tested. In China and India and other parts of the world, several plants species has been investigated to search an ideal contraceptive agent amongst traditional medicinal plants, since use of plant product caused minimal or no side effects as compared to synthetic agent. Therefore, the traditional medicinal plants viz Citrulus colocynthis, Euphorbia nerriifolia, Martynia annua and Withania somnifera were evaluated to search a safe, easily available, cheap, orally administrable and reversible fertility regulating agent for human male. Materials and Methods: The alcoholic extracts of these plants were prepared according to WHO method and administered orally in fertility proven healthy adult male wistar rats for 60 days at the dose levels of 50,100 mg/kg.b.wt./day. All animals were maintained under controlled conditions and feed with standard rat feed. On 61 day the body weights of all animals were recorded and sacrificed. The weights of vital as well as testes, epididymides and other sex accessory organs weights were recoded after removing the adherent tissue. The sperm motility in cauda epididymis and sperm density in testis as well as cauda epididymis was estimated. The blood was collect and serum was separated for hematological and biochemical analysis to observe if the drug cause any toxic affects on general body metabolism. Testis, epididymides, vas deferens, seminal vesicle and ventral prostate as well as vital organs were processed for biochemical analysis of protein, glycogen, sialic acid, fructose and ascorbic acid contents. The blood was collect and serum was separated. For histopatological examination of the organs, the testes, epididymids, and other sex accessory organs were fixed in Bouin’s fluids, dehydrated in graded alcohol then embedded in paraffin wax. Serial sections of 5 m were made with the help of microtome and stained with Harris hematoxylin and eosin. The study was carried out under the guidance of ethical committee of Department of Zoology, University of Rajasthan, Jaipur. CPCSEA (ICMR, 2006) guidelines were followed for the maintenance and use of the experimental animals. The data were analyzed statistically by using student’s “t” test for the significance. Results: The sperm motility and density were declined high significantly in the extracts treated rats. However, the body weights of the treated rats does not show any significant alteration, the weight of testis, epididymides, seminal vesicle and other accessory reproductive organs were decreased in extracts treated rats. The protein, ascorbic acid, sialic acid and fructose contents were declined significantly in the testes and other accessory reproductive organs of the extracts treated rats. The results of histological examinations of testis of the treated rats reveal degenerative changes in germinal epithelium of testes and gradual reduction of spermatogenic cycle. The drugs treatments reduce the number of spermatogonia, spermatocytes and mature spermatozoa in the semniferous tubules. The presence of spermatogonia in the seminiferous tubules showed reversible efficacy of the extracts. Conclusions: The sperm density, motility and fertility in extracts treated rats were reduced significantly. The decreased contents of proteins, sialic acid and fructose in the testis and sex accessory of the rats indicative of decrease androgenic contents caused degenerative changes in germinal epithelium of seminiferous tubules and fertility reduction. Acknowledgments: Author is thankful to The Head and Coordinator CAS, Department of Zoology, Jaipur for providing laboratory facilities.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
recurrent fetal loss syndrome in 66%; 96% pts were delivered after 37 weeks. Patients had not recurrence of placental abruption or VTE. Conclusions: Thrombophilia might be the main pathogenetic mechanism of recurrent pregnancy complications. Due to thrombophilia involvement in trophoblast invasion and placentation early treatment is essential. O572 Infertility services: low level of priority in the public health sector in Brazil M. Makuch1 , M. Osis1 , K. Simˆonia de Padua1 , C. Petta2 . 1 Center for Research on Reproductive Health of Campinas, Cemicamp, Campinas, S˜ ao Paulo, Brazil, 2 Department of Obstetrics an Gynecology, Faculty of Medicine, State University of Campinas, Campinas, S˜ ao Paulo, Brazil Objective: To study access of infertile couples and service offered, including assisted reproductive technology (ART) in the public sector in Brazil. Subjects and Methods: A descriptive cross-sectional study conducted with health authorities of the 29 states, Federal District, state capitals, and cities with more than 500.000 inhabitants. Telephone questionnaires were utilized to interview policy makers. Results: Sixty-eight interviews were conducted. Eight (32%) out of the 29 states offer infertility services, the most common reasons for the inexistence of these services were lack of political decision (76%) and of human resources (53%). Sixteen (40%) out of 40 cities offered infertility services, the main reasons for the inexistence of these services were lack of funds (52%), of political decision (43%) and of interest among providers (16%). Four state policy makers referred that ART were available. Two states that offered ART reported a long waiting list. Almost two thirds (64%) of the states responded that there were no plans to implement these services, being the main reason given lack of political decision (69%). Only one municipal policy maker referred providing intrauterine insemination and 84% having no plans to implement infertility or RTA services. In the majority of cases couples were referred to university services that were not free of charge. Conclusions: Our findings showed an inequity in the access to infertility services including RTA for low-income couples and reflect the low political commitment with this kind of attention. Financial Support: Fundac˜ ¸ ao de Amparo a Pesquisa do Estado de S˜ao Paulo – FAPESP O573 Are herbal male contraceptives a better option to control human population P. Mali. University of Rajasthan, Jaipur Objective: Since, unchecked and uncontrolled human population growth pose a serious threatens to sustainable development and mankind existence, fertility regulation has therefore become the major global concern of people of all walks of life. While millions women are motivated to avoid unwanted pregnancy, difficulties in using methods consistently, varying side effects and a wide range of failure rates may create obstacles to contraceptive use. It is estimated that 210 million pregnancies that occur worldwide each year, 40% are of unplanned. Although, several types of contraceptives, includes chemical and mechanical barrier methods, hormonal methods, trans-cervical sterilization and immunocontraceptives, an injection, skin patch, implant, condoms, cervical barrier methods for women, or natural methods are available and has been used to control human population in developed and developing countries. However, hormonal contraceptives are easy to use and have highly effective. But, there are numerous side-effects and health risks involving hormonal contraceptives. Hormonal contraceptives may increase risk of breast cancer and cervical cancer, fatigue and tiredness, headaches, high blood pressure, high cholesterol, insulin resistance, constipation,
vaginal discharge and decreased libido etc, but reduce the risk of uterine or ovarian cancer. Many novel compounds that have antifertility and possible antimicrobial effects are currently being developed and tested. In China and India and other parts of the world, several plants species has been investigated to search an ideal contraceptive agent amongst traditional medicinal plants, since use of plant product caused minimal or no side effects as compared to synthetic agent. Therefore, the traditional medicinal plants viz Citrulus colocynthis, Euphorbia nerriifolia, Martynia annua and Withania somnifera were evaluated to search a safe, easily available, cheap, orally administrable and reversible fertility regulating agent for human male. Materials and Methods: The alcoholic extracts of these plants were prepared according to WHO method and administered orally in fertility proven healthy adult male wistar rats for 60 days at the dose levels of 50,100 mg/kg.b.wt./day. All animals were maintained under controlled conditions and feed with standard rat feed. On 61 day the body weights of all animals were recorded and sacrificed. The weights of vital as well as testes, epididymides and other sex accessory organs weights were recoded after removing the adherent tissue. The sperm motility in cauda epididymis and sperm density in testis as well as cauda epididymis was estimated. The blood was collect and serum was separated for hematological and biochemical analysis to observe if the drug cause any toxic affects on general body metabolism. Testis, epididymides, vas deferens, seminal vesicle and ventral prostate as well as vital organs were processed for biochemical analysis of protein, glycogen, sialic acid, fructose and ascorbic acid contents. The blood was collect and serum was separated. For histopatological examination of the organs, the testes, epididymids, and other sex accessory organs were fixed in Bouin’s fluids, dehydrated in graded alcohol then embedded in paraffin wax. Serial sections of 5 m were made with the help of microtome and stained with Harris hematoxylin and eosin. The study was carried out under the guidance of ethical committee of Department of Zoology, University of Rajasthan, Jaipur. CPCSEA (ICMR, 2006) guidelines were followed for the maintenance and use of the experimental animals. The data were analyzed statistically by using student’s “t” test for the significance. Results: The sperm motility and density were declined high significantly in the extracts treated rats. However, the body weights of the treated rats does not show any significant alteration, the weight of testis, epididymides, seminal vesicle and other accessory reproductive organs were decreased in extracts treated rats. The protein, ascorbic acid, sialic acid and fructose contents were declined significantly in the testes and other accessory reproductive organs of the extracts treated rats. The results of histological examinations of testis of the treated rats reveal degenerative changes in germinal epithelium of testes and gradual reduction of spermatogenic cycle. The drugs treatments reduce the number of spermatogonia, spermatocytes and mature spermatozoa in the semniferous tubules. The presence of spermatogonia in the seminiferous tubules showed reversible efficacy of the extracts. Conclusions: The sperm density, motility and fertility in extracts treated rats were reduced significantly. The decreased contents of proteins, sialic acid and fructose in the testis and sex accessory of the rats indicative of decrease androgenic contents caused degenerative changes in germinal epithelium of seminiferous tubules and fertility reduction. Acknowledgments: Author is thankful to The Head and Coordinator CAS, Department of Zoology, Jaipur for providing laboratory facilities.