Antioxidant therapy for the infertile male
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Transcript of Antioxidant therapy for the infertile male
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Te r a p i a a n t i o x i d a n t e p a r a h o m e m c o m i n f e r t i l i d a d e ?
S I M !G u i l h e r m e L e m e
Especialista em Cirurgia Geral e Urologia/Andrologia – HC-FMUSPEspecialista em Reprodução Assistida – Setor Integrado de Reprodução Humana – EPM-UNIFESP
Membro Titular da Sociedade Brasileira de Urologia [TiSBU]Médico Andrologista – Engravida Reprodução Humana
Médico Urologista – Clínica Vivere Sanus – Saúde Masculina Integral
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1 5 % c a s a i s = i n f é r t e i s p a r t i c i p a ç ã o m a s c u l i n a 5 0 % 1 / 2 0 h o m e n s
3 0 - 8 0 % s u b f e r t i l i d a d e m a s c u l i n a = s t re s s ox i d a t i v o
N ã o é s u p l e m e n t e ç ã o v i t a m í n i c a
C o n t ro l e q u í m i c o d o s t re s s ox i d a t i v o
Te r a p i a a n t i o x i d a n t e D e fi n i ç õ e s e e s t a t í s t i c a s p a r a o u r o l o g i s t a
Tournaye, 2006Attia, 2007Tremellen, 2008
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ROSPlasma
antioxidants
Aitken, 2004Coccuza, 2007
Te r a p i a a n t i o x i d a n t e C o n c e i t o s
S t r e s s o x i d a ti v o = R O S > d e f e s a s a n ti o x i d a n t e s▫ S e l e n i o v i t E▫ v i t C f o l a t o▫ z i n c o c a r n i ti n a s
g r a n d e # S P Z e s p é c i e h u m a n a m e c a n i s m o e v o l u t i v o
re l a ç ã o R O S X a n t i ox i d a n t e s
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Dano à cromatina Dano à membrana
Menor fertilizaçãoMais abortamento
MotilidadePenetração oocito
Agarwal, 2003Shiva , 2011
Te r a p i a a n t i o x i d a n t e C o n c e i t o s
R a c i o n a l b i o l ó g i c o t e r a p i a s i s t ê m i c a ↑ d e f e s a s a n ti o x i d a n t e s b a l a n c e a r a r e l a ç ã o r e d u z i r s t r e s s o x i d a ti v o
a t u a ç ã o c a u s a d o ↑ R O S a t u a ç ã o u ro l ó g i c a
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Agarwal & Sekhon, 2010
↓ R O S
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Cochrane Reviews, 2014
melhora SPG + gravidez + nascidos vivos
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Forest plot of comparison: 1 Antioxidant(s) versus placebo or no treatment, outcome: 1.1 Live birth; type of antioxidant.
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Forest plot of comparison: 1 Antioxidant(s) versus placebo or no treatment, outcome: 1.3 Clinical pregnancy; type of antioxidant.
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Forest plot of comparison: 1 Antioxidant(s) versus placebo or no treatment, outcome: 1.6 Sperm DNA fragmentation; type of antioxidant.
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Antioxidant(s) versus placebo or no treatment, outcome: 1.7 Total sperm motility
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Antioxidant(s) versus placebo or no treatment, outcome: 1.13 Sperm concentration
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Antioxidant(s) versus placebo or no treatment, outcome: 1.5 Adverse events.
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L-carnitina: 2-6g [3] L-Acetyl carnitina: 1g Vitamina E: 300-800mg [400] Selênio: 100-225µg [200] Ac. Fólico 5mg Vitamina C: 1000-2000mg [1000] Zinco (sulfato): 66-500mg [66]
N-Acetil-Cisteína: 600mg Coenzima Q10: 60-400mg [60] Cochrane Reviews, 2014
C o m o p r e s c r e v e r ?
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L-carnitina: 2-6g [3] L-Acetyl carnitina: 1g Vitamina E: 300-800mg [400] Selênio: 100-225µg [200] Ac. Fólico 5mg Vitamina C: 1000-2000mg [1000] Zinco (sulfato): 66-500mg [66]
N-Acetil-Cisteína: 600mg Coenzima Q10: 60-400mg [60]
D e v o u t i l i z a r p o l i v i t a m í n i c o s ?
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L-carnitina: 2-6g [3] L-Acetyl carnitina: 1g Vitamina E: 300-800mg [400] Selênio: 100-225µg [200] Ac. Fólico 5mg Vitamina C: 1000-2000mg [1000] Zinco (sulfato): 66-500mg [66]
N-Acetil-Cisteína: 600mg Coenzima Q10: 60-400mg [60]
D e v o u t i l i z a r p o l i v i t a m í n i c o s ?
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L-carnitina: 2-6g [3] L-Acetyl carnitina: 1g Vitamina E: 300-800mg [400] Selênio: 100-225µg [200] Ac. Fólico 5mg Vitamina C: 1000-2000mg [1000] Zinco (sulfato): 66-500mg [66]
N-Acetil-Cisteína: 600mg Coenzima Q10: 60-400mg [60]
NÃO
D e v o u t i l i z a r p o l i v i t a m í n i c o s ?
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B a i xo c u s t o E v i d ê n c i a s a f a v o r Ra c i o n a l b i o l ó g i c o
S e m e v i d ê n c i a s - m a l e f í c i o s Pa r t e d e u m c o n j u n t o t e r a p ê u t i c o
A n ti o x i d a ç ã o ≠ v i t a m i n a s P o l i v i t a m í n i c o s c o m e r c i a i s n ã o s ã o u m a o p ç ã o M a n i p u l a ç ã o c o n f o rm e e v i d ê n c i a s – p ro d u t o s i n t e rn a c i o n a i s ?
“ Ta k e - h o m e ”T e r a p i a A n t i o x i d a n t e ? ? - - - - S I M !
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[OBRIGADO]