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  • Original Article

    Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

    Rev Bras Ginecol Obstet. 2024;46:e-rbgo33

    Summary

    Original Article

    Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

    Rev Bras Ginecol Obstet. 2024;46:e-rbgo33

    DOI 10.61622/rbgo/2024rbgo33

    Views189

    Abstract

    Objective:

    Evaluate histological changes in testicular parameters after hormone treatment in transgender women.

    Methods:

    Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors).

    Results:

    Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence.

    Conclusion:

    Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

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  • Original Article

    Ovarian Tissue Culture to Preserve Fertility in Transgender Male Patients after Hormonal Treatment

    Rev Bras Ginecol Obstet. 2022;44(3):251-257

    Summary

    Original Article

    Ovarian Tissue Culture to Preserve Fertility in Transgender Male Patients after Hormonal Treatment

    Rev Bras Ginecol Obstet. 2022;44(3):251-257

    DOI 10.1055/s-0042-1742410

    Views1

    Abstract

    Objective

    To evaluate the reproductive and histological characteristics of fresh cultured ovarian tissue from transgender male patients.

    Methods

    An in vitro pilot study in which samples were collected during sex reassignment surgery for transgender male patients. The ovarian cortex was cut into fragments of 2 mm, 3mm, and 4 mm, and placed in a 96-well plate suitable for cultivation at days 0, 2, 4, 6, and 8, when the histology was analyzed.

    Results

    Stromal hyperplasia was observed in all samples, and it was not associated with the obtainment of primordial or primary follicles. Peripheral reduction in cell count was also a recurrent finding. Primordial and primary follicles were identified with a heterogeneous pattern in fragments from the same patient and from different patients, and follicles in more advanced stages of development (secondary and antral) were not found. There was an association between the diameter of the ovarian fragments and the identification of primary follicles (p=0.036). The number of days in culture was associated with histological signs of tissue damaging in the fragments (p=0.002). The total number of follicles identified in the samples with 2mm in diameter was significantly lower than in those that measured 4mm in diameter (p=0.031).

    Conclusion

    A diameter of 4mm is suitable for ovarian tissue culture with the benefit of ease of handling. Even after prolonged exposure to testosterone, the ovarian fragments presented primordial and primary follicles, maintaining viability throughout the days they were exposed to the culture. Freezing the ovarian cortex of transgender patients who will undergo surgery for gender reassignment would be an interesting option, in the future, for the preservation of fertility.

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    Ovarian Tissue Culture to Preserve Fertility in Transgender Male Patients after Hormonal Treatment
  • Original Article

    Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes?

    Rev Bras Ginecol Obstet. 2018;40(6):332-337

    Summary

    Original Article

    Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes?

    Rev Bras Ginecol Obstet. 2018;40(6):332-337

    DOI 10.1055/s-0038-1656718

    Views3

    Abstract

    Objective

    To determine which mode and potency of electrocoagulation, using a modern electrosurgical generator, yields the smallest unobstructed area of the Fallopian tubes.

    Methods

    In an experimental study, tubes from 48 hysterectomies or tubal ligation were evaluated. Tubes were randomly allocated to one of the following groups: group A) 25 W x 5 seconds (n = 17); group B) 30 W x 5 seconds (n = 17); group C) 35 W x 5 seconds (n = 18), group D) 40 W x 5 seconds (n = 20); group E) 40 W x 5 seconds with visual inspection (blanch, swells, collapse) (n = 16); group F) 50 W x 5 seconds (n = 8). Bipolar electrocoagulation was performed in groups A to E, and monopolar electrocoagulation was performed in group F. Coagulation mode was used in all groups. Digital photomicrography of the transversal histological sections of the isthmic segment of the Fallopian tube were taken, and themedian percentage of unobstructed luminal area (mm2) was measured with ImageJ software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The Kruskal-Wallis test or analysis of variance (ANOVA) was used for statistical analysis.

    Results

    Ninety-six Fallopian tube sections were analyzed. The smallest median occluded area (%; range) of the Fallopian tube was obtained in the group with 40 W with visual inspection (8.3%; 0.9-40%), followed by the groups 25 W (9.1%; 0-35.9%), 40 W (14.2; 0.9-43.2%), 30 W (14.2; 0.9-49.7%), 35 W (15.1; 3-46.4%) and 50 W (38.2; 3.1-51%). No statistically significant difference was found among groups (p = 0.09, Kruskal-Wallis test).

    Conclusion

    The smallest unobstructed area was obtained with power setting at 40 W with visual inspection using a modern electrosurgical generator. However, no statistically significant difference in the unobstructed area was observed among the groups using these different modes and potencies.

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    Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes?

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