Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil.
Surgery Department, Medical School - Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil.
JBRA Assist Reprod. 2020 Oct 6;24(4):480-491. doi: 10.5935/1518-0557.20200007.
Approximately 50% of the causes of infertility are of genetic origin. The objective of this study was to analyze the role of genetics in human reproduction by reviewing the main genetic causes of infertility and the use of preimplantation genetic testing in Brazil. This literature review comprised articles in English and Portuguese published on databases PubMed, Scielo, and Bireme from 1990 to 2019. Randomized clinical trials and specialized guidelines were given preference whenever possible. Genetic cause can be traced back to up to 20% of the cases of severe azoospermia or oligozoospermia. Subjects with these conditions are good candidates for genetic screening. In women, genetic causes of infertility (fragile X syndrome, X-trisomy, and Turner's syndrome, some of which diagnosed with karyotyping) culminate with premature ovarian failure. Genetic screening helps advise couples of the risk of experiencing early reproductive capacity loss and of the chances of their offspring carrying genetic disorders. In addition to enhancing the prevention of serious diseases in the offspring of couples at increased risk of genetic diseases, preimplantation genetic screening improves the success rates of assisted reproduction procedures by allowing the selection of euploid embryos for transfer. The interface between genetics and human reproduction has gained significant relevance, but discussions are still needed on which procedures are clinically and ethically acceptable and how they should be regulated.
约 50%的不孕原因具有遗传因素。本研究旨在通过回顾不孕的主要遗传原因和巴西应用胚胎植入前遗传学检测(PGT)的情况,分析遗传因素在人类生殖中的作用。本文献复习纳入了 1990 年至 2019 年发表在 PubMed、SciELO 和 Bireme 数据库的英文和葡萄牙文文献。只要可能,我们更倾向于选择随机临床试验和专业指南。遗传原因可追溯至高达 20%的严重少精症或弱精症病例。这些情况下的患者是遗传筛查的合适人选。在女性中,不孕的遗传原因(脆性 X 综合征、X 三体和特纳综合征,其中一些通过核型分析诊断)最终导致卵巢早衰。遗传筛查有助于告知夫妇早期生殖能力丧失的风险以及其后代携带遗传疾病的可能性。除了提高对遗传疾病高风险夫妇后代严重疾病的预防外,胚胎植入前遗传学筛查还通过选择可用于转移的整倍体胚胎来提高辅助生殖程序的成功率。遗传学与人类生殖之间的联系已变得非常重要,但仍需要讨论哪些程序在临床和伦理上是可接受的,以及应如何对其进行监管。