MALE FERTILITY: MARKET IN LATIN AMERICA AND DEVELOPMENT OF SYSTEMS FOR DETECTING PATHOGENS IN HUMAN SEMEN
Fertility trade. Male infertility. Assisted reproductive technologies. Multiplex PCR. Seminal quality.
According to the World Health Organization (WHO), infertility is a disease of the reproductive system that results in limited fertility in men and women. On a global scale, more than 186 million individuals face infertility challenges, with the majority of them residing in developing countries. This has driven the growth of the infertility treatment industry, including the male fertility market, since around 15% of men of reproductive age face infertility problems. However, diagnosing infertility in men still faces challenges, with semen infections being one of the potential causes. Recent studies have shown that different microorganisms, such as viruses and bacteria, can impact on semen quality, causing damage to organs and cells through inflammatory mediators. In this context, this dissertation aimed to characterize the main topics related to the fertility and assisted reproduction market in Latin America and Brazil, to emphasize the growth of the male fertility market and the challenges faced in diagnosing infertility in men, as well as to develop systems for detecting the main pathogens that infect semen. Three studies were conducted to achieve these objectives: two literature reviews to describe the markets and the last study developed primers and validated in silico three multiplex PCR panels for the detection of the main seminal pathogens of clinical importance already described. The main conclusions of the studies include: 1) Fertility services could earn up to $31.59 billion by 2029 and the use of assisted reproductive technologies (ART) has become a thriving commercial business within fertility services. It was noted that the fertility market has seen significant growth in both Brazil and Latin America. Specifically in Brazil, there has been growth over the last few years, with approximately 40% of assisted reproduction clinics in Latin America and revenues of around R$1.3 billion. It is estimated that between 2021 and 2025, around 77,588 patients up to the age of 35 will be treated via ART in the country. At the same time, both public policies and private sector initiatives aimed at fertility are increasing, underlining the importance of fertility in people's lives (Chapter I). 2) The male fertility market has also shown significant growth as the fertility and assisted reproduction market expands. According to market reports, global trade related to male fertility is estimated to be worth billions of dollars and is expected to reach more than $6 billion by 2027 (Chapter II). 3) Based on the data collected, three panels were developed in silico that focus on seminal quality, covering HPV-16, HPV18, HBV, HHV-5, HSV-1, HSV-2, HIV-1, HIV-2, ZIKV, HCV, Treponema pallidum, Neisseria gonorrhoeae and Chlamydia trachomatis. The implementation of these panels represents a significant advance in seminal quality control, providing more accurate diagnoses for semen banks and guidance for couples facing infertility. The proposed assay promises to meet the needs of the male fertility market, as well as simplifying workflow, allowing it to be used in routine diagnostic laboratories with basic molecular facilities (Chapter III). Overall, all the information gathered in this dissertation contributes to new areas of research in the areas of the market, improving techniques and diagnosing conditions related to male infertility and global reproductive health.