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Evaluation of male sexual parameters in infertile couples with a history of abortion
Evaluación de parámetros sexuales masculinos en parejas infértiles con historia de aborto
Mehmet Caniklioglua,
Corresponding author
dr.mehmetcaniklioglu@gmail.com

Corresponding author.
, Fatih Firatb, Ünal Oztekina, Sercan Saria, Volkan Selmia, Levent Işikaya
a Yozgat Bozok University, Faculty of Medicine, Department of Urology, Yozgat, Turkey
b Tokat State Hospital, Department of Urology, Tokat, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Infertility is the inability to achieve pregnancy after a year of regular and unprotected sexual intercourse&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> Insemination can be provided in these couples via assisted reproductive techniques &#40;ART&#41;&#46; The ratio of having baby with ART were given as 17&#8211;24&#37; in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">2&#44;3</span></a> However&#44; some of the couples under treatment experience a spontaneous abortion&#46; In general&#44; recurrent spontaneous abortion &#40;RSA&#41; rate is accepted as 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> However&#44; it is reported that if there was an abortion history&#44; the rate of developing RSA would be given as higher than 25&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The couples that experienced abortion&#44; are thought to be affected regarding physiologic and sexual status&#46; It could be said that especially the woman who has a limited time for having a baby and who lives all the process within her body&#44; might have been affected from abortion much more than the man&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a> On the other hand&#44; the man might be affected deeply in male factor infertility&#46; A study shows that male factor infertility is one of the characteristics of patients with recurrent implantation failure&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> In this case&#44; this situation might be disruptive for the man and affects his psychological status&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sexual dysfunction and impaired libido are likely to be related with anxiety and depressive disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> It is also likely to be affected the sexual life of the couples who have been having psychologically hard times caused by abortion and curettage&#59; besides&#44; the stress of infertility itself&#46; The increased desire for having a baby and the anxiety of being infertile may cause an increase in anxiety status and health anxiety status as well as an amplification in perceiving somatic and visceral sensations&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> In addition&#44; psychogenic symptoms accompanied by sexual dysfunction may advance when the time for having a baby delayed because of abortion and RSA processes&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this study we aimed to evaluate the male sexual functions in infertile couples who had experienced abortion and&#47;or curettage once or more than once&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Seven hundred and ninety-three infertile men who were admitted to our clinic between November 2017 and April 2020&#44; were included into the study&#46; Patients under 18-year-old&#44; patients with psychiatric disorders&#44; patients who have chronic disease and drug usage&#44; cancer history were excluded from the study&#46; The data of the rest 547 patients were evaluated retrospectively&#46; Demographic data&#44; history of abortion and&#47;or curettage&#44; libido&#44; morning erections and intercourse frequency were analyzed&#46; Libido&#44; morning erections and intercourse frequency were the subjective parameters which acquired from our routine questionary form from infertility &#38; andrology outpatient clinic&#46; The patients who reported coitus activity less than once a week were evaluated as impaired intercourse frequency&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> According to the abortion or curettage history&#44; the patients were divided into two groups&#58; Group 1 consisted of the males of the couples who had not experienced abortion&#47;curettage and group 2 was consisted of the males of the couples that had experienced abortion&#47;curettage once or more than once&#46; Follicular stimulating hormone &#40;FSH&#41;&#44; luteinizing hormone &#40;LH&#41; and total testosterone &#40;TT&#41; were analyzed as hormonal parameters&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The data of 176 patients who had filled &#8220;International Index of Erectile Function&#8221; &#40;IIEF&#41;&#44; Beck anxiety and Beck depression questionnaires were evaluated separately&#46; The data from group 1 was allocated as sub-group 1 and from group 2 was called sub-group 2&#46; IIEF questionnaires were evaluated in terms of erectile functions&#44; intercourse satisfaction&#44; orgasmic functions&#44; sexual desire and overall satisfaction&#46; The sum of the scores of the first 5 questions and 15th question was calculated and used to evaluate the erectile function&#46; The total score varies from 0 to 30&#46; The lower the total score&#44; the higher the severity of the individual&#39;s erectile dysfunction&#46; According to the chart&#44; the scores were evaluated as following&#58; 0&#8211;10 severe&#44; 11&#8211;16 moderate&#44; 17&#8211;21 mild to moderate&#44; 22&#8211;25 mild and 26&#8211;30 no ED&#46; Sexual desire scores was collected as the sum of question 11 and 12&#46; The sum of 6th to 8th questions for intercourse satisfaction&#44; 9th and 10th for orgasmic functions&#44; 11th and 12th for sexual desire and 13th and 14th for overall satisfaction were taken into consideration&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Beck anxiety inventory &#40;BAI&#41; is a reliable tool to assess the anxiety level of a patient&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> It consists of 21 questions with up to 3 points for each&#46; Beck depression inventory &#40;BDI&#41; is the tool for assessing depression level of the patients&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> The number of questions and scoring were the same as BAI&#46; It also has a particular scale to categorize depression levels of patients&#46; We used these tools to investigate the anxiety and depression symptoms of the patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All statistical analyses were performed with SPSS Statistics for Windows&#44; v25&#46;0 &#40;IBM Corp&#46; Released 2017&#46; Armonk&#44; NY&#41;&#46; Kolmogorov&#8211;Smirnov and Shapiro&#8211;Wilk&#39;s tests were used for estimating the distributions of the groups&#46; Categorical data were analyzed using 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2 Chi-square test between the groups&#46; Numerical data were compared using Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test between the groups&#46; Linear regression analysis was performed to reveal whether there was relationship between abortion history and the parameters such as IIEF and psychiatric scale scores &#40;BAI&#44; BDI&#41;&#46; The significance level was accepted as <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Demographic data and laboratory result of the two groups were summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Four hundred and fifty-three &#40;82&#46;8&#37;&#41; of couples did not have an abortion history and the rest 94 &#40;17&#46;2&#37;&#41; have abortion and&#47;or curettage history&#46; According to the results the two groups did not differ in terms of BMI&#44; intercourse frequency&#44; morning erections&#44; libido&#44; FSH&#44; LH and TT levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; However&#44; there were significant differences both in marriage time and age &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Abortion history rate was 14&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; among the patients whose IIEF and Beck queries were obtained&#46; Erectile function scores were 26&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;57 in sub-group 1 and 26&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;45 in sub-group 2 and the results were similar statistically &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Intercourse satisfaction scores were 12&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;24 in sub-group 1 and 11&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;16 in sub-group 2 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Orgasmic functions showed significant decrease in sub-group 2 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;036&#41;&#46; The scores were 9&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;52 in sub-group 1 and 8&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;83 in sub-group 2&#46; Sexual desire scores were 7&#46;68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;50 and 7&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;49 in sub-group 1 and 2&#44; respectively&#46; There was a significant difference between the two sub-groups and it was lower in sub-group 2 than sub-group 1 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; Overall satisfaction scores also lower in sub-group 2 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41;&#46; The scores were 8&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;69 and 8&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;17 in sub-group 1 and 2&#44; respectively&#46; BAI scores of the sub-groups were 13&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;73 and 14&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;75&#44; respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; BDI scores were also similar in both of the sub-groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and 12&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;34 in sub-group 1 and 14&#46;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;08 in sub-group 2&#46; All the data about IIEF and Beck queries were summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Linear regression analysis results were given in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Abortion history did not have any relationships with psychiatric scale scores and IIEF scores except orgasmic functions in men &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Orgasmic functions have a significant indirect relationship with abortion history &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; According to this finding&#44; orgasmic functions impaired when abortion history existed&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Infertility is an important health problem which causes sociopsychological stress&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> It is responsible for a severe stress both in man and women without considering the disease originates from which of them&#46; According to Simon et al&#46; the diseases with uncertain etiology and which have prolonged treatment process&#44; like in infertility&#44; may increase depression and anxiety levels in patients&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a> It could be thought that the stress in question is more prominent in woman who lives all the process within her body&#46; However&#44; man&#39;s stress might be as bad as in woman especially in male infertility cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Abortion and curettage processes are also other stressor factors especially affecting female partner&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> Herrero et al&#46; went one step further and they described the psychological status of woman after abortion as a syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> Jacop et al&#46; gave the rate of depression and other psychological disorder 8&#46;9&#37; one year after abortion&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> In another study&#44; Jacop et al&#46; determined that infertile patients who had experienced induced or spontaneous abortion show direct correlation with the psychiatric disorders ranges from 1&#46;4&#37; to 45&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> It is thought that this psychological stress should be transient&#46; However&#44; there are several studies that reported the psychological effects of abortion last for many years&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The relationship between sexual dysfunction in woman and the psychological disorders such as anxiety and depression is a known fact&#46; McCool-Myers et al&#46; reported abortion was a consistently risk factor of sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> The same relationship exists in man&#46; Rajkumar et al&#46; indicated that anxiety and depression affected sexual desire and erectile functions in man&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> Thase et al&#46; found that the nocturnal erections impaired after depression and they indicated to the relationship between depression and sexual functions&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Another point that should not overlooked is the existence of a sexual interaction between the partners&#46; &#199;ayan et al&#46; showed that female partners of the men with ED&#44; suffer from several sexual disorders and these could be treated by the treatment that given to the men for ED&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a> On the other hand&#44; Muin et al&#46; showed that female sexual treatment with oxytocin or placebo significantly improved the sexual quality of the male partner&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In the light of these data&#44; it seems impossible to think of the sexual life of male partner does not affected from abortion or curettage processes&#46; As it is mentioned above&#44; female partner affected from these interventions seriously&#46; Besides&#44; the stress of infertility itself&#44; male should be affected for being a witness for a female partner who is suffering&#46; Although there have been studies evaluating the relationship between infertility and male sexual functions&#44; there have not been a comprehensive study about this issue&#46; Therefore&#44; this study is a unique study focusing on male sexual functions after abortion or curettage&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">According to the result of this study&#44; male partner of the couples with abortion history have significant decreases in orgasmic function&#44; sexual desire and overall satisfaction&#46; However&#44; linear regression analyses showed that male partner did not affected from this process&#46; In parallel with this data&#44; the differences in these parameters except orgasmic functions cannot be the cause for the decreases in both sexual desire and overall satisfaction&#46; Also&#44; male partner do not have any decrease in libido and morning erections&#46; And coitus frequency of the couples were not different from each other between the two sub-groups&#46; Orgasmic functions may have relationship with abortion history&#46; However&#44; the mechanism cannot be explained while the psychological parameters and hormonal parameters were normal&#46; In fact&#44; we thought that there might be other factors which affect orgasmic functions&#46; And these factors may probably be related with female mental and sexual status&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As it is known&#44; male sexual functions &#8211; notably ED &#8211; have many organic and psychogenic etiologic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> Testosterone deficiency is accepted as the most common cause of ED among the organic factors&#46; Foresta et al&#46; showed that TT has a critical role in the control of erection&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> Isidori and Corona indicated to the importance of TT in terms of erection in their meta-analyses&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">28&#44;29</span></a> Also&#44; it is another known fact that some psychological factors may sometimes come first than the organic factors in ED&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> In our study&#44; neither TT levels nor psychiatric scale scores did not show any significant changes between the sub-groups and this could help us to understand why the erectile functions did not differ between the sub-groups of this study&#46; When it comes to orgasmic functions&#44; it is mostly accepted as orgasmic dysfunction is related with neurological disorders and psychological drugs besides endocrine disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">31&#44;32</span></a> However&#44; as a repetition&#44; our psychological and hormonal results did not differ between the sub-groups and these parameters cannot explain the difference in orgasmic functions&#46; In the literature&#44; orgasmic dysfunction incidence in infertile men was given as 8&#8211;11&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#8211;35</span></a> Elia et al&#46; reported that the reason beyond orgasmic dysfunction could be the difference between the aims of sexual intercourse&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a> In their study they emphasized that orgasmic disorders were lower in the couples who are having sex to get pleasure&#44; than the others who are trying to have a baby&#46; This approach seems logical in explaining the orgasmic difference in our study&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">There are a few study that emphasized that the male should be included into the all steps of the invasive processes such as abortion and curettage&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> However&#44; it is not a well-known issue that how these processes affect men&#46; In this study&#44; we found that male partner did not affect from the abortion or curettage history regarding psychologically and sexually&#44; except orgasmic dysfunction&#46; In linear regression analyses the diminishing of the significance values determined in two-paired comparisons and the inability to conduct some regression models made us think there was other factors that affected man&#39;s sexual life&#46; At this point&#44; it is a limitation of our study that female partner&#39;s hormonal&#44; psychological and sexual queries were not evaluated&#46; These factors might be related with the sexual and psychological status of woman partner&#46; However&#44; we cannot make any further evaluations because of the lack of the data&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">There are several limitation of this study&#46; First of all the data obtained from the queries might be subjective&#46; Also&#44; the study includes only a population of a local area&#46; Multicenter studies always gives more reliable information&#46; In addition&#44; retrospective design of the study limits our evaluation and exposition capabilities&#46; For example we do not have some parameters that might affect the psychological status and sexual life of the couples&#44; such as infertility duration&#44; information about a previous marriage&#44; etc&#46; These data would have given us a chance to write a broader discussion&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study showed that male partner is not affected from abortion process in which female partner get involved&#46; Men only have orgasmic dysfunction when there is one or more abortion history in couples&#46; However&#44; there might be other possible factors that could affect the orgasm in men&#46; More comprehensive prospective randomized multicenter trials are needed to conclude about this issue&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest&#46;</p></span></span>"
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            1 => "Curettage"
            2 => "Erectile dysfunction"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">It is thought that both individuals are affected psychologically and sexually in couples experiencing abortion&#46; In addition to the stress caused by infertility&#44; sexual life may also be negatively affected in couples who experience psychogenic wear&#44; such as abortion and curettage&#46; The aim of this study is to evaluate male sexual functions in infertile couples with a history of abortion and male infertility component&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Five hundred forty-seven male patients&#8217; data were evaluated retrospectively&#46; Group 1 was the included the males of the couples without abortion history and the rest with abortion history was group 2&#46; In addition to demographic data&#44; abortion history&#44; libido level&#44; presence of morning erection and intercourse frequency were evaluated&#46; Hormone levels of all patients were evaluated&#46; After that we created sub-group 1 and sub-group 2 from these groups&#44; respectively&#44; due to whether the patients fulfilled the international index of erectile function &#40;IIEF&#41;&#44; Beck anxiety inventory &#40;BAI&#41; and Beck depression inventory &#40;BDI&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were not any significant differences between the groups regarding psychiatric scale scores&#44; hormone levels&#44; libido&#44; intercourse frequency and IIEF scores&#46; Only orgasmic dysfunction was significant in the males of the couples with abortion history&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Man is not affected from abortion process in which woman get involved&#46; Men only have orgasmic dysfunction when there is one or more abortion history in couples&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se piensa que ambos individuos se ven afectados psicol&#243;gica y sexualmente en las parejas que experimentan un aborto&#46; Adem&#225;s del estr&#233;s causado por la infertilidad&#44; la vida sexual tambi&#233;n puede verse afectada negativamente en las parejas que experimentan desgaste psic&#243;geno&#44; como el aborto y el legrado&#46; El objetivo de este estudio es evaluar las funciones sexuales masculinas en parejas inf&#233;rtiles con antecedentes de aborto y componente de infertilidad masculina&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron retrospectivamente los datos de 547 pacientes masculinos&#46; El grupo 1 fue el que incluy&#243; a los varones de las parejas sin antecedentes de aborto y el resto con antecedentes de aborto fue el grupo 2&#46; Adem&#225;s de los datos demogr&#225;ficos&#44; se evalu&#243; el historial de abortos&#44; nivel de libido&#44; presencia de erecci&#243;n matutina y frecuencia de coito&#46; Se evaluaron los niveles hormonales de todos los pacientes&#46; Posteriormente se cre&#243; el subgrupo 1 y el subgrupo 2 de estos grupos&#44; respectivamente&#44; seg&#250;n si los pacientes cumpl&#237;an con el &#237;ndice internacional de funci&#243;n er&#233;ctil &#40;IIEF&#41;&#44; el inventario de ansiedad de Beck &#40;BAI&#41; y el inventario de depresi&#243;n de Beck &#40;BDI&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">No hubo diferencias significativas entre los grupos con respecto a las puntuaciones de la escala psiqui&#225;trica&#44; los niveles hormonales&#44; la libido&#44; la frecuencia de las relaciones sexuales y las puntuaciones del IIEF&#46; Solo la disfunci&#243;n org&#225;smica fue significativa en los varones de las parejas con antecedentes de aborto&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El hombre no se ve afectado por el proceso de aborto en el que se involucra la mujer&#46; Los hombres solo tienen disfunci&#243;n org&#225;smica cuando hay uno o m&#225;s antecedentes de aborto en las parejas&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group 1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>453&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">422 &#40;93&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;89&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Impaired&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absent&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">LH &#40;IU&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sub-group 1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>150&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sub-group 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Marriage time &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intercourse frequency &#40;n&#59; &#37;&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;91&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;88&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Impaired&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Morning Erections &#40;n&#59; &#37;&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Libido &#40;n&#59; &#37;&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Impaired&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140 &#40;95&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;92&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous infertility treatment history</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male &#40;<span class="elsevierStyleItalic">n</span>&#59; &#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;87&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;81&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;12&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Absent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;20&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;14&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Present&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 &#40;79&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;85&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">465&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>188&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">480&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>136&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos