ABSTRACT
En el año 2018 se conmemoraron 40 años desde el primer resultado exitoso producto de una fertilización in vitro (FIV), el nacimiento de Louise Brown en Inglaterra. Se estima que a la fecha han nacido más de 8 millones de seres humanos gracias a las tecnologías de reproducción asistida (TRA), técnicas que están en constante avance y desarrollo. Sin embargo, a pesar de ser cada vez más relevantes como tratamiento de la infertilidad, su acceso todavía es muy limitado y poco equitativo, alcanzando menos del 15% de la población a nivel global. En esta revisión analizamos los aspectos epidemiológicos de la infertilidad y exponemos el contraste entre la necesidad teórica de TRA y los ciclos realizados a nivel mundial, reflejando el bajo acceso a los tratamientos. Se enfatiza la realidad latinoamericana y con especial detalle la chilena, explorando tanto su dimensión histórica como actual, perfilando los desafíos que como país deberemos enfrentar en los próximos años.
The 40-year anniversary of the first in vitro fertilization (IVF) newborn, Louise Brown in England, was celebrated in 2018. To date, over 8 million children have been born with assisted reproductive technologies (ART), a group of techniques in continuous development. Despite the increasing relevance of such technologies as treatments for infertility, the access to ART has been limited to less than 15% of the world population.In this review, we analyze the epidemiological aspects of infertility and present the contrast between the theoretical demand and the actual number of ART cycles performed worldwide, reflecting the low access to infertility treatments. We put emphasis on the Latin American historic and current context, then provide more details on the Chilean reality, and finally outline the challenges Chile will face in the future regarding access to ART.
Subject(s)
Humans , Male , Female , Adult , Reproductive Techniques, Assisted/statistics & numerical data , Infertility/therapy , Infertility/epidemiology , Fertilization in Vitro , Chile , Health Equity , Sociodemographic Factors , Health Services Accessibility , Latin AmericaABSTRACT
RESUMEN Introducción y objetivos: Aunque la criopreservación embrionaria es frecuentemente utilizada como parte de las técnicas de reproducción asistida, no existe información cuantitativa de cómo las parejas infértiles viven la experiencia de tener embriones criopreservados en Chile. El objetivo del estudio fue examinar las percepciones y creencias que tienen mujeres y hombres respecto de sus embriones criopreservados, sus perspectivas respecto de la donación reproductiva y destino de los embriones remanentes. Metodología: 153 mujeres y hombres con embriones criopreservados provenientes de un hospital público, Instituto de Investigaciones Materno Infantil y un centro privado, Clínica Las Condes, en Santiago, Chile, respondieron durante mayo 2015 a mayo 2016 un cuestionario en línea, anónimo, respecto de sus percepciones y creencias sobre criopreservación embrionaria. Resultados: Los encuestados reconocen a sus embriones criopreservados como un hijo (53.2%) o un proyecto de hijo (40.7%). Sólo 8% los considera un grupo organizado de células; sobre el 60% rechaza la opción de descartarlos o usarlos para investigación. Los participantes del hospital público tenían mayor disposición a donar sus embriones remanentes a otras parejas que aquellos del privado (61% vs 40%; P=0.016). Un 34% de las personas encuestadas estuvo de acuerdo con donar embriones a parejas de un mismo sexo. Conclusión: Este estudio muestra que las personas chilenas tienen un vínculo emocional con sus embriones criopreservados y no consideran descartarlos. Los resultados de este estudio pueden servir para dar adecuada consejería a las personas que se realizan técnicas de reproducción asistida, de tal modo de tomar decisiones informadas respecto de la criopreservación.
ABSTRACT Background and objetive: Although embryo cryopreservation is frequently used as part of assisted reproductive technology, quantitave information addressing how infertile couples live the experience of having cryopreserved embryos is lacking in Chile. The aim of this study is to examine men and women's perception and beliefs regarding their cryopreserved embryos, as well as their perspective on embryo donation and disposition. Methods: 153 women and men with frozen embryos from a public hospital, Instituto de Investigactiones Materno Infantil, and a private clinic, Clínica Las Condes, in Santiago, Chile, responded between May 2015 and May 2016 to an anonymous online survey addressing their perceptions and beliefs concerning their cryopreserved embryos. Results: Respondents considered their frozen embryos to be equivalent to a child (53.2%) or a potential child (40.7%). Only 8% regard them as an organized group of cells. Over 60% of respondents disagree with destroying surplus embryos or using them for research. Participants from the public hospital are more willing to donate their embryos to another couple than those from the private center (61% vs 40%; P=0.016); 34% of respondents agreed to donate surplus embryos to same sex couples. Conclusion: This study reveals that Chilean couples are emotionally bound to their frozen embryos, and that discarding them is not an option. The results from this survey will help strengthen counseling for couples to enable them to make informed decisions regarding their surplus embryos.
Subject(s)
Humans , Male , Female , Perception , Cryopreservation/statistics & numerical data , Reproductive Medicine/statistics & numerical data , Embryo Disposition/psychology , Surveys and Questionnaires , Decision Making , Observational StudyABSTRACT
Background: The clinical manifestations of endometriosis are infertility, dysmenorrhea, sexuality disturbances, and chronic pelvic pain. It is the cause of 30 to 50% of infertility cases. In developed countries, the prevalence of endometriosis among women undergoing surgical sterilization is approximately 6%. Aim: To determine the prevalence of endometriosis among women with proven fertility in Santiago de Chile. Material and Methods: Review of surgical protocols of 287 women aged 25 to 49 years, subjected to a surgical sterilization between 2007 and 2011. Results: Endometriosis was found in 14 of the 287 women (4.9%). In spite of being asymptomatic, five of the 14 women with endometriosis were classified as severe, due to the presence of at least one endometrioma. In order of frequency, the most commonly affected anatomical sites were the ovary, the peritoneum, the posterior cul-de-sac and uterosacral ligaments. Conclusions: Our findings are very similar to those found elsewhere and suggest that fertile women could better tolerate endometriosis than their infertile counterparts.
Subject(s)
Adult , Female , Humans , Middle Aged , Endometriosis/epidemiology , Sterilization, Tubal/statistics & numerical data , Chile/epidemiology , Endometriosis/diagnosis , Prevalence , Retrospective StudiesABSTRACT
Background: Smoking may hamperfemale fertility, probably modifying ovarian reserve. Antimüllerian hormone (AMH) is an accurate marker for ovarian reserve. Aim: To look for an association between smoking status and plasma AMH concentration. Patients and Methods: A cohort of 141 infertile women in a university setting in Santiago, Chile was studied. Demographic and smoking data, including the number of cigarettes smoked during the last week, were collected. A blood sample was obtained and kept frozen until determination of AMH by ELISA and follicle stimulating hormone (FSH) and estradiol at day three of the menstrual cycle, by radioimmunoanalysis. Results: Thirty two participants smoked (23%). There were no significant differences in age, parity, body mass index, causes of infertility and day three FSH and estradiol between smokers and nonsmokers. According to a regression analysis, there was a significant decrease in AMH concentration with age and active cigarette smoking. A drop in AMH of -0.189 ng/mL with a unitary change in age and a decrease of -2.29 ng/mL when everything else remains constant, except the smoking status, were established (p < 0.001 and r2 = 0.134). However, no dose response was observed when the number of cigarettes smoked during the last week were introduced in the model. Furthermore, no significant association ofplasma AMH with day three plasma FSH and estradiol concentrations was observed. Conclusions: Cigarette smoking is associated with decreased AMHplasma concentrations among infertile women. However there was no dose response relationship. The mechanisms underlying this association are unknown and further investigation is required.
Subject(s)
Adult , Female , Humans , Anti-Mullerian Hormone/blood , Infertility, Female/blood , Ovary/metabolism , Smoking/blood , Biomarkers/blood , Linear Models , Smoking/adverse effects , Statistics, NonparametricABSTRACT
Los hongos-roya (Uredinales, Basidiomycetes) representan uno de los grupos de microorganismos fitoparásitos más diversos y con mayor importancia económica mundial en la producción agrícola y forestal. Se caracterizan por ser patógenos obligados y por presentar una estrecha coevolución con sus hospedantes vegetales. Su taxonomía se ha basado fundamentalmente en el estudio de caracteres morfológicos, resultando en muchos casos en la formación de taxones polifiléticos. Sin embargo, en los últimos años se han tratado de incorporar herramientas moleculares que conduzcan a la generación de sistemas de clasificación basados en afinidades evolutivas. En esta revisión se ofrece una mirada general a las características de los uredinales, enfatizando en el surgimiento reciente de estudios filogenéticos que plantean la necesidad de establecer una profunda revisión de la taxonomía de este grupo. Finalmente se alerta sobre la necesidad de que en dichos estudios taxonómicos se incluya un alto número de especies de royas neotropicales, pues esta zona es reconocida no sólo por su alta diversidad de hongos-royas, sino también por las características únicas de sus ciclos de vida.
Rust fungi (Uredinales, Basidiomycetes) are one of the most diverse and economically important plant pathogens of crops world-wide. They are obligated parasites and have a close evolutionary relationship with their plant hosts. Taxonomy of this group has been based on morphological treats, resulting in generation of polyphyletic taxa. Recently, different studies have incorporated molecular techniques addressed to establishing evolutionary affinities between these fungi. This review presents a general view of the biological characteristics of rust fungi, with a detailed discussion on the phylogenetic studies regarding the group. Finally, the review proposes the necessity to establish phylogenetic studies on rust fungi from the neotropics, where these fungi present a very high diversity and unique life cycles.
ABSTRACT
Prenatal treatment of pregnancies at risk of congenital adrenal hyperplasia (CAH) may prevent ambiguous genitalia in female fetuses. We present the prenatal treatment performed in an extended family with two mutations. The proband, a boy with CAH-salt losing form, and his relatives were studied. The proband's paternal uncles/aunts were married to the maternal aunts/uncles, respectively. The relatives had normal basal and stimulated 170HProgesterone levels, which did not clarify their carrier status. The CYP21A2 gene was sequenced. The proband and the paternal relatives harbored a Q318X, R483W mutation in one alíele. The maternal relatives and the proband exhibited an R483 frameshift mutation. Early dexametasone treatment was given during two pregnancies and stopped when male gender was confirmed by early ultrasonography Both newborns were healthy and had normal 170HProgesterone levels. This family had three mutations which abolish the 21-hydroxilase activity. Two mutations were detected in codon 483 of CYP21A2 gene, exon 10, which have not been reported previously in Latin-America. The molecular study performed in this family allowed us to give an appropriate genetic counseling and prenatal treatment.
Subject(s)
Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , Adrenal Hyperplasia, Congenital/diagnosis , Mutation , Prenatal Diagnosis/methods , /genetics , /blood , Adrenal Hyperplasia, Congenital/drug therapy , Adrenal Hyperplasia, Congenital/enzymology , Dexamethasone/adverse effects , Dexamethasone/therapeutic use , Genotype , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic useABSTRACT
La inseminación intrauterina es una técnica ampliamente utilizada por la Medicina reproductiva en el tratamiento de causas específicas de infertilidad, como también como coadyuvante. En el éxito de este método influyen diversos factores que se analizan en esta revisión y cuyos resultados se comentan.
Subject(s)
Humans , Male , Female , Pregnancy , Infertility, Female/therapy , Infertility, Male/therapy , Insemination, Artificial/methods , PrognosisABSTRACT
La estimación ecográfica del peso fetal es una herramienta confiable y de utilidad en el manejo clínico de los embarazos de pretérmino. Las mejores fórmulas para estimar el peso fetal en nuestra población son las de Deter y de Hadlock. La correlación de la estimación ecográfica es buena en los recién nacidos de bajo peso y es un elemento valioso en el manejo de estos embarazos de pretérmino