Pulsão de Morte e Sublimação: A (Re)invenção da Vida nas Dobras da Racionalidade Técnico-Científica / Death Drive and Sublimation: The (Re)invention of Life in the Folds of Technical-Scientific Rationality / Pulsión de Muerte y Sublimación: (Re)invención de la Vida en las Doblas de la Técnica

O advento das biotecnologias no mundo contemporâneo, em particular das Novas Tecnologias Reprodutivas (NTR's), liberando a sexualidade dos antigos imperativos da procriação, nos oferece uma prova contundente da abertura ilimitada da vida à transformação das condições em que as normas vitais engajam os organismos no processo de individuação. Mais do que isso, evidencia o caráter essencialmente contingente da ligação entre vida, morte e sexualidade. O objetivo deste trabalho é examinar a fecundidade da concepção freudiana de sublimação - lida sob o registro das transformações que a ela se impõem com o advento do conceito de pulsão de morte (1920) - em subsidiar uma reflexão ética e política acerca dos efeitos da incidência das Novas Tecnologias Reprodutivas (NTR's) nos campos da reprodução, da sexualidade e do laço social. Nossa hipótese é a de que o fenômeno das biotecnologias desvela, sob a cobertura do temor, tão frequentemente evocado por alguns de nossos contemporâneos, de dilapidação das instituições e dos modos de vida sobre os quais acreditávamos poder fundar nossa fantasmática "humanidade", a infinita potência da vida em recriar-se diante d'isso que quer destruí-la.

The advent of biotechnologies in the contemporary world, particularly New Reproductive Technologies (NTRs), freeing sexuality from the old imperatives of procreation, offers us overwhelming proof of the unlimited opening up of life to the transformation of conditions in which vital norms engage the organisms in the individuation process. Even more so, it highlights the essentially contingent character of the connection between life, death, and sexuality. The aim of this study is, therefore, to examine the fruitfulness of the Freudian conception of sublimation, read under the register of the transformations imposed upon this notion with the advent of the death drive concept (1920), in subsidizing an ethical and political reflection on the effects of the incidence of NTRs in the reproduction, sexuality and social bond fields. Our hypothesis is that the biotechnologies phenomenon reveals, under the cover of fear, so often evoked by some of our contemporaries, of institutional dilapidation and ways of life in which we believed we could establish our fantastic "humanity", the infinite life's power to recreate itself in the face of that which wants to destroy it.

La llegada de las biotecnologías en el mundo contemporáneo, en particular de las Nuevas Tecnologías Reproductivas (NTR's), liberando la sexualidad de los imperativos de la procreación, nos ofrece una prueba contundente de la abertura ilimitada de la vida a la transformación de las condiciones en que las normas vitales capacitan el organismo a la individuación. Más allá de eso, se evidencia el carácter esencialmente contingente de la ligación entre vida, muerte y sexualidad. El objetivo de este estudio es examinar la fecundidad de la concepción freudiana de sublimación - leída bajo el registro de las transformaciones que a ella se imponen con la llegada del concepto de pulsión de muerte (1920) - en subsidiar una reflexión ética y política acerca de los efectos de la incidencia de las Nuevas Tecnologías Reproductivas (NTR's) en los campos de la reproducción, de la sexualidad y del lazo social. Nuestra hipótesis es que el fenómeno de las biotecnologías desvela, bajo la cobertura del temor, tan frecuentemente evocado por algunos de nuestros contemporáneos, de dilapidación de las instituciones y de los modos de vida sobre los cuales creíamos poder fundar nuestra fantasmática "humanidad", la infinita potencia de la vida en recrearse de ante d'eso que quiere destruirla.

Cuidados reprodutivos para a pessoa transgênero ­ do planejamento gestacional ao puerpério: uma revisão narrativa / Reproductive care for transgender persons ­ from gestational planning to puerperium: a narrative review

Objetivo: Apesar de 0,69% da população brasileira em idade reprodutiva se identificar como transgênero, os cuidados relacionados ao ciclo gravídico-puerperal e ao planejamento gestacional ainda são desconhecidos pelos profissionais de saúde. Métodos: Esta revisão narrativa avaliou o planejamento gestacional e contracepção; a possibilidade do emprego de técnicas de reprodução assistida segundo as recomendações do Conselho Federal de Medicina no Brasil; e a gestação, pré-natal e puerpério na população transgênero. Resultados: Dos 664 artigos encontrados no PubMed e Embase, 29 foram considerados para a confecção desta revisão. O uso da testosterona por trans masculinos, apesar de promover amenorreia, não é considerado um método contraceptivo. Contraindicações aos métodos hormonais devem seguir as mesmas orientações propostas para as mulheres cisgênero. Cuidados pré-natais não diferem dos habituais, Pessoas transgênero podem desejar amamentar. Conclusão: O desconhecimento das melhores práticas voltadas para o acolhimento e seguimento das pessoas transgênero pode resultar em negligência aos cuidados essenciais durante esse período. O conhecimento e a validação dessas identidades e o preparo das equipes são essenciais para melhorar o acesso dessa população às redes de saúde.

Objective: Although 0.69% of the Brazilian population of reproductive age identify themselves as transgender, care related to the pregnancy-puerperal cycle and pregnancy planning is still unknown to health professionals. Methods: This narrative review assessed pregnancy planning and contraception; the possibility of using Assisted Reproduction Technologies according to the recommendations of the Federal Council of Medicine in Brazil; and pregnancy, prenatal, and puerperium in the transgender population. Results: Of the 664 articles found in PubMed and Embase, 29 were considered for the compilation of this review. The use of testosterone by transgender male, despite promoting amenorrhea, is not considered a contraceptive method. Contraindications to hormonal methods should follow the same guidelines for cisgender women. Prenatal care and delivery should not differ from the usual. Transgender might be able to breastfeed. Conclusion: The lack of knowledge for transgender follow-up may result in neglect of prenatal care. Knowledge and validation of these identities and staff training are essential to improve the access of this population to health networks.

O impacto das intervenções de meditação breve e extremamente breve nas taxas de sucesso de Técnicas de Reprodução Assistida: um estudo controlado randomizado / The impact of brief and extremely brief meditation interventions on the success rates of Assisted Reproductive Techniques: a randomized controlled trial

Introdução: As taxas de sucesso da gravidez com as técnicas de reprodução assistida (ART) têm melhorado constantemente. O efeito das intervenções não farmacológicas, como a meditação, como terapias adjuvantes, nos resultados dos ciclos de ART tem sido pesquisado com resultados promissores. No entanto, até onde sabemos, há muitas dúvidas sobre os efeitos os efeitos de meditação breve e extremamente breve nas taxas de sucesso em ART. Portanto, uma meditação extremamente breve guiada por facilitador e uma meditação breve em formato de áudio e autogerenciada foram estudadas. Objetivo: Investigar o efeito das intervenções da meditação breve (IMB) e extremamente breve (IMEB) na taxa de gravidez em mulheres submetidas à Tecnologia de Reprodução Assistida (TRA). Método: Trata-se de um estudo prospectivo, randomizado, controlado com três braços. As intervenções foram realizadas no período de espera entre a transferência de embriões e o teste de gravidez ß-hCG. O tamanho da amostra foi calculado pelo qui-quadrado de Pearson com base no poder de 80%, tamanho do efeito de 0,4 e nível de confiança de 95%. As variáveis relacionadas ao sucesso da TRA foram incluídas na análise: idade em anos, número de embriões/blastocistos transferidos, número de embriões/blastocistos com qualidade excelente ou muito boa, número de ciclos de fertilização in vitro, faixa etária e se foi transferido embrião ou blastocisto. O teste qui-quadrado (χ2) e ANOVA compararam os valores das variáveis entre os grupos de intervenções e controle. A Análise de Regressão Logística Univariada avaliou se cada variável relacionada ao sucesso da TRA influenciou ou não a resposta da variável de desfecho "gravidez". Utilizou-se Análise de Regressão Logística Múltipla para avaliar a influência dessas variáveis em conjunto no desfecho da gravidez. Resultados: Foram incluídas 68 mulheres com idade de 37,5+4,3 anos (IMEB, n=24; IMB n=22 e GC, n=22). O teste qui-quadrado de Pearson e o teste t de Student para amostras independentes mostraram que não houve diferenças significativas (p<0,05) entre os grupos intervenção e grupo controle. Tanto a IMEB quanto a IMB não tiveram efeito significativo na taxa de gravidez em mulheres submetidas à ART. Conclusão: O uso da meditação breve ou extremamente breve não demonstrou diferenças significativas na taxa de gravidez entre os grupos intervenção e grupo controle, em mulheres sob tratamento com Técnicas de Reprodução Assistida. Os resultados dos efeitos da meditação na taxa de gravidez de mulheres em TRA são inconclusivos na literatura. Necessita-se de ensaios controlados randomizados com amostras maiores comparando ambas as intervenções de meditações breves e extremamente breves a um grupo controle para confirmar os achados deste estudo.

Introduction: Pregnancy success rates with assisted reproductive technology (ART) have steadily improved. The effect of non-pharmacological interventions such as meditation as adjunctive therapies on the outcomes of ART cycles has been researched with promising results. However, to the best of our knowledge, there is much doubt about the effects of brief and extremely brief meditation on ART success rates. Therefore, an extremely brief facilitatorguided meditation and an audio-guided, self-paced short meditation were studied. Objectives: To investigate the effect of extremely brief meditation (EBMI) or brief mindfulness interventions (Brief MI) on pregnancy rate in women undergoing Assisted Reproductive Technology (ART). Method: This is a prospective three arms randomized, controlled study. Interventions were performed in the waiting period between embryo transfer and the ß-hCG pregnancy test. The sample size was calculated using Pearson's chi-square based on a power of 80%, effect size of 0.4 and a confidence level of 95%. Variables related to the success of ART included in the analysis consisted of age in years, number of embryos/blastocysts transferred, number of embryos/blastocysts with excellent or very good quality, number of in vitro fertilization cycles, age range, and whether the embryo was transferred or blastocyst. Chi-square test (χ2) and ANOVA compared variable values between intervention and control groups. Univariate Logistic Regression Analysis evaluated whether each variable related to ART success influenced or not the response of the outcome variable "pregnancy". Multiple Logistic Regression Analysis assessed if these variables could influence jointly the outcome of pregnancy. Results: A total of 68 women aged 37.5+4.3y were included (EBMI, n=24; Brief MI, n=22 and CG, n=22) were. Pearson's Chi-square test and Student's t test for independent samples showed that there were no significant differences (p<0.05) between the intervention groups and control group. Both EBMI and BMI had no significant effect on pregnancy rate in women undergoing ART. Conclusion: The use of brief or extremely brief meditation did not demonstrate significant differences in the pregnancy rate between the intervention and control groups in women undergoing treatment with Assisted Reproductive Techniques. The results of the effects of meditation on the pregnancy rate of women on ART are inconclusive in the literature. Larger sample randomized controlled trials comparing both brief and extremely brief meditation interventions to a control group are needed to confirm the findings of this study.

Los sentidos sobre los fetos y embriones: imágenes, discursos y tecnología en las experiencias de usuarias de TRHA en Argentina / Os sentidos de fetos e embriões: imagens, discursos e tecnologia nas experiências de usuárias de TRHA na Argentina / The senses about fetuses and embryos: Images, discourses and technology in the ARTs user's experiences in Argentina

Resumen El presente trabajo analiza los sentidos que las usuarias de TRHA construyen sobre los embriones y fetos de forma situada. Desde un método cualitativo y un enfoque biográfico, se exploran las maneras en que las usuarias dan sentido y subjetivan a los embriones en diferentes momentos: durante la gestación, ante la pérdida de un embarazo, como frente a las tecnologías de visualización y de criopreservación, dando cuenta de diferentes interpretaciones y resignificaciones. Situado en la Provincia de Córdoba, estas experiencias permiten dar cuenta de los sentidos locales de lo reproductivo y comprender las controversias que afrontan las usuarias un campo biomédico poco regulado en Argentina.

Resumo Este documento analisa os significados que as usuárias de TRHA constroem sobre embriões e fetos de uma forma situada. Utilizando um método qualitativo e uma abordagem biográfica, exploramos as formas como as usuárias dão sentido e subjetividade aos embriões em diferentes momentos: durante a gestação, face à perda de gravidez, e face às tecnologias de visualização e criopreservação, dando conta de diferentes interpretações e ressignificações. Situadas na província de Córdoba, estas experiências nos permitem dar conta dos significados locais das questões reprodutivas e compreender as controvérsias enfrentadas pelos utilizadores de um campo biomédico mal regulado na Argentina.

Abstract The present work analyzes the construction-meaning process in ART users about embryos and fetuses in a situated way. From a qualitative method and a biographical approach, it explores the ways that ART users construct and subject ART embryos at different times: during gestation, in the face of pregnancy loss, as well as in front of visualization and cryopreservation technologies, accounting for different interpretations and resignifications. Located in the Province of Córdoba, these experiences allow us to account for the local meanings of reproductive issues and to understand the controversies faced by users of a biomedical field that is not very regulated in Argentina.

Complicaciones obstétricas y perinatales en mujeres infértiles que se embarazan / Obstetric and perinatal complications in infertile women who become pregnant

Las pacientes infértiles tienen un riesgo aumentado de resultados obstétricos y perinatales adversos que dependen de los factores de infertilidad subyacentes previos y de factores inherentes a los tratamientos recibidos para lograr el embarazo. La edad materna, las patologías previas ginecológicas, hormonales, endocrinológicas, metabólicas y anatomo funcionales son reconocidas como factores de riesgo para resultados adversos obstétricos y perinatales. Los tratamientos como la hiperestimulación ovárica y los tratamientos de reproducción asistida condicionan riesgos adicionales, especialmente por el aumento de embarazos múltiples que se generan con estas terapias. El aumento de la edad materna de pacientes tratadas por infertilidad y la necesidad creciente de tratamientos de reproducción asistida determinan probablemente, un mayor riesgo futuro de complicaciones obstétricas y perinatales. Muchos de estos factores de riesgo pueden ser modificados y manejados antes de iniciar los tratamientos con la finalidad de mejorar el pronóstico para la madre y el recién nacido. La consideración de estos factores de riesgo y sus consecuencias en el embarazo son parte esencial del consejo reproductivo que debiera recibir toda paciente que se somete a tratamientos por infertilidad.El objetivo de esta revisión es mostrar la relación existente entre las pacientes que consultan por infertilidad, los tratamientos usados y los potenciales riesgos obstétricos y perinatales cuando se produce el embarazo.

Infertile patients have an increased risk of adverse obstetric and perinatal outcomes that depend on underlying infertility factors and on those treatments recieved to become pregnant. Maternal age, hormonal, endocrinologial, metabolic and anatomic/functional gynecological diseases are widely recognized risk factors for adverse obstetric and perinatal outcomes. Infertility treatments like controlled ovarian hyperstimulation and assisted reproductive technologies add aditional risks, specially related to multiple pregnancies that are associated to. The higher maternal age of patients seeking for infertility treatment and the increasing need of assisted reproductive technologies probably determines a higher and increasing risk of obstetric and perinatal adverse outcomes. In many cases risk factors can be adequately modified and controlled before treatments are initiated thus improving maternal and neonatal prognosis. This risk factors and their consequences in pregnancy have to be strongly considered in reproductive counselling that should recieve every patient treated for infertility.The aim of this article is to show the relation between infertile patients seeking for treatment and their potential risks of obstetric and perinatal adverse outcomes when they get pregnant.

Pregnancy and live birth rates in women with endometriosis related infertility in Latvia

Background: Women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. According to European Society of Human Reproduction and Embryology guidelines, surgery and assisted reproductive technologies (ART) are an appropriate treatment in cases of endometriosis-associated infertility. There are controversial data on the results of surgery and ART in patients with endometriosis.Methods: Retrospective analysis including 99 infertile patients aged between 25 and 48 years old. All of them had laparoscopic surgery as the primary option. 51 of them undergoing in vitro fertilization or intracytoplasmic sperm injection or frozen embryo transfer from 2003 through 2018 at SIA ‘Clinic EGV’.Results: The mean age of women was 34.2±4.5. In 56 (33.5%) cases was only surgery with 28 (50.9%) biochemical pregnancies and 26 (48.1%) live birth. In 111 (66.5%) cases there were surgery with ART with 48 (47.6%) biochemical pregnancies and 23 (22.7%) live birth. In 1 group patients mean age 30.7±4.6 and 2 group with mean age 35.1±4.2 (p=0.000). It was found that there is significant difference between endometriosis phenotype, infertility type, duration of infertility, repeated laparoscopic surgery, ART cycles, retrieved oocyte count and biochemical pregnancy rate.Conclusions: Patients with endometriosis related infertility should undergo surgical treatment as the primary option. Those patients who do not become pregnant after surgery must be treated with assisted reproductive technology. The optimal time to perform ART is first year after endometriosis surgery.

Las vicisitudes de la identidad y la identificación en el marco de la concepción heteróloga / The vicissitudes of identity and identification within the framework of heterologous conception

La fecundación heteróloga, producto de los procedimientos de alta complejidad reproductiva, genera muchos interrogantes. ¿Qué es lo que deben saber las personas que fueron concebidas con gametos donados? En los últimos años, las guías de buenas prácticas médicas recomiendan la revelación del origen genético, bregando por la apertura y la transmisión intrafamiliar. Constatamos sin embargo, dificultades ante la revelación. El presente trabajo indaga la noción de identidad y los caminos de la identificación, que desde el discurso psicoanalítico aporta valiosos elementos de juicio. La lectura de los artículos del Código Civil y Comercial Argentino (2015) de muestra las contradicciones y dificultades inherentes a la normativización de ciertos aspectos filiatorios. Concluimos que la identidad, en tanto noción a construir, se encuentra enraizada en tramas identificatorias, significantes, que al no agotarse en el derecho de acceder a determinada información, requiere de una tramitación singular capaz de situar la posición subjetiva en el entramado de la novela familiar.

The donation of gametes (eggs/sperm) or heterologous fertilization as a consequence of high-complexity assisted reproduction procedure has raised many questions. Should people know that they were conceived with donated gametes? What information can they access? Although the anonymity vs. non-anonymity debate of gamete donation is not new, we are witnessing a shift in which guidelines suggest disclosure and openness, but leave the final decision to the parents. While local and international professional guidelines (ASRM. Ethics Committee. Informing offspring of their conception by gamete or embryo donation: A committee opinion. American Society for Reproductive Medicine; Fertility and Sterility, 2013; Nuffield Council on Bioethics. Donor conception: ethical aspects of information sharing. London, 2013; The Human Fertilization and Embryology Authority. Code of Practice 8th edition. London, 2015) recommend disclosures of genetic information at an early age, the facts reveal that people face many troubles to disclose this information to their children. Is this going against people's right to identity? In other words, can reproductive choices affect an individual´s identity? The following essay explores the notion of identity and its relation with the psychoanalytical term of identification (Freud-Lacan) aiming to develop a novel perspectives to address the present discussion. It provides also an examination of selected articles of the Argentine Civil and Commercial Code (2015), extracted from the Family Relations section (Arts. 401-723), trying to show the inherent contradictions and difficulties express in the regulatory domain to address the filiatory aspects. In conclusion, it may be said that identity is a concept that need to be build considering many and diverse features. Within the technical procedures of gamete donation, complex processes of subjectivation are involved which are necessary to investigate. Personal identity is rooted in identification traits, which are not fully dependent on the right to know the donor's identifying information, but are connected to singular constitutional process, which implies the elaboration of the subjective positioning in the family novel.

Cell Count of Mouse Blastocyst on Pre-clinical Evaluation of Safety of Medical Devices in Assisted Reproductive Technologies / 中国医疗器械杂志

Various types of medical devices used in assisted reproductive technologies (ART) should be detected for their safety by strict biological assays. Mouse embryo assay(MEA)has been recognized as one of the most important and standardized methods with the threshold more than 80% of blastocyst formation rate (BR) after 96 h culture of fertilized eggs. The disadvantage using BR for embryonic quality control has been concerned as it is ubiquitously dependent of embryonic morphology and the detailed data including molecular and genetic information is obviously missing and incomplete. This leads to the urgent requirement for more sensitive and efficient assessments for the quality control of ART. This study evaluated the reliability of an immunofluorescent MEA by counting total cell and differential number of the cells in the inner cell mass (ICM) and trophectoderm (TE) in the blastocyst. This method improved the traditional MEA, provided a sensitive and powerful platform to assess embryonic developmental viability and should be suggested as a standard assay to be globally used for the quality control of medical devices and pre-clinical procedures in ART.

Preservação da fertilidade em mulheres com câncer / Fertility preservation in women with cancer

Introdução: A fertilidade em mulheres que passaram por tratamento oncológico é um assunto de suma relevância no cenário da medicina atual. É importante que tais pacientes estejam cientes dos possíveis danos à fertilidade que o tratamento para neoplasias pode acarretar; assim como, é essencial que os médicos que lidam com elas saibam expor as opções para a preservação da fertilidade. Métodos: Os artigos foram pesquisados na base de dados PubMed em junho de 2018, utilizando os termos descritores oncologia; câncer, mulheres e fertilidade. Como critérios de inclusão, foram considerados artigos publicados nos últimos 10 anos, no período de junho de 2008 a junho de 2018, artigos que abordassem pesquisas apenas com humanos e aqueles publicados em língua portuguesa, inglesa ou espanhola. Resultados: Na pesquisa inicial, utilizando os termos descritores, foram encontrados 4173 artigos; restringindo aos últimos 10 anos, restaram 2370 artigos; desses, foram selecionados apenas aqueles com pesquisas em seres humanos, restaram 2201 artigos e desses foram selecionados 2063 que estão nos idiomas escolhidos. Elegeu-se 8 artigos para a elaboração desta revisão da literatura. Conclusões: Através deste artigo, foi possível revisar evidências atuais referentes a preservação da fertilidade em mulheres com diagnóstico de câncer. Atualmente há uma ampla variedade de abordagens para manutenção da fertilidade. Diante do desejo de gestar, as escolhas vão depender, principalmente, da idade da paciente, da reserva ovariana e da presença de parceiro.

Introduction: Fertility in women whom went through an oncologic treatment is a subject of utmost importance in the current medical scenario. It is important that these patients are aware of the possible damages to fertility due to oncologic treatments; as well as, it is essential for physicians that deal with cancer patients knowing how to disclose the options available for fertility preservation. Methods: The articles were researched in the PubMed database in June 2018, using descriptor terms as oncology; cancer; women; and fertility. As an inclusion criterion, articles published in the last 10 years were considered, from June 2008 to June 2018, articles whose research was based solely on humans and those published in Portuguese, English and Spanish. Results: In the initial research, using the descriptor terms, 4173 articles were found; restricting those to the last 10 years, 2370 were left; of these, 2201 articles whose research was solely based on humans were selected, of which 2063 are on the selected languages. Eight articles were elected for the formulation of this literature review. Conclusions: Through the elaboration of this article, it was possible to review the current relative evidence to the conservation of fertility in women with the diagnosis of cancer. Nowadays there is a broad range of approaches for the preservation of fertility. Faced on the desire to gestate, choices will vary from the age of the patient and ovarian reserve, to the presence of a male partner.

Práticas reprodutivas lésbicas: reflexões sobre genética e saúde / Lesbian reproductive practices: reflections on genetics and health

Resumo A relação entre ciência, tecnologia e capital, intrínseca às Tecnologias Reprodutivas (TR), torna estas uma possibilidade de escolha reprodutiva e uma alternativa para lésbicas que querem ter filhos. O artigo se propõe a refletir sobre os projetos formulados a partir dos depoimentos de casais de lésbicas que utilizaram ou que tinham planos de utilizar as TR. Foram entrevistados oito casais de mulheres com idade entre 26 e 45 anos, todas autodeclaradas brancas e com nível superior completo, residentes na Grande São Paulo/SP, entre 2010-2011. Os resultados revelam a preferência das entrevistadas pelo doador proveniente de banco de esperma e também a valorização da informação sobre o histórico familiar de saúde do doador. Destaca-se o interesse pela importação de sêmen de banco americano, em razão de uma alegada pouca disponibilidade de amostras no Brasil e por ele conter mais informações sobre os doadores. Assim, ao mesmo tempo que as TR possibilitam uma parentalidade não biológica, a genética é valorizada concorrendo para uma medicalização do parentesco.

Abstract The relationship between science, technology and capital, which are intrinsic to Reproductive Technologies (RT), makes them a possibility of reproductive choice and an alternative for lesbians who wish to have children. The article seeks to reflect on the projects formulated based on the statements of lesbian couples who had used or had plans to use RT. Interviews were conducted with eight couples of women with ages between 26 and 45, all self-declared Caucasians, who had completed higher education and were living in the Greater São Paulo region between 2010 and 2011. The results reveal the preference of the respondents for donor sperm originating from a sperm bank and also the importance placed on information on the family history of health of the donor. A noteworthy finding is the interest in importing from an American sperm bank, because of an alleged limited availability of samples in Brazil and the fact that they provide more information about the donors. Thus, while RT enable non-biological parenting, genetics is considered important thereby contributing to the medicalization of parenthood.

Dilemas éticos en embriones criopreservados: avance de investigación / Ethical dilemmas in cryopreserved embryos: research update

Los adelantos en medicina reproductiva han producido cambios y transformaciones en la estructura familiar. El impacto de la técnica sobre la subjetividad requiere de un trabajo interdisciplinario capaz de conceptualizar las variantes y los efectos de esas transformaciones sobre el tejido social de la Argentina. En esta oportunidad, el foco será la conceptualización del embrión in vitro; se estudiará cómo el modo de percibirlos afecta el destino de los embriones criopreservados. Este trabajo presenta un primer acercamiento, en el marco de una investigación posdoctoral (CONICET) que tiene por objeto el desarrollo de una guía psico-educativa de buenas prácticas para la resolución de dilemas éticos en embriones criopreservados. La indagación se llevó a cabo en 27 pacientes/usuarios de técnicas de reproducción humana asistida (TRHA) por medio de una encuesta estructurada on-line autoadministrable, que indaga la representación del embrión no implantado en dos casos controvertidos de la práctica clínica: disposición de embriones en caso de fallecimiento de uno de los progenitores (viñeta 3) y disposición de embriones posdivorcio (viñeta 4).

Improvements in reproductive medicine have transformed the structure of families. The impact of the technique on the subjectivity of those involved in these processes requires interdisciplinary work in order to conceptualize the variations and effects of these transformations on the Argentinean society. In this opportunity, the focus will be the conceptualization of the in vitro embryo and the effects of this perception in its possible destinations. This paper summarizes a first approach, within the framework of a postdoctoral research (CONICET) which aims to develop a psycho-educational guide for the resolution of ethical dilemmas in cryopreserved embryos. The inquiry was carried out in 27 patients of assisted reproductive technologies (ARTs) by a self-administered structured online survey, which explores the perception of in vitro embryos in two controversial cases of clinical practice: embryos dispositions after death (case 3) and after divorce (case 4).

Congenital Malformations in Infants of Mothers Undergoing Assisted Reproductive Technologies: A Systematic Review and Meta-analysis Study / 예방의학회지

OBJECTIVES: This meta-analysis aimed to evaluate congenital malformations in infants conceived by assisted reproductive techniques (ART), compared with infants conceived spontaneously. METHODS: In this study, available resources searched to find relevant articles included PubMed, ScienceDirect, Scopus, Google Scholar, Cochrane, ProQuest, Iranmedex, Magiran, and Scientific Information Database. After extracting the necessary information from evaluated articles, meta-analysis on the articles’ data was performed using Stata version 11.2. RESULTS: In this study, from a total of 339 articles, extracted from the initial investigation, ultimately 30 articles were selected for meta-analysis that assessed the use of ART on the risk of congenital abnormalities and some birth complications on 5 470 181 infants (315 402 cases and 5 154 779 controls). The odds ratio (95% confidence interval [CI]) for low birth weight was 1.89 (95% CI, 1.36 to 2.62), preterm labor 1.79 (95% CI, 1.21 to 2.63), cardiac abnormalities 1.43 (95% CI, 1.27 to 1.62), central nervous system abnormalities 1.36 (95% CI, 1.10 to 1.70), urogenital system abnormalities 1.58 (95% CI, 1.28 to 1.94), musculoskeletal disorders 1.35 (95% CI, 1.12 to 1.64), and chromosomal abnormalities in infants conceived by ART was 1.14 (95% CI, 0.90 to 1.44), which were all statistically significant, except chromosomal abnormalities. CONCLUSIONS: The risk of congenital abnormalities and some birth complications were significantly higher in ART than normal conception, while chromosomal abnormalities were not; therefore, the application of ART should be selected individually for patients by detailed assessment to reduce such risks in the population.

A Experiência Paterna da Gestação no Contexto da Reprodução Assistida / Father’s Experience of Pregnancy in the Context of Assisted Reproduction

RESUMO Quando o projeto parental é inviabilizado em decorrência da infertilidade e o casal recorre às Técnicas de Reprodução Assistida (TRA), a construção da paternidade pode ser afetada. Este estudo qualitativo, que teve como objetivo investigar a experiência paterna da gestação nesse contexto, foi realizado com 13 pais cujas companheiras engravidaram por meio de TRA e se encontravam no terceiro trimestre gestacional A análise de conteúdo das entrevistas revelou que os participantes estavam envolvidos com a gestação e com o bebê, bem como com aceitação da ideia de se tornar pai. Destaca-se que essa vivência foi permeada pelas repercussões da infertilidade e do tratamento, o que pode trazer dificuldades e especificidades para a paternidade. Nesse contexto, em que o desejo e a realização da paternidade sofrem entraves desde seu início, é importante que se possa oferecer aos futuros pais o apoio de profissionais da área da saúde mental.

ABSTRACT When plans to become parents cannot be realized due to infertility, and when the couple resort to Assisted Reproductive Technologies (ART), the construction of fatherhood may be affected. The objective of this qualitative study with 13 men whose partners conceived through ART and were in their third trimester of pregnancy was to investigate the experience of pregnancy according to the fathers’ perceptions. Content analysis of the interviews showed that the majority of participants was involved with pregnancy and the baby, and also accepted the idea of becoming a father. It is noteworthy that this experience was permeated by the repercussions of infertility and its treatment, which may lead to difficulties and specificities to fatherhood. In this context, in which the desire to become a father and the possibility to fulfill such a dream are difficult since the beginning, the authors suggest that these men may be supported by mental health professionals.

Indagações sobre as novas formas de fabricação o humano à luz da noção de dádiiva de marcel mauss / Questions about new forms of human manufacture the light of the notion of dádiiva of Marcel Mauss

Buscaremos articular a lógica implicada nas doações de material de engendramento (sêmen, óvulos e embriões), praticadas no campo das novas tecnologias reprodutivas (NTR), com o sistema de trocas de algumas sociedades arcaicas, descrito por Marcel Mauss em seu célebre artigo Ensaio sobre a dádiva (1924/1974). Esta articulação será também trabalhada a partir de três importantes intérpretes deste ensaio - Lévi-Strauss, Maurice Godelier e George Bataille -, de modo a extrair dela algumas consequências e explicitar alguns questionamentos que as NTR colocam para a psicanálise e vice-versa.

Questioning the new forms of human fabrication in the light of Marcel Mauss's concept of gift. In this article, we will articulate the logic involved in donations from engenderment material (semen, eggs and embryos), practiced in the field of new reproductive technologies, with the system of exchanges of some archaic societies described by Marcel Mauss in his celebrated article Essay on the gift (1924/1974). This articulation will also be crafted from three important interpreters of this essay - Lévi-Strauss, Maurice Godelier and George Bataille - in order to extract some consequences and clarify some questions that the NRT address to psychoanalysis and vice versa.

Current status of assisted reproductive technology in Korea, 2010 / 대한생식의학회지

OBJECTIVE: Great advances have been made in the field of assisted reproductive technology (ART) since the first in vitro fertilization (IVF) baby was born in Korea. This study was designed to report on the current status of ART therapy in South Korea between January 1 and December 31 of 2010. METHODS: A revised survey, originally developed by the International Committee Monitoring Assisted Reproductive Technologies, was sent to all available ART centers via email in 2013. Fresh embryo transfer (FET) cases were categorized into standard IVF or intracytoplasmic sperm injections. These cases, the thawing embryo transfer (TET) cases, and other related procedures were surveyed. RESULTS: Data from 30,785 ART procedures were provided by 78 clinics. Of the 28,200 cycles in which oocytes were retrieved, 92.2% of these cycles were completely transferred. In addition, 8,075 cycles were confirmed to be clinical pregnancies in the FET cycles, which represent a pregnancy rate of 28.6% per oocyte pick-up and 31.1% per embryo transfer. The most common number of embryos transferred in the FET was three embryos (37.3%) followed by two embryos (36.3%) and one embryo (14.0%). Of the 6,648 TET cycles transferred, 2,356 clinical pregnancies were confirmed by ultrasonography. The most common number of embryos in the TET group was two embryos (43.4%) followed by three embryos (25.4%) and one embryo (18.9%). CONCLUSION: The clinical pregnancy rate per transfer in the FET cycles was similar in 2009 and 2010. Among the FET cycles where one or two embryos were transferred, the clinical pregnancy rate per transfer slightly increased from 2009 (28.7%) to 2010 (32.9%).

Dilemas bioéticos en torno a la fertilización in vitro (FIV) y la mujer gestante: hacia la figura de un consejero reproductivo / Dilemas bioéticos em torno da fertilização in vitro (FIV) e a mulher gestante: em torno da figura de um conselheiro reprodutivo / Bioethical dilemmas around in vitro fertilization (IVF) and gestational woman: towards the figure of a reproductive counselor

Este artículo plantea algunos dilemas importantes en torno a la fertilización in vitro (FIV) y la mujer gestante. En él se contrastan las dos posturas bioéticas predominantes: liberal y conservadora respecto de ambos fenómenos. Se llevó a cabo un análisis cualitativo respecto a las posturas teóricas dominantes y el estado del arte de las tecnologías reproductivas y la gestación subrogada. En conclusión,se propone una figura bioética innovadora en la práctica de la reproducción asistida: un consejero reproductivo que ayude en la toma de decisiones durante el proceso de reproducción artificial de la pareja o persona sola,y sea un interlocutor entre ellos y el especialista. Además, se proponen mínimos éticos para la selección de la mujer gestante.

This paper studies some important dilemmas around in vitro fertilization (IVF) and gestational woman. Two predominant bioethical views are contrasted: liberal and traditional with respect to both phenomena. Qualitative analyses were carried out with respect to dominant theoretical views and the state of the art of reproductive technologies and subrogate pregnancy. As conclusion, an innovative bioethical figure in the practice of assisted reproduction is proposed: a reproductive counselor that helps in decision making during the process of artificial reproduction of the couple or single person to be an interlocutor between the users and the specialist. Furthermore, an ethical minimum for the selection of gestational women is proposed.

Este artigo propõe alguns dilemas importantes em torno da fertilização in vitro (FIV) e a mulher gestante. Nele se contrastam as duas posturas bioéticas predominantes: liberal e conservadora, a respeito de ambos os fenômenos. Foi levada a cabo uma análise qualitativa a respeito das posturas teóricas dominantes e do estado da arte das tecnologias reprodutivas e da gestação substituta. Em conclusão, se propõe uma figura bioética inovadora na prática da reprodução assistida: um conselheiro reprodutivo que ajude na tomada de decisões durante o processo de reprodução artificial do casal ou de apenas uma pessoa, e seja um interlocutor entre eles e o especialista. Ademais, se propõem mínimos éticos para a seleção da mulher gestante.

Reprogenética: avance técnico y avatares subjetivos / Reprogenetics: technical progress and subjective avatars

La especie humana es por esencia una extraordinaria torsión, única y singular. Allí radica algo de la peculiaridad de la condición humana. El desarrollo de las tecnologías reproductivas han cambiado el mundo tal como lo conocíamos. ¿Podemos hablar –siguiendo a Kuhn– de un cambio de paradigma? Eso habrá que verlo. Por el momento presentamos diferentes escenarios que ponen en interlocución el avance científico, el campo normativo y la dimensión subjetiva. Entre necesidad y azar el campo de la reprogenética nos confronta con interrogantes que atraviesan el devenir de la condición humana, mina las bases y hace estallar el modelo de familia tradicional dando lugar al amplio abanico de las nuevas conformaciones familiares. Siguiendo los desarrollos propuestos por Foucault en Historia de la sexualidad I, La voluntad de Saber se da entrada a un discurso que permite reflexionar en torno a la incidencia del poder en las prácticas cotidianas. Poner al deseo en discurso, implica analizar cuáles son los “mecanismos de poder para cuyo funcionamiento el discurso sobre el sexo ha llegado a ser esencial.” “Sexualidad” y “familia” serán entonces nuestros disparadores para pensar la articulación de la biopolítica en el discurrir de las narrativas sobre el cuerpo. Por último, un escenario cinematográfico será la ocasión ideal para desentrañar los aspectos oscuros y controvertidos del planteo eugenésico en las antípodas de la reprogenética...

The human being is an extraordinary torsion, essentially unique and singular. We might find there something of its particular value. The development of assisted reproductive technologies has changed the world as we knew it. Following Thomas Kuhn ideas, can we argue that we are under a "paradigm shift" in terms of this revolution? We´ll see… For instance we will present some specific scenarios in which the scientific breakthrough, the regulatory and legislative field, and the subjective dimension are interconnected. In-between chance and necessity, the concerns of reprogenetics faced us with huge question which cross the evolution of human condition, erode the foundations and crush into the traditional model of the "contemporary" family leading to a wide range of new family conformation. Following some ideas of Michel Foucault proposed in The History of Sexuality I, The Will to Knowledge we will analyze how power affects daily practices. To put the desire into discourse suppose to analyze which are the mechanism of power in which the discourse on sex has become essential. "Sexuality" and "Family" will be our triggers to reflect on the impact of biopolitics in the narrative discourse over the body. Finally we have chosen a film to explore the dark and controversial aspects of the eugenics strategy opposed to reprogenetics approach

La muerte antes del nacimiento / Death before birth

¿Podemos verdaderamente estar muertos antes de haber nacido? Los avances de la medicina prenatal y el cambio del estatuto del feto que surge de ellos, nos confrontan con este tipo de preguntas paradojales. A partir de las imágenes que ofrece la ecografía, el niño por nacer adquiere una existencia concreta. Si llega a desaparecer, se pierde un ser que ya es cercano, que se sentía vivo en el vientre materno y cuyo duelo aparece problematizado. Este artículo aborda esta compleja cuestión apelando a las lecciones de la Antígona, de Sófocles, analizando el lugar de la nominación y la sepultura frente a las nociones de vida y muerte a que dan lugar los desarrollos en materia de medicina predictiva...

Can we truly be dead before being born? Advances in prenatal medicine and the resulting change in the statute of the fetus, confront us with this type of paradoxical questions. From the moment an ultrasound image of an unborn child is obtained, the child acquires a concrete existence. Should it disappear, mourning the loss of a being that is already close, that was alive in the womb, becomes a traumatic experience. This complex subject is addressed by resorting to Antigone, Sophocles, analyzing the importance of place that naming and burial have, when confronted with the notions of life and death that have given rise to the developments in predictive medicine

O fio cirúrgico da laqueadura é tão pesado!: laqueadura e novas tecnologias reprodutivas / The surgical thread used in tubal sterilization is so heavy!: tubal sterilization and new reproductive technologies

A laqueadura é um método de esterilização cirúrgica feminina, que consiste em cortar cirurgicamente as trompas, que unem os ovários ao útero. É um método considerado seguro, irreversível, cujas taxas dobraram desde 2003, no contexto brasileiro. O presente estudo é pesquisa qualitativa com o objetivo de descrever e analisar os pensamentos e as avaliações acerca da laqueadura entre as mulheres que buscavam auxílio das novas tecnologias reprodutivas para conceber novamente. As entrevistas foram realizadas em um hospital da rede pública de saúde, na região Sudeste do Brasil, São Paulo, com 16 mulheres esterilizadas. Como resultados, as seguintes temáticas emergiram do estudo: o não cuidado com a vida reprodutiva; laqueadura e habitus; e o arrependimento traduzido pela frase proferida por Rosa: “O fio cirúrgico da laqueadura é tão pesado!”. O estudo desvelou a necessidade de que as mulheres sejam mais bem informadas sobre os procedimentos cirúrgicos que desejam aceder: seja à laqueadura, seja a tratamentos na área das novas tecnologias reprodutivas. O acesso às informações pode promover melhor familiaridade com os termos e mais segurança ante as escolhas.

Tubal sterilization is a method of female sterilization, consisting of the surgical severance of the fallopian tubes which connect the ovaries to the uterus. This method, the rates for which have doubled in Brazil since 2003, is considered safe and irreversible. This study is a qualitative research project which seeks to describe and analyze the thought process and assessment of sterilization by women who have subsequently sought the help of new reproductive technologies to enable them to conceive. Sixteen sterilized women were interviewed at a hospital within the public health system in São Paulo, southeastern Brazil. As a result, the following themes emerged from the study: women’s lack of care regarding their reproductive life; sterilization and (constitution) habitus, and the remorse expressed in the phrase proffered by Rosa: “The surgical thread used in tubal sterilization is so heavy!” The study highlighted the need for women to be better informed about the surgical procedures available to them: whether about tubal ligation or about treatments in the field of new reproductive technology. Access to this information can promote greater understanding of the terms and greater confidence in dealing with the choices involved.

The research progress and applications of anti-müllerian hormone / 中华检验医学杂志

Anti-müllerian hormone (AMH) is mainly produced by the granulose cells of the developing preantral and antral follicles in women and a reliable marker of the reproductive function of women.The mean terminal t1/2 of AMH is calculated as (27.6 ± 0.8) h.Serum concentration of AMH declines by 5.6％ per year and several reproductive and lifestyle factors are associated with age-specific AMH levels.AMH can be applied to predict the precise age of the menopause and is a marker of ovarian reserve in women of 25 year old and older.Iu the field of assisted reproductive technologies,AMH is beneficial in the individualization of stimulation protocols at controlled ovarian hyperstimulation and may be positively associated with clinical pregnancy rates,live-birth rates and twin gestation after assisted reproduction.The researches of AMH may be helpful in the studies of mechanism of polycystic ovary syndrome (PCOS).AMH measurement may be included as a diagnostic criterion of PCOS and a useful predictive marker for the efficiency of the treatment of PCOS.AMH has been also shown to inhibit tumor growth in vitro and in vivo and can be used as a tumor marker in granulosa cell tumors.By using AMH,ovarian reserve damages caused by different kinds of diseases and treatments,including rheumatoid arthritis,laparoscopic surgeries of endometriomas,chemotherapy of female cancers have been studied.Some researchers have begun to pay attention to the potential relationship between AMH and the function of human brain.In the future,the applications of AMH maybe probably do significant contributions to make ideal and individualized treatment programs in more and more related fields.