Revelar e ter com quem contar: infertilidade e apoio social / Revelar y tener con quien contar: infertilidade y apoyo social / To disclose and have someone to count on: infertility and social support

Infertile couples seeking treatment experience a social stigma that can lead to the need for privacy and, in turn, compromise their access to social support. This multiple case study, that involved the collection of sociodemographic and health data and interviews with four heterosexual couples accessed by convenience, aimed to examine the perception of the couples about the social support received after the disclosure of the condition of infertility and/or of the assisted reproductive technology treatment. The cases were analysed individually and comparatively. From the couples' statements, it is highlighted that all of them revealed something about infertility and/or treatment at some point in the process, although some considered not revealing it. Both support and lack of support were perceived from the revelations. The non-disclosure was motivated by self-preservation and by avoidance of social pressure. The findings indicate the importance of psychological intervention to expand the couples' social support.

Parejas infértiles que buscan tratamiento experimentan un estigma social que puede acarrear la necesidad de privacidad y, a su vez, comprometer el acceso al apoyo social. Ese estudio de múltiples casos, que involucró la recogida de datos sociodemográficos, de salud y entrevistas con cuatro parejas heterosexuales accedidas por conveniencia, buscó examinar la percepción de las parejas sobre el apoyo social después de la revelación de la condición de infertilidad y/o del tratamiento con técnicas de reproducción asistida. Los casos fueron analizados individual y comparativamente. De las declaraciones de las parejas, se destaca que todas revelaron algo sobre la infertilidad y/o el tratamiento en algún momento del proceso, aunque algunos consideraron no revelarlo. Se percibió tanto el apoyo como la falta de apoyo a partir de las revelaciones. La no revelación fue motivada por la autopreservación y por la evitación de presión social. Los hallazgos indican la importancia de la intervención psicológica para ampliar el apoyo social de las parejas.

Casais inférteis que buscam tratamento experimentam um estigma social que pode acarretar a necessidade de privacidade e, por sua vez, comprometer o acesso ao apoio social. Este estudo de casos múltiplos, que envolveu a coleta de dados sociodemográficos, de saúde e entrevistas com quatro casais heterossexuais acessados por conveniência, objetivou examinar a sua percepção sobre o apoio social recebido após a revelação da condição de infertilidade e/ou de tratamento com técnicas de reprodução assistida. Os casos foram analisados individualmente e comparativamente. A partir das falas, destaca-se que todos revelaram algo sobre a infertilidade e/ou o tratamento em algum momento do processo, ainda que alguns tenham considerado não revelar. Percebeu-se tanto apoio como falta de apoio diante das revelações. A não revelação foi motivada pela autopreservação e pela evitação de pressão social. Os achados indicam a importância da intervenção psicológica para ampliar o apoio social dos casais.

Imaginários Morais no Discurso Midiático Sobre o Uso da Inseminação Caseira por Mulheres Lésbicas / Moral Imaginaries on the Media Discourse on the Use of Homemade Insemination by Lesbian Women / Imaginarios Morales en el Discurso Mediático Sobre Uso de la Inseminación Domiciliaria por Mujeres Lesbianas

O presente artigo objetiva refletir sobre o discurso moral midiático produzido em torno da Inseminação Caseira e seu uso como tecnologia reprodutiva por casais de mulheres lésbicas. Esta é uma modalidade reprodutiva autônoma, que consiste em uma autoinseminação de baixo custo, feita com o uso de material biológico de doador não anônimo. Para esta reflexão, utilizou-se cinco obras midiáticas produzidas por canais de comunicação de grande alcance no cenário nacional, analisadas sob a ótica da análise do discurso. Foram traçadas cinco categorias analíticas: apresentação textual-imagética das obras; narrativa das mulheres tentantes; discursos promovidos pelos ditos especialistas; e representação da figura do doador. Conclui-se pela necessidade de estímulo ao debate acerca da inseminação caseira realizada por mulheres lésbicas, de modo que tanto profissionais da área da saúde como a sociedade de uma forma geral não se baseiem apenas em discursos morais condenatórios ditos científicos, como aqueles propagados pela grande mídia em relação à Inseminação Caseira. Soma-se a isso a importância em garantir visibilidade para os relatos das mulheres que estão se submetendo à inseminação caseira, compreendendo-as enquanto protagonistas da produção de sua saúde sexual e reprodutiva e projetos parentais e que, por isso, devem ter seus discursos e experiências legitimados.

The present article aims to reflect on the media moral discourse produced around Homemade Insemination and its use as a reproductive technology by lesbian couples. This is an autonomous reproductive modality, which consists in a low-cost self-insemination performed with the use of biological material from a non-anonymous donor. This reflection was made using five media works produced by communication channels of great reach in the Brazilian scenario, analyzed from the point of view of discourse analysis. Five analytical categories were drawn: textual-imagetic presentation of the works; narrative of women trying to conceive; speeches promoted by the so-called experts; and representation of the donor figure. We conclude that it is necessary to stimulate the debate about homemade insemination performed by lesbian women, so that both health professionals and society in general do not rely only on condemning moral speeches called scientific, such as those propagated by the media in relation to Homemade Insemination. Added to that it is important to ensure visibility of the reports of women who are submitting themselves to homemade insemination, understanding them as protagonists of the production of their sexual and reproductive health and parental projects and that, therefore, they must have their speeches and experiences legitimated.

Este artículo pretende reflexionar sobre el discurso moral mediático producido sobre la Inseminación Domiciliaria y su uso como tecnología reproductiva por parejas lesbianas. Se trata de una modalidad reproductiva autónoma, que consiste en una autoinseminación de bajo coste realizada con el uso de material biológico de donante no anónimo. Para esta reflexión, se utilizaron cinco obras mediáticas producidas por canales de comunicación de gran alcance en Brasil analizadas desde la perspectiva del análisis del discurso. Se trazaron cinco categorías analíticas: presentación textual-imagen de las obras; narración de las mujeres que intentan; discursos promovidos por los llamados especialistas; y representación de la figura del donante. Se concluye por la necesidad de estimular el debate sobre la Inseminación Domiciliaria realizada por mujeres lesbianas, de manera que tanto los profesionales de salud como la sociedad en general no se basen apenas en los discursos morales condenatorios de los científicos, como los propagados por la gran prensa sobre Inseminación Domiciliaria. A esto se suma la importancia de garantizar la visibilidad de los relatos de las mujeres que hacen la Inseminación Domiciliaria, entendiéndolas como protagonistas de la producción de su salud sexual y reproductiva y de sus proyectos parentales y debe tener sus discursos y experiencias legitimados.

Técnicas de reproducción asistida en personas del mismo sexo y solas por opción: realidad en Chile 2021 / Assisted reproduction techniques in people of the same sex and alone by option: reality in Chile 2021

Resumen El concepto de familia ha cambiado con los años y la constitución de los hogares en Chile ya no es la misma que hace un siglo. Las familias diversas en nuestro país han existido durante toda la vida, pero el conocimiento de cómo se han constituido y la existencia de un catastro en Chile son escasos. El objetivo de esta revisión es mostrar cómo se han constituido las familias diversas en Chile, cómo ha sido el acceso de estas a las técnicas de reproducción asistida, cuál ha sido la política del Estado y las aseguradoras de salud (Fonasa e Isapres) en las coberturas, y qué ha pasado con la legislación a lo largo de los años que ha facilitado la constitución de nuevas familias. Por otra parte, se pretende mostrar cuáles son las barreras al acceso por parte de las familias diversas y la necesidad de una ley de reproducción asistida que permita el acceso a todas las personas independientemente de su estado civil, orientación sexual o identidad de género, y que proteja a todos los nacidos chilenos por igual.

Abstract The image of a typical family has changed in recent years, as the makeup of households in Chile is no longer the same as decades ago. While gender and sexual diverse families in our country have always existed, there is a scarcity of reliable data. We review the evolution of the makeup of these diverse families in Chile and their access to assisted reproduction techniques. We also review national policies and health insurance coverage by both governmental and private carriers (Fonasa and Isapres) and how changes in legislation over the years have facilitated the constitution of these families. We outline barriers to access assisted reproduction techniques and the need for further legislative action to guarantee access to all citizens regardless of their marital status, sexual orientation, or gender identity.

As inconstitucionalidades da Resolução CFM nº 2294/2021 sobre a utilização das técnicas de reprodução assistida / The unconstitutionalities of Resolution CFM nº 2294/2021 on the use of assisted reproduction techniques

O Conselho Federal de Medicina acaba de editar a Resolução nº 2.294/2021, publicada em 15 de junho de 2021, que aponta normas para a utilização das técnicas de reprodução assistida. Apesar de o propósito ser o aperfeiçoamento das práticas e a observância aos princípios éticos e bioéticos para trazer maior segurança e eficácia a tratamentos e procedimentos médicos, repete inconstitucionalidades das normatizações pretéritas e impõe mais restrições ao sonho das pessoas de ter filhos. Desse modo, mais do que avanços, o novo regramento provoca um retrocesso que não se coaduna com a garantia constitucional e legal que assegura o livre planejamento familiar.(AU)

The Brazilian Federal Council of Medicine has just edited the Resolution nº 2.294/2021, published on June 15, 2021, which sets out rules for the use of assisted reproduction techniques. Although the purpose is to improve practices and observe ethical and bioethical principles to bring greater safety and efficacy to medical treatments and procedures, it repeats the unconstitutionalities of past regulations and imposes more restrictions on people's dreams of having children. In this way, more than advances, the new regulation provokes a setback that is not consistent with the constitutional and legal guarantees of free family planning.(AU)

Affordability and quality of cross-border reproductive care from the perspective of surrogacy mediating agencies in Spain / Asequibilidad y calidad de la atención reproductiva transfronteriza desde la perspectiva de las agencias mediadoras de gestación por sustitución en españa

RESUMEN La gestación por sustitución contribuye a la transformación de las concepciones sociales de la filiación y los cambios en las estrategias reproductivas de las familias. En la presente contribución se relaciona la teoría de la atención reproductiva transfronteriza con las teorías posmodernas de la vida familiar, con el propósito de explorar qué temáticas, elementos y contenidos utilizan las agencias intermediarias de gestación por sustitución que tienen por destinatarios a las madres y padres de intención españoles. Se utiliza la metodología cualitativa y la técnica de análisis de contenido temático tras el registro de la información online recogida de las agencias. Los resultados evidencian el papel de estas agencias mediadoras en los procesos de gestación por sustitución en España, además de generar conocimiento en el área de las nuevas formas familiares constituidas mediante técnicas de reproducción asistida.

ABSTRACT Substitution pregnancy contributes to the transformation of social conceptions of filiation and changes in the reproductive strategies of families. This contribution relates the theory of cross-border reproductive care with post-modern theories of family life in order to explore which themes, elements and contents are used by intermediary surrogate pregnancy agencies which target Spanish mothers and fathers. The qualitative methodology and the technique of thematic content analysis after registration of the online information collected from the agencies is used. The results show the role of these intermediary agencies in the process of gestation by substitution in Spain, as well as generating knowledge in the area of new family forms constituted by assisted reproduction techniques.

Implementación de técnicas de reproducción asistida en el Centro de Reproducción Humana de la Universidad de Valparaíso: resultados del primer trienio (2015 - 2017) / Implementation of assisted reproduction techniques at the Center of Human Reproduction of the Universidad de Valparaíso: results of the first triennium (2015 - 2017)

INTRODUCCIÓN Y OBJETIVOS: La infertilidad es una enfermedad altamente prevalente que afecta aproximadamente a un 8-10% de las parejas en edad reproductiva. Las Técnicas de Reproducción Asistida (TRA) han experimentado un importante incremento en el número de tratamientos realizados, no obstante, el acceso en Chile sigue siendo limitado y centralizado. El presente estudio resume la experiencia y los resultados de TRA del primer trienio del Centro de Reproducción Humana de la Universidad de Valparaíso (CRHUV). MÉTODOS: Estudio de cohorte retrospectiva de las pacientes sometidas a TRA en el CRHUV desde 1 de enero de 2015 a 31 diciembre 2017. Se realizó un análisis descriptivo e inferencial. La distribución de variables fue analizada con la prueba de Shapiro-Wilk. Para variables cualitativas se usó la prueba exacta de Fisher. RESULTADOS: Se iniciaron un total de 581 ciclos. Para un total de 340 ciclos en fresco con ovocitos propios, la tasa de embarazo (TE) y de parto (TP) por ciclo aspirado fue de 43,5% y 36,7% respectivamente. En el mismo grupo, la TE y TP por transferencia embrionaria fue de un 48,4% y un 40,9% respectivamente, siendo superior al comparar transferencia doble con un embrión (p < 0,05). También se observó un aumento de TE en menores de 35 años (p < 0,05). La TE y TP por transferencia embrionaria fue semejante en transferencia de embriones frescos y congelados. Al transferir embriones producto de ovocitos donados se observó un incremento significativo de la TE y TP con tasas de 73,1% y 61,5% respectivamente. Las tasa globales y estratificadas de embarazo y parto fueron comparables en el trienio estudiado con los resultados de la REDLARA. CONCLUSIÓN: La exitosa implementación del CRHUV se respalda en los resultados comparables a lo reportado por literatura internacional.

INTRODUCTION AND OBJECTIVES: Infertility is a highly prevalent disease that affects approximately 8-10% of couples in reproductive age. Assisted reproduction techniques (ART) have experienced a significant increase in the number of treatments performed, however, access in Chile remains limited and centralized. This study summarizes the experience and results of the first triennium of the Center for Human Reproduction of the Universidad de Valparaíso (CRHUV). METHODS: Retrospective cohort study of patients undergoing ART at the CRHUV from January 1, 2015 to December 31, 2017. A descriptive and inferential analysis was performed. The distribution of the variables was analyzed with the Shapiro-Wilk test. For qualitative variables, Fisher's exact test was used. RESULTS: A total of 581 cycles were started. For a total of 340 fresh cycles with own oocytes, the pregnancy (RP) and delivery (DR) rate per oocyte retrival was 43.5% and 36.7%. In the same group, PR and DR per embryo transfer was 48.4% and 40.9%, being higher when comparing double with a single embryo transfer (p <0.05). A higher PR was also observed in < 35 years patients (p <0.05). The PR and DR per embryo transfer was similar using fresh and frozen embryo. In oocytes donation, a significant increase in PR and RD per embryo transfer was observed with rates of 73.1% and 61.5%, respectively. The global and stratified rates of pregnancy and delivery were comparable in the studied triennium compared to the results of REDLARA. CONCLUSION: The successful implementation of the CRHUV is supported by results comparable to those reported by international literature.

Abnormal fertilization in ICSI and its association with abnormal semen parameters: a retrospective observational study on 1855 cases / 亚洲男科学杂志(英文版)

Intracytoplasmic sperm injection (ICSI) efficiently addresses male factor infertility. However, the occurrence of abnormal fertilization, mainly characterized by abnormal pronuclei (PN) patterns, merits investigation. To investigate abnormal fertilization patterns following ICSI and identify their respective associations with abnormal parameters in semen analysis (SA), a retrospective observational study including 1855 cycles was performed. Male infertility diagnosis relied on the 2010 WHO criteria. The population was divided into groups based on their SA results. The presence of 2PNs and extrusion of the second polar body (PB) indicated normal fertilization. A Kruskal-Wallis test along with a Wilcoxon post hoc evaluation and Bonferroni correction was employed for comparison among the groups. For the pregnancy rate, logistic regression was employed. No correlation was established between the SA abnormalities and the 1PN or 3PN formation rates. The highest and lowest 0PN rates were reported for the oligoasthenoteratozoospermic and normal groups, respectively. The lowest cleavage formation rates were identified in the oligoasthenozoospermic and oligoasthenoteratozoospermic groups. The aforementioned groups along with the oligoteratozoospermic group similarly presented the lowest blastocyst formation rates. For the clinical pregnancy rate, no statistically significant difference was observed. In conclusion, the incidence of two or more abnormal SA parameters - with the common denominator being oligozoospermia - may jeopardize normal fertilization, cleavage, and blastocyst rates. Once the developmental milestone of achieving blastocyst stage status was achieved, only oligoasthenozoospermia and oligoasthenoteratozoospermia were associated with lower rates. Interestingly, following adjustment for the number of blastocysts, no statistically significant differences were observed.

Análise crítica sobre a evolução das normas éticas para a utilização das técnicas de reprodução assistida no Brasil / Critical analysis on the evolution of ethical norms for the use of assisted reproduction techniques in Brazil

Resumo O Conselho Federal de Medicina (CFM) publicou em 1992 a resolução CFM nº 1.358/1992 com o objetivo de adotar normas éticas para utilização das técnicas de Reprodução Assistida (TRA). Esta resolução foi atualizada em 2010 (CFM nº 1.957/2010), em 2013 (CFM Nº 2.013/13) e teve sua última atualização 2015 (CFM nº 2.121/2015). O objetivo desse artigo é fazer uma análise crítica sobre a evolução das normas éticas propostas pelo CFM para a utilização de TRA no Brasil. Foi realizada uma análise documental do texto das quatro Resoluções publicadas onde estão descritas as normas éticas para utilização das TRA. Foi observado que a resolução evoluiu em relação aos direitos dos homossexuais, adotou medidas mais permissivas em relação a criopreservação, doação de gametas e embriões e cessão de útero e por fim autorizou alguns procedimentos em TRA como a reprodução post mortem, doação e gestação compartilhada. A partir de 2013 a resolução ganhou um caráter liberal estando atualizada com a prática clínica. Para as próximas atualizações seria interessante incluir procedimentos em TRA os quais não foram abordados como a transferência nuclear e citoplasmática. A frequência de atualização (a cada dois anos) deve ser mantida para as normas éticas que norteiam a TRA continuar evoluindo juntamente com o avanço da ciência.

Abstract The Federal Medical Council (FMC) published FMC Resolution No. 1,358/1992 with the aim of adopting ethical standards for the use of Assisted Reproduction Techniques (ART). This resolution was updated in 2010 (CFM No. 1957/2010), in 2013 (CFM No. 2,013/13) and the last update was in 2015 (CFM No. 2.121/2015). The scope of this article is to conduct a critical analysis of the evolution of the ethical norms proposed by FMC for the use of ART in Brazil. A documentary analysis of the text of the four published Resolutions was carried out, in which the ethical standards for the use of ART were described. It was observed that the resolution evolved in relation to the rights of homosexuals, adopted more permissive measures regarding cryopreservation, donation of gametes and embryos and uteruses on loan and lastly authorized some procedures in ART such as postmortem reproduction, donation and shared gestation. From 2013 onwards the resolution gained a liberal character being updated in terms of clinical practice. For the next updates it would be interesting to include procedures in ART not previously addressed such as nuclear and cytoplasmic transfer. The update frequency (every two years) should be kept to the ethical standards enabling the ART to continue evolving together with the advancement of science.

Mid-life fertility: Challenges & policy planning

This review highlights the challenges, priority areas of research and planning, strategies for regulation of services and the need to develop guidelines and laws for fertility treatments during mid-life. The success rate of all treatments is poor in advanced age women because of declining ovarian reserve and natural fertility. There is often a need of third-party involvement which has its own ethical, legal and medical issues. Welfare of children born to older women and early death of parents are important concerns. Most of the new techniques such as the pre-implantation genetic diagnosis, oocyte augmentation, use of stem cells or artificial gametes, ovarian tissue preservation and ovarian transplantation are directed to improve, preserve or replace the declining ovarian reserve. These techniques are costly and have limited availability, safety and efficacy data. Continued research and policies are required to keep pace with these techniques. The other important issues include the patients' personal autonomy and right of self-determination, welfare of offspring, public vs. private funding for research and development of new technologies vs. indiscriminate use of unproven technology. It is important that mid-life fertility is recognized as a distinct area of human reproduction requiring special considerations.

Características demográficas de las madres e hijos sometidos a técnicas de reproducción asistida en el Hospital Español de México en 2016 / Demographic characteristics of mothers and children undergoing assisted reproduction techniques at Hospital Español de México in 2016

Resumen Introducción La infertilidad es una enfermedad caracterizada por la incapacidad de lograr un embarazo después de 12 meses o más de relaciones sexuales no protegidas. En México, la reproducción asistida se encuentra a la par de cualquier país, siendo la tercera nación de Latinoamérica con mayor número de centros de reproducción. Objetivo Determinar las características demográficas de las madres e hijos sometidos a técnicas de reproducción asistida (TRA) en el Hospital Español de México en 2016. Material y métodos Se trata de un estudio descriptivo, retrospectivo que incluyó a los recién nacidos producto de TRA del Hospital Español de México en 2016. Se obtuvo información sobre el método de interrupción del embarazo, el número de productos, las semanas de gestación al nacimiento, peso y talla al nacimiento y si requirieron ingreso a la UCIN, así como las complicaciones presentadas. Resultados Se incluyeron 292 pacientes sometidas a TRA. De las complicaciones maternas asociadas, las más prevalentes fueron las infecciones durante el embarazo. Se obtuvieron datos de 373 recién nacidos. Se describen las complicaciones en estos pacientes; las más frecuentes fueron las respiratorias. Conclusiones Las TRA son tratamientos cada vez más utilizados. Hay que ser cuidadosos a la hora de informar a los futuros padres acerca de las complicaciones asociadas, teniendo en cuenta la variabilidad de datos disponibles.

Abstract Introduction Infertility is a disease characterized by the inability to achieve a pregnancy after 12 months or more of unprotected sex. In Mexico, assisted reproduction is on par with any country, being the third nation in Latin America with the largest number of reproduction centers. Objective To determine the demographic characteristics of mothers and children undergoing assisted reproduction techniques (ART) at the Hospital Español de México in 2016. Material and methods This is a descriptive, retrospective study that included newborns product of ART performed in the Hospital Español de México in 2016. Information was obtained on the method of delivery, number of products, weeks of gestation at birth, birth weight and height, and if they required admission to the NICU, as well as the complications presented. Results 292 patients undergoing ART were included. Of the associated maternal complications, the most prevalent were infections during pregnancy. Data were obtained from 373 newborns. The complications in these patients are described, the most frequent being respiratory. Conclusions ART are increasingly used treatments. Care must be taken when informing prospective parents about associated complications, taking into account the variability of the available data.

Consecuencias perinatales de embarazos logrados mediante reproducción asistida versus embarazos espontáneos / Perinatal results of pregnancy achieved by assisted reproduction therapy versus spontaneous pregnancy

Resumen OBJETIVO: Describir y comparar las consecuencias perinatales de los embarazos logrados por reproducción asistida versus espontáneos. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y analítico. Se incluyeron pacientes que terminaron el embarazo en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes; se excluyeron las embarazadas con expediente clínico incompleto, terminación del embarazo antes de las 22 semanas. Se analizaron y compararon las principales consecuencias perinatales en ambos tipos de embarazos. El análisis de asociación entre terapia de reproducción asistida y complicaciones perinatales se hizo mediante una regresión logística simple y ajustada por variables confusoras. RESULTADOS: De 448 ciclos iniciados, se analizaron 98 embarazos únicos logrados por reproducción asistida; menor probabilidad para recién nacido pretérmino (p < 0.05) e ingreso a la unidad de cuidados intensivos neonatales (p <0.05) y embarazos múltiples; una probabilidad significativa de amenaza de parto pretérmino versus embarazos espontáneos (p < 0.05). CONCLUSIONES: Se registraron menos complicaciones perinatales en embarazos únicos por reproducción asistida y en embarazos múltiples mayor probabilidad de amenaza de parto pretérmino sin mayor prevalencia de recién nacido pretérmino. La adecuada atención multidisciplinaria previa a la concepción tiene mayor peso en las repercusiones perinatales que la técnica de fertilización asistida por sí misma.

Abstract BACKGROUND: As demand for assisted reproduction techniques has increased, so have concerns about associated perinatal outcomes and whether they are different from spontaneously achieved pregnancies. OBJECTIVE: to describe and compare perinatal outcomes of pregnancies achieved by assisted reproduction versus spontaneous pregnancies. MATERIALS AND METHODS: Observational, cross-sectional, retrospective, analytical study. Pregnancies with resolution within the institute were included; those with an incomplete clinical record, termination of pregnancy before 22 weeks were excluded. The main perinatal results in both types of pregnancies were analyzed and compared. The analysis of the association between assisted reproduction therapy and perinatal complications was made by a simple logistic regression and adjusted for confounding variables. RESULTS: Of 448 cycles initiated, 98 pregnancies achieved by assisted reproduction were analyzed, observing in single pregnancies; lower probability for preterm newborns (p <0.05) and admission to the neonatal intensive care unit (p <0.05) and in multiple pregnancies; a significant probability to present threat of preterm delivery versus spontaneous pregnancies (p <0.05). CONCLUSIONS: There were fewer perinatal complications in single pregnancies for assisted reproduction and in multiple pregnancies a greater probability of threat of preterm delivery without a higher prevalence of preterm newborn, concluding that having an adequate preconceptional multidisciplinary management has a greater weight in perinatal outcomes than Fertilization technique assisted by itself.

Prevalencia de autoinmunidad tiroidea en mujeres subfértiles / Prevalence of thyroid autoimmunity in subfertile women

Resumen OBJETIVO: estimar la prevalencia de enfermedad tiroidea autoinmunitaria en pacientes subfértiles y saber si existe asociación entre enfermedad tiroidea autoinmunitaria aislada en mujeres eutiroideas y los resultados en técnicas de reproducción asistida. MATERIALES Y MÉTODOS: estudio observacional, transversal, ambispectivo, que evaluó mujeres de 18 a 43 años de edad atendidas en el servicio de Reproducción Humana del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes que tuvieran una determinación del perfil tiroideo con anticuerpos antitiroideos en la primera consulta de infertilidad. RESULTADOS: la prevalencia de enfermedad tiroidea autoinmunitaria en mujeres infértiles fue de 19%. El 48% tuvieron seropositividad para anticuerpos antitiroideos, 32% para anticuerpos antitiroglobulina más anticuerpos antiperoxidasa y 20% restante solo para anticuerpos antitiroglobulina. En el grupo de pacientes con enfermedad tiroidea autoinmunitaria se observó una prevalencia de hipotiroidismo clínico de 8% y subclínico de 48%. La media de TSH para las mujeres con enfermedad tiroidea autoinmunitaria fue de 4.6 μUI/L. Las mujeres con enfermedad tiroidea autoinmunitaria aislada eutiroideas representaron 8.3% de la población y tuvieron una alta tasa de abortos espontáneos previos (45.5%) y de fracaso en técnicas de reproducción asistida (70%). CONCLUSIÓN: la determinación de la autoinmunidad tiroidea debe ralizarse de manera rutinaria en la población de mujeres.

Abstract OBJECTIVE: To estimate the prevalence of autoimmune thyroid disease in subfertile patients who come to the Human Reproduction service of the National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico city. MATERIAL AND METHODS: A retrospective, cross-sectional, observational, ambispective study evaluating 18- to 43-year-old women from the INPer "Isidro Espinosa de los Reyes" human reproduction service with a thyroid profile determination with anti-thyroid antibodies in The first consultation of infertility. RESULTS: The prevalence of TEE in the population of infertile women is 19%. 48% have seropositivity for Ac-TPO, 32% for Ac-tiroglobulina plus Ac-TPO and the remaining 20% only for Ac-tiroglobulina. A prevalence of clinical hypothyroidism of 8% and subclinical of 48% was observed in the group of patients with ATE. The mean TSH for women with ATE was 4.6 μUI/L. Women with isolated euthyroid ETA represent 8.3% of the population and have a high rate of previous spontaneous abortions (45.5%) as well as failure in assisted reproduction techniques (70%). CONCLUSION: Determination of thyroid autoimmunity should be routinely performed in the female population.

Significados de la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida / Meanings of lived experience of pregnancy and labor of a woman with infertility diagnosis who did conceive through assisted reproduction techniques

OBJETIVO: Develar la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida. MÉTODO: Se trata de un estudio de caso con diseño fenomenológico. Se seleccionó una mujer portadora del fenómeno en estudio que accedió a compartir su experiencia mediante una entrevista en profundidad. La pregunta que guió el estudio fue ¿Cómo se muestra la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida? El análisis fue realizado de acuerdo a Streubert(1). Los pasos a seguir fueron: obtener la descripción de la participante, separar los supuestos del investigador ("bracketing"), leer la transcripción hecha "verbatim", revelar esencias, comprender las unidades de significado, desarrollar las descripciones, devolver a la participante para su validación, revisar literatura relevante, y compartir los resultados con la comunidad de enfermería. RESULTADOS: Destacan unidades de significado sobre sufrimiento por el tratamiento y las múltiples pérdidas que enfrenta la entrevistada. Se contraponen felicidad y angustia durante el embarazo, y esperanza al lograr el objetivo de vida planteado con su pareja. Surge el fortalecimiento del vínculo con su esposo, y finalmente miedo ante el verse enfrentada a la maternidad. Como conclusión se permite comprender que las mujeres enfrentadas a TRA tienen necesidades de cuidado únicas, por lo que el rol de enfermería es fundamental, sobre todo de acompañamiento. Se debe seguir estudiando este fenómeno en mujeres chilenas, e involucrar la perspectiva del padre.

OBJECTIVE: Reveal the lived experience of pregnancy and delivery of a woman diagnosed with infertility who did conceive through assisted reproduction techniques. METHOD: This is a case study with a qualitative health research design of phenomenology. The participant was a woman who is carrier of the phenomenon understudy and that agreedto share her experience through an in-depth interview. The study base question was ¿How the pregnancy and delivery process lived experience of a woman with infertility diagnosis who did conceive through assisted reproduction techniques is shown?. According to Streubert(1),the phenomenological analysis process steps are: to obtain the participant's description, to separate the assumptions of the researcher ("bracketing"), to read the transcript made "verbatim". Reveal essences, understand the units of meaning, develop the descriptions, return the participant for validation, review relevant literature, and share the results with the nursing community. RESULTS: There are significant units of meaning of suffering due to the treatment and the multiple losses that the interviewee faces. There is also the contrast between happiness and anguish in the course of pregnancy, and hope for having achieved the goal of life raised with her partner. The strengthening of the bond with her husband arises, and finally fears of being confronted with motherhood. As a conclusion, it is possible to understand that women facing ART have unique care needs, so the role of nursing is fundamental, especially accompaniment. This phenomenon should continue to be studied in Chilean women, and involve the perspective of the father.

Consideraciones bioéticas y jurídicas sobre la biotecnología con fines eugenésicos / Considerações bioéticas e jurídicas sobre a biotecnologia com finalidades eugenésicas / Bioethical and legal considerations about biotechnology with eugenic goals

Los nuevos avances biotecnológicos vinculados con la reproducción plantean cuestiones bioético-jurídicas de no poca envergadura. En efecto, a medida que las posibilidades reproductivas proliferan, también lo hacen los conflictos éticos relacionados con el favorecimiento de la eugenesia: la selección de embriones, la selección de sexo de la persona que va a nacer, el uso de personas con finalidad terapéutica para terceros. En este artículo se analizarán los aspectos bioéticos en conflicto, sin olvidar la regulación jurídica que existe al respecto de estas prácticas biotecnológicas vinculadas con la reproducción.

New biotechnology achievements linked to reproduction raises bioethical-legal questions of great importance. Indeed, as reproductive possibilities proliferate, ethical conflicts proliferate as well favoring eugenics: embryo selection, sex selection of the person to be born, use of persons with therapeutic end for others. In this article, bioethical issues in conflict will be analyzed, not forgetting existing legal regulation of these biotechnological practices linked to reproduction.

Os novos avanços biotecnológicos vinculados com a reprodução propõem questões bioético-jurídicas de não pouca envergadura. Com efeito, a medida que as possibilidades reprodutivas proliferam, também o fazem os conflitos éticos relacionados com o favorecimento da eugenesia: a seleção de embriões, a seleção de sexo da pessoa que vai nascer, o uso de pessoas com finalidade terapêutica para terceiros. Neste artigo se analisarão os aspectos bioéticos em conflito, sem esquecer a regulamentação jurídica que existe a respeito destas práticas biotecnológicas vinculadas com a reprodução.

Factores clínico-terapéuticos que influyen en el logro de embarazo en pacientes tratadas por fertilización in vitro / Clinical and therapeutic factors influencing the achievement ofpregnancy among patients undergoing in vitro fertilization

Introducción: La fertilización in vitro es la técnica de reproducción asistida de alta tecnología que con más frecuencia se emplea como tratamiento en pacientes infértiles. Objetivo: determinar los factores clínico-terapéuticos que influyen en el logro de embarazo clínico mediante la técnica de fertilización in vitro. Métodos: se realizó un estudio de cohorte longitudinal retrospectivo, en 654 parejas infértiles para precisar la influencia de algunos factores, como la edad materna, años de infertilidad, causa y tipo de infertilidad, número de folículos aspirados, grosor endometrial, estradiol sérico antes de la administración de gonadotropina coriónica humana, calidad del semen, valor basal de hormona folículo estimulante, esquema de tratamiento con análogos de hormona liberadora de gonadotropinas y las modificaciones a este, en el logro de embarazo por fertilización in vitro. Resultados: se obtuvo que el 25,10 por ciento de las pacientes incluidas quedaron embarazadas. Entre las pacientes que se embarazaron y las que no, hubo diferencia estadísticamente significativa en cuanto a la edad (p= 0,001), concentración de estradiol (p= 0,003), grosor endometrial (p= 0,001) y folículos aspirados (p= 0,045). La infertilidad secundaria incrementó la probabilidad de embarazarse en 15 por ciento, el semen óptimo en 47 por ciento y el esquema terapéutico con acetato de leuprorelina en 28 por ciento. En el análisis multivariado, las variables más relacionadas con el logro de embarazo fueron, el esquema terapéutico con acetato de leuprorelina (p= 0,001), el semen óptimo (p= 0,028) y el grosor endometrial (p= 0,036).Conclusiones: el esquema de tratamiento, la calidad del semen y el grosor endometrial, son factores independientes que influyen en que una paciente sometida a la técnica de fertilización in vitro se embarace(AU)

Introduction: In vitro fertilization is the high technology assisted reproduction method most commonly used in the treatment of infertile patients. Objective: determine the clinical and therapeutic factors influencing the achievement of pregnancy by in vitro fertilization.Methods: a retrospective longitudinal cohort study was conducted with 654 infertile couples to determine the influence of a number of factors upon the achievement of pregnancy by in vitro fertilization. The factors considered were maternal age, years of infertility, type of infertility and cause, number of aspirated follicles, endometrial thickness, serum estradiol before the administration of human chorionic gonadotropin, semen quality, basal follicle-stimulating hormone, and treatment with gonadotropin-releasing hormone analogues and its modifications. Results: 25.10 percent of the patients included became pregnant. A statistically significant difference was found between patients becoming and not becoming pregnant as to age (p= 0.001), estradiol concentration (p= 0.003), endometrial thickness (p= 0.001) and aspirated follicles (p= 0.045). Secondary infertility increased the probability of becoming pregnant by 15 percent, optimal semen by 47 percent and treatment with leuprorelin acetate by 28 percent. The multivariate analysis variables most closely related to the achievement of pregnancy were treatment with leuprorelin acetate (p= 0.001), optimal semen (p= 0.028) and endometrial thickness (p= 0.036). Conclusions: treatment scheme, semen quality and endometrial thickness are independent factors influencing the achievement of pregnancy in patients undergoing in vitro fertilization(AU)

La ética y la bioética de la programación de la humanidad

El juicio ético se realiza mediante la integración interdisciplinar del sentido natural de los procesos biológicos con su significado humano. Las Técnicas de Reproducción Asistida son paradigmáticas de una experimentación que no cumple los requisitos científicos ni éticos. La biología de la fecundación ha sido pasto de ficciones al no reconocer los límites naturales. Sobre esa pseudo-biología, la bioética ha sufrido la embestida de la ideología del hombre autónomo, que se arroga reinventar al hombre y dirigir el progreso con base en poder tecnológico. La ética de la bioética exige una nueva reflexión que parta de una ciencia libre de prejuicios.

Ethical judgment is made by the interdisciplinary integration of the natural sense of the biological processes and its human meaning. Assisted reproduction techniques are a paradigm of experiments that do not fulfill both the scientific and the ethical requirements. Fecundation biology has been a subject of frictions as it has not recognized the natural boundaries. On that pseudo-biology, bioethics has suffered the attack of the autonomous man's ideology, which claims that it re-invents the concept of mankind and manages progress, based on technological power. The ethics of bioethics demands a new reflection based on a prejudice-free science.

O juízo ético se realiza mediante a integração interdisciplinar do sentido natural dos processos biológicos com seu significado humano. As Técnicas de Reprodução Assistida são paradigmáticas de uma experimentação que não cumpre os requisitos científicos nem éticos. A biologia da fecundação foi pasto de ficções ao não reconhecer os limites naturais. Sobre essa pseudobiologia, a bioética sofreu a investida da ideologia do homem autônomo, que se arroga reinventar ao homem e dirigir o progresso com base em poder tecnológico. A ética da bioética exige uma nova reflexão que parta de uma ciência cesses and its human meaning. Assisted reproduclivre de preconceitos.

Cultura de células da granulosa humanas com fenótipo de fase folicular: influência do sistema quimicamente definido na morfologia, ultraestrutura, secreção de esteroides e relaxina / Culture of human granulosa cells with follicular phase phenotype:influence of chemically defined system on morphology, ultrastructure,secretion of steroids and relaxin

Está bem descrito na literatura o padrão de cultivo de células da granulosa (CG) humanas que perpetua a luteinização, simulando a fase lútea do ciclo. Nesse sistema, há redução na secreção de estradiol (E2) e aumento na síntese de progesterona (P4) e relaxina (RLN). Objetivamos padronizar um sistema de cultura livre de soro, com o intuito de reverter o processo de luteinização de CG obtidas em ciclos de fertilização in vitro (FIV), pré-luteinizadas pela gonadotrofina coriônica humana (hCG), para aplicação na maturação in vitro de folículos ovarianos pré-antrais. Foi feito estudo experimental com GC obtidas de 10 mulheres em tratamento de reprodução assistida. As CG foram cultivadas em α-MEM contendo IGF-I, ITS, androstenediona, PVP-40 (meio quimicamente definido) ou TCM-199 contendo FSH/soro. Após 48, 96 e 144 horas, foram avaliados: morfologia das culturas, produção de E2, P4 (Quimioluminescência/Immulite), RLN (Elisa) e ultraestrutura (Microscopia Eletrônica). Os dados foram analisados por Anova e regressão linear com efeitos mistos (SAS versão 9.0). Células cultivadas em α-MEM apresentam alta capacidade estrogênica e padrão de produção hormonal característico da fase folicular, mantendo características morfológicas/ultraestruturais semelhantes a células in vivo. No sistema de cultura padronizado, as CG não completam in vitro o processo de luteinização deflagrado pela hCG, assumindo fenótipo de fase folicular.

It is well described in the literature the granulosa cells (GC) culture pattern that perpetuates human luteinizing simulating the luteal phase of the cycle. In this system, there is a reduction in the secretion of estradiol (E2) and increased synthesis of progesterone (P4) and relaxin (RLN). We aim to standardize a serum-free culture system, in order to reverse the luteinization process of GC obtained in IVF cycles, pre-luteinized by hCG, for use in in vitro maturation of preantral ovarian follicles. An experimental study was conducted with GC obtained from10 women undergoing treatment for assisted reproduction. The GC were cultured in α-MEM containing IGF-I, STI, androstenedione, PVP-40 (chemically defined medium) or TCM-199 containing FSH/serum. After 48, 96 and 144 h were analyzed: culture morphology, concentrations of E2, P4 (Chemioluminescence/Immulite), and RLN (Elisa), and ultrastructure (ElectronMicroscopy). Data were analyzed by Anova and linear mixed-effects regression (SAS version9.0). Cells cultured in α-MEM present estrogenic capacity and pattern of hormone production characteristic of the follicular phase, maintaining morphological/ultrastructural features similar that in vivo cell. In standard culture system, the CG not completes in vitro luteinization process triggered by hCG, assuming follicular phase phenotype.

La fragmentación de ADN espermático, influencia sobre las técnicas de reproducción asistida y la calidad embrionaria / The influence of sperm DNA fragmentation on assisted reproduction techniques and embryo quality

Objetivo: presentar una revisión de la literatura sobre la fragmentación del ADN espermático, su impacto en las técnicas de reproducción asistida y la calidad embrionaria. Metodología: se utilizó la base de datos MEDLINE/PubMed. Los términos de búsqueda fueron: fragmentación espermática, parámetros seminales, técnicas de reproducción asistida y calidad embrionaria. Se revisaron los artículos publicados entre 1999 y 2010. Resultados: los estudios de fragmentación espermática proveen información complementaria acerca de la calidad espermática del paciente, siendo una prueba paralela al análisis seminal. Partiendo del diagnóstico de dichas pruebas se puede tomar la decisión acerca de la técnica de reproducción a emplear. Conclusión: el índice de fragmentación de ADN espermático es una herramienta valiosa para conocer la capacidad fecundante del paciente.

Objective: presenting a review of the literature about sperm DNA fragmentation, its impact on assisted reproduction techniques and embryo quality. Methodology: the MEDLINE/PubMed database was searched; the search terms used were: sperm fragmentation, semen parameters, assisted reproduction techniques and embryo quality. Articles published from 1999 to 2010 were reviewed. Results: sperm fragmentation studies provided complementary information about a patient’s sperm quality, this being a parallel test to semen analysis. Such tests’ diagnoses represent the starting point for taking decisions about the reproduction technique to be used. Conclusion: the sperm ADN fragmentation index represents a valuable tool for ascertaining a patient’s fertilising ability.

Embarazo heteroóópico: presentación de un caso / Ectopic pregnancy: Presentation of a case

El embarazo ectópico se considera por algunos autores, según su comportamiento en este decenio, como enfermedad epidémica muchas veces mortal para las mujeres que lo padecen. Nos propusimos revisar y analizar la evidencia científica disponible en la literatura mundial para determinar las manifestaciones clínicas más frecuentes delembarazo heterotópico, así como los mediosdiagnóstico más empleados en la actualidad. Se presentó un caso de embarazo heterotópico espontáneo en una paciente de 26 años de edad y 10 semanas de amenorrea. Se realizó laparotomía de urgencia y salpingectomía derecha. El embarazo intrauterino presentó una evolución favorable hasta el término. Se realizó una revisión bibliográfica actualizada acerca del embarazo heterotópico. Su tendencia actual a incrementar la incidencia en Cuba y en el mundo se atribuye a la mayor frecuencia de los factores etiopatogénicos relacionados con esta enfermedad. Se describen las formas clínicas de presentación y los métodos de diagnósticos tradicionales Se revisaron algunos aspectos de la etiología, diagnóstico y tratamiento de esta entidad.

Ectopic pregnancy is considered by some authors, according to its behaviour in this decennium, as an epidemic disease sometimes mortal for women who suffer it. We proposed to review and analyze the scientific evidence available in the world literature for determining clinical manifestations most frequent in heterotopic pregnancy as well as diagnostic means widely used in current times. A case of spontaneous heterotopic pregnancy was presented in a 26 year old patient with amenorrhea: 10 weeks. Emergency laparotomy and right salpingectomy were performed. The intrauterine pregnancy continued successfully to term. An updated bibliographic review of heterotopic pregnancy was made. It is an important topic and its current trend towards the increase of its incidence in Cuba and in the world is attributed to the higher frequency of the etiopathogenic factors related to this disease. The clinical forms of presentation and the traditional diagnostic methods are described. Some aspects of the etiology, diagnosis and treatment of this entity were reviewed.