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.

Application of Optical Genome Mapping Technology in Detecting Complex Chromosomal Rearrangement / 中山大学学报(医学科学版)

ObjectiveTo investigate the application of optical genome mapping （OGM） technology in detecting complex chromosomal rearrangement. MethodsWe recruited five patients who were diagnosed as complex chromosomal rearrangement at the Reproductive Medicine Center of the Sixth Affiliated Hospital of Sun Yat-sen University from January 2022 to June 2023. They underwent OGM， nanopore sequencing and pre-implantation genetic testing （PGT）. The results were compared with the results of karyotype and chromosomal microarray analysis （CMA）/ copy number variation sequencing （CNV-Seq）. ResultsOGM could detect translocation， invert inversion， and triplet translocation， which were consistent with the results of OGM and CMA/ CNV-Seq. But OGM could not detect Robertsonian translocation. ConclusionBecause of its ultra-long reads， OGM realizes the detection across repetitive regions， and it has great advantages when applied in patients with complex chromosome rearrangement or uncertain karyotype analysis. It can accurately locate breakpoints.

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.

Cuando el cuerpo no puede / When the Body can't

En el presente trabajo nos proponemos visibilizar el padecimiento psíquico de las mujeres que atraviesan un cáncer ginecológico y que, además, deben hacer frente a la imposibilidad de gestar como consecuencia de la enfermedad. Y también reflexionar sobre el trabajo del psicólogo en este ámbito. Para cumplir con nuestro objetivo nos valdremos del episodio cinco de la segunda temporada de la serie televisiva estadounidense "New Amsterdam" (S2, E 5), estrenada en el año 2018 en Netflix, la plataforma de streaming estadounidense

In this paper we intend to make visible the psychological suffering of women who go through a gynecological cancer and who, in addition, must face the impossibility of gestating as a result of the disease. And also reflect on the work of the psychologist in this area. To meet our goal, we will use episode five of the second season of the American television series "New Amsterdam" (S2, E 5), premiered in 2018 on Netflix, the American streaming platform

Asynchrony between in vivo and in vitro rabbit embryos

Background: Comparative features of embryos developed under in vitro and in vivo conditions are particularly important in designing embryo transfer procedures that fulfil embryo-recipient synchronization requirements. Objective: To determine the degree of asynchrony in rabbit embryo development between cultured and in vivo embryos. Methods: A total of 55 non- lactating multiparous female rabbits were used. Embryos were classified as 16-cells or early morulae at 48 hours post-coitum (hpc). Embryos were cultured during 30 or 32 h and embryo development was compared with in vivo embryos of 72 hpc. In vitro and in vivo embryos at 72 hpc were classified as early or compacted morulae. Bayesian statistics was used. Difference between in vivo and in vitro embryos and the actual probability of the difference between the in vivo and in vitro embryo higher than zero (P) was estimated. Results: The percentage of compacted morulae was higher in in vivo embryos than in in vitro embryos with +6 h of asynchrony (73.5 and 32.8%, P=1.00). But the percentage of compacted morulae was similar with +8 h asynchrony. Conclusions: In vitro embryos delay their development by + 8 hours compared to in vivo embryos.

Antecedentes: El desarrollo comparativo de embriones producidos in vitro e in vivo es particularmente importante para el diseño de procedimientos de transferencia de embriones cuando se requiere sincronización entre el embrión y la hembra receptora. Objetivo: Determinar el grado de asincronía en el desarrollo embrionario entre embriones in vivo y cultivados. Métodos: Un total de 55 conejas multiparas no lactantes fueron utilizadas. Los embriones se clasificaron en 16 células o mórulas tempranas a las 48 horas después del coito (hpc). Los embriones se cultivaron durante 30 ó 32 horas y el desarrollo embrionario se comparó con embriones de 72 hpc obtenidos in vivo. Los embriones in vitro e in vivo a 72 hpc se clasificaron como mórulas tempranas o compactas. Se utilizó estadística bayesiana. Se estimó la diferencia entre embriones in vivo e in vitro y la probabilidad de que la diferencia sea superior a cero (P). Resultados: El porcentaje de mórulas compactas fue mayor en embriones in vivo que en embriones in vitro con +6 horas de asincronía (73,5 y 32,8%, P=1,00), pero el porcentaje de mórulas compactas fue similar con asincronía de +8 horas. Conclusión: Los embriones cultivados retrasan +8 horas su desarrollo en comparación con los embriones in vivo.

Antecedentes: A aquisição do desenvolvimento de embriões produzidos in vitro e in vivo é particularmente importante na concepção de procedimentos de transferência de embriões em que a sincronização entre o embrião e a fêmea receptora é necessária. Objetivo: Determinar o grau de assincronia no desenvolvimento embrionário entre embriões cultivados e in vivo. Métodos: Um total de 55 coelhos multíparos não lactantes foram usados. Os embriões foram classificados em 16 células ou mórulas iniciais 48 horas de gestação (hpc). Os embriões foram cultivados por 30 ou 32 horas e o desenvolvimento embrionário foi comparado com embriões de 72 hpc obtidos in vivo. Embriões in vitro e in vivo a 72 hpc foram classificados como mórulas precoces ou compactadas. Estatísticas bayesianas foram usadas. A diferença entre embriões in vivo e in vitro e a probabilidade de que a diferença seja maior que zero (P) foi estimada. Resultados: A porcentagem de mórulas compactadas foi maior em embriões in vivo do que em embriões in vitro com +6 horas de assincronia (73,5 e 32,8%, P=1,00). Mas a porcentagem de mórulas compactadas foi semelhante com assincronia de +8 horas. Conclusão: Embriões cultivados atrasam seu desenvolvimento em +8 horas em comparação com embriões in vivo.

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)

A transição para parentalidade de um casal heterossexual que recorreu à ovodoação / The transition to parenting of a heterosexual couple who resorted to egg donation / La transición a la parentalidad de una pareja heterosexual que recurrió a la donación de óvulos

Este estudo objetivou compreender a experiência da parentalidade de um casal heterossexual que recorreu à ovodoação e que tevetrigêmeos. O casal respondeu, individualmente, as entrevistas sobre maternidade e paternidade em três períodos: gestação, três meses e primeiro ano de vida dos bebês. Após repetidas leituras das entrevistas, construiu-se o relato clínico. Os resultados revelaram questionamentos da mãe sobre a própria maternidade e uma compensação exacerbada nos cuidados com os bebês para suprir a ligação não consanguínea com os filhos. Além disso, as dúvidas a respeito da revelação da origem dos trigêmeos demonstraram angústia e desamparo frente ao contexto da ovodoação.

This study aimed to understand the parenting experience of a heterosexual couple who resorted to egg donation and who had triplets. The couple responded individually to interviews about motherhood and paternity in three periods: pregnancy, three months and the babies' first year of life. After repeated readings of the interviews, the clinical report was constructed. The results revealed questions from the mother about her own motherhood and an exacerbated compensation in the care of the babies to supply the non-consanguineous connection with the children. In addition, doubts about the disclosure of the triplets' origin showed anguish and helplessness in the context of egg donation.

Este estudio tuvo como objetivo comprender la experiencia de parentalidad de una pareja heterosexual que recurrió a la ovodonación y que tenía trillizos. La pareja respondió, individualmente, a las entrevistas sobre maternidad y paternidad en tres períodos: embarazo, tres meses y el primer año de vida de los bebés. Después de repetidas lecturas de las entrevistas, se construyó el informe clínico. Los resultados revelaron preguntas de la madre sobre su propia maternidad y una compensación exacerbada en el cuidado de los bebés para suplir los lazos no consanguíneos con los niños. Además, las dudas sobre la revelación del origen de los trillizos mostraron angustia e impotencia en el contexto de la ovodonación.

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.

Effect of Modified Wuzi Yanzongwan Periodic Staging Treatment on Outcome of Assisted Pregnancy in Patients with Poor Ovarian Response / 中国实验方剂学杂志

Objective:To observe the effect of modified Wuzi Yanzongwan periodic staging treatment on the outcome of assisted pregnancy in patients with poor ovarian response （POR） and kidney deficiency syndrome. Method:One hundred and four patients were randomly divided into observation group and control group， with 52 cases in each group. Both groups received gonadotropin releasing hormone （GnRH） antagonist regimen. The patients in control group additionally took Bushen Yutaiwan orally， 5 g/time， 3 times/day. The patients in observation group additionally took modified Wuzi Yanzongwan during pre-ovulation and post-ovulation periods， 1 dose/day. The treatment courses were 3 menstrual cycles （or termination after clinical pregnancy） in both groups. The number of eggs obtained， the number of available embryos， the number of fertilization， the number of high-quality embryos， the number of embryos implanted， the number of cycles cancelled， and the clinical pregnancy were recorded. Human chorionic gonadotropin （HCG） was injected， and then follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， estrogen （E₂）， anti-Müllerian hormone （AMH）， basal antral follicle count （AFC） and endometrial thickness were measured daily. The number of days and dosage of Gn used， scores of kidney deficiency syndrome were recorded before and after treatment， and the adverse reactions during the study period were recorded. Result:The number of eggs captured， rate of harvested eggs， number of available embryos， rate of available embryos， number of high-quality embryos， rate of high-quality embryos， and fertilization rate in observation group were higher than those in control group （<italic>P</italic><0.05 or <italic>P</italic><0.01）. The cycle cancellation rate was lower than that in the control group； the embryo implantation rate and clinical pregnancy rate were superior than those in control group， but the difference was not statistically significant. The FSH level and FSH/LH ratio in observation group were lower than those in control group during HCG day （<italic>P</italic><0.01）， while E₂， AMH， AFC and endometrial thickness were higher than those in control group （<italic>P</italic><0.01）. Simultaneously， the number of days and amount of Gn used in observation group was lower than that in control group （<italic>P</italic><0.01）. Conclusion:The Modified Wuzi Yanzongwan periodic staging treatment combined with GnRH antagonist scheme for patients with POR kidney deficiency syndrome， can regulate the level of endocrine hormones， promote follicular development， improve ovarian reserve， increase the number of eggs obtained， improve egg quality， help improve pregnancy outcomes， and increase the chances of successful pregnancy with assisted reproductive technology. It is worthy of further clinical research.

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.

Quality Control and Safety Evaluation of Culture Medium for Human Assisted Reproduction / 中国医疗器械杂志

OBJECTIVE@#In this paper, the key points of quality control and safety evaluation of human assisted reproductive medium were summarized to provide reference for the establishment of relevant standards and quality control in the future.@*METHODS@#Through literature research, the key factors of quality control and risk control of human assisted reproductive medium were summarized, and the problems in clinical transformation were discussed.@*RESULTS@#It is very important for the development of human assisted reproduction technology to study the active ingredients and their harmful degradation products and drugs in the culture medium of assisted reproduction.@*CONCLUSIONS@#At present, the biggest challenge is to effectively control the quality of the culture medium for human assisted reproduction, establish corresponding inspection methods and quality standards for the key components, ensure the safety and effectiveness during the product shelf life, and thus improve the success rate of human assisted reproduction technology.

Entre el deseo y la demanda: Procreación artificial en la modernidad líquida / Between desire and demand: Artificial Procreation in Liquid Modernity

Se presenta aquí un informe de avances del proyecto: "Nuevas representaciones de la parentalidad. A partir de la reproducción asistida en la Modernidad líquida", que se enmarca en la Convocatoria CyTMA2 2020 (UNLaM); el recorte comprende la síntesis de los resultados obtenidos en su primera etapa, cuyo objetivo específico fue: describir las características de la reproducción asistida, como oferta de parentalidad. Para la misma se han realizado 10 entrevistas abiertas en profundidad, a referentes clave en el acompañamiento de la reproducción asistida, cuyo relato permitió identificar las dimensiones vinculadas a las representaciones en la oferta de estas prácticas médicas. Se trató de una estudio no experimental, de carácter exploratorio-descriptivo con enfoque cualitativo, cuya muestra, intencional, ha sido seleccionada por conveniencia a partir de criterios de accesibilidad. El análisis e interpretación de los resultados obtenidos se llevó a cabo a partir del método psicoanalítico, tomado el mismo como método indiciario(AU)

A report on the progress of the project is presented here: "New representations of parenting. From assisted reproduction in Liquid Modernity", which is part of the CyTMA2 2020 Call (UNLaM); the clipping includes the synthesis of the results obtained in its first stage, whose specific objective was: to describe the characteristics of assisted reproduction, as a parental offer. For the same, 10 open in-depth interviews have been carried out, with key references in the accompaniment of assisted reproduction, whose report allowed to identify the dimensions linked to the representations in the offer of these medical practices. It was a non-experimental study, of an exploratory-descriptive nature with a qualitative approach, whose intentional sample has been selected for convenience based on accessibility criteria. The analysis and interpretation of the results obtained was carried out from the psychoanalytic method, taken as the index method(AU)

Analysis of maternal clinical risk factors for different degrees of small for gestational age infant / 上海交通大学学报（医学版）

Objective : To explore the pregestational and gestational risk factors associated with small for gestational age infant (SGA) by dif-ferent degrees. Methods ¡¤ Mothers and single newborns delivered at Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from September 2013 to December 2016 were included. Multivariate Logistic regression was used to analyze the correlation between maternal preg-nancy and pre-pregnancy risk factors and the occurrence of SGA by different degrees. Results ¡¤ There were no statistically significant differ-ences in maternal age, number of birth, education level, incidence of preterm birth and fetal sex in SGA. Maternal body mass index (BMI), gesta-tional hypertension and accepting assisted reproduction were significantly correlated with SGA (all P<0.05). The incidence of moderate SGA in mothers with low pre-pregnancy BMI and gestational hypertension were 3.6 and 4.0 times higher than that of the mothers with normal BMI and blood pressure. The incidence of severe SGA in mothers receiving assisted reproduction was 6.4 times higher than that in those who did not. Mild SGA was not associated with the above risk factors. Conclusion ¡¤ Maternal low BMI and hypertension are the risk factors of moderate SGA and accepting assisted reproduction are the risk factors of severe SGA, and the risk factors of SGA by different degrees are not the same.

A review of initial data on pregnancy during the COVID-19 outbreak: implications for assisted reproductive treatments

The current outbreak of the novel 2019 coronavirus disease (COVID-19) started in China in December 2019 and has since spread to several other countries. On March 25, 2020, a total of 375,498 cases had been confirmed globally with 2,201 cases in Brazil, showing the urgency of reacting to this international public health emergency. While in most cases, mild symptoms are observed, in some cases the infection leads to serious pulmonary disease. As a result, the possible consequences of the COVID-19 outbreak for pregnant women and its potential effects on the management of assisted reproductive treatments, demand attention. In this review, we summarize the latest research progress related to COVID-19 epidemiology and the reported data of pregnant women, and discuss the current evidence of COVID-19 infections during pregnancy and its potential consequences for assisted reproductive treatments. Reported data suggest that symptoms in pregnant women are similar to those in other people, and that there is no evidence for higher maternal or fetal risks. However, considering the initial data and lack of comprehensive knowledge on the pathogenesis of SARS-CoV-2 during pregnancy, human reproduction societies have recommended postponing the embryo transfers and do not initiate new treatment cycles. New evidence must be considered carefully in order to adjust these recommendations accordingly at any time and to guide assisted reproductive treatments.(AU)

Reprodução medicamente assistida: paradoxo, ética e destino / Medically assisted reproduction: paradox, ethics, and destiny / Reproduction médicalement assistée: paradoxe, éthique et destin / Reproducción médica asistida: paradoja, ética y destino

Resumo O objetivo deste artigo é construir um estudo comparativo entre a clínica psicanalítica e a médica, referente a quem elas se destinam, o paradoxo derivado de suas bases epistemológicas e o destino dado a este paradoxo. Trazemos para o contexto os discursos do campo clínico da medicina reprodutiva no Brasil, em especial o texto regulador das práticas de reprodução com materiais doados e duas críticas oriundas da esfera jurídica. Na primeira parte, a comparação entre métodos clínicos considera que, apesar do compartilhamento de bases epistemológicas comuns, as clínicas concebem, de formas distintas, a lógica de funcionamento daquele a quem destinam sua prática. Todavia a atual regulação das práticas clínicas de reprodução assistida expõe um paradoxo referente ao processo de filiação parental, que implica as bases epistemológicas médicas e psicanalíticas, com efeitos em suas práticas. Na segunda parte do artigo, compararemos os diferentes destinos dados a este paradoxo.

Abstract This is a comparative study concerning the relation between the psychoanalytic clinic and the physician, referring to whom both serve, the paradox derived from their epistemological grounds, and the fate given to this paradox. We contextualize the discourses of the clinical field of reproductive medicine in Brazil, in particular the regulatory text on reproduction practices with donated materials and two criticisms arising from the legal sphere. In the first section, the comparison between clinical methods considers that, despite the sharing of common epistemological grounds, clinics conceive the logic of functioning of the one to whom they direct their practice in different ways. However, the current regulation of Medically Assisted Reproduction clinical practices in Brazil exposes a paradox pertaining to the process of parental affiliation, which implies different medical and psychoanalytical epistemological bases, affecting their practices. In the second part of the article, we compare the different destinations resulting from this paradox.

Résumé Cet article à pour but construire une étude comparative entre la clinique psychanalytique et la clinique médicale, relatif à qui ils sont destinés, le paradoxe dérivé de leurs bases épistémologiques et le destin donné à ce paradoxe. Nous apportons au contexte les discours du domaine clinique de la médecine reproductive au Brésil, en particulier le texte réglementaire des pratiques de reproduction avec des matériaux donnés et deux critiques de la sphère juridique. Dans la première partie, la comparaison entre les méthodes cliniques considère que, malgré le partage de bases épistémologiques communes, les cliniques considèrent, de différentes manières, la logique du fonctionnement de celui à qui ils sont destinés à la pratique. Cependant, la réglementation actuelle des pratiques cliniques de Reproduction médicalement assistée au Brésil expose un paradoxe concernant le processus d'affiliation parentale, qui implique les bases épistémologiques de la médecine et de la psychanalyse, et influence leurs pratiques. Ce sera dans la deuxième partie de l'article que nous comparerons les différentes destinations données à ce paradoxe.

Resumen El objetivo de este artículo es construir un estudio comparativo entre la clínica psicoanalítica y la médica relacionada a quien destinan, la paradoja derivada de sus bases epistemológicas y el destino dado a esta paradoja. Ponemos en discusión los discursos del campo clínico de la medicina reproductiva en Brasil, en particular el texto regulador de las prácticas de reproducción con materiales donados y dos críticas del marco jurídico. En la primera parte, la comparación entre los métodos clínicos permite considerar que, a pesar de que se compartan bases epistemológicas comunes, las clínicas conciben de forma distinta la lógica de funcionamiento para aquel a quien destinan sus prácticas. Sin embargo, la actual regulación de las prácticas clínicas de reproducción asistida en Brasil presenta una paradoja relacionada al proceso de afiliación parental, lo cual relaciona las bases epistemológicas médicas y psicoanalíticas, con efectos sobre sus respectivas prácticas. En la segunda parte del artículo comparemos los diferentes destinos dados a esta paradoja.

Clinical study comparing outcome of post in vitro fertilisation triplet pregnancy reduced to twins versus non reduced in vitro fertilisation triplet pregnancies

Background: There has been an upsurge in the number of multiple pregnancies with its attributability to increasing use of artificial reproductive techniques. To study clinical outcome of post IVF triplet pregnancy reduced to twin pregnancies   compared to those without triplet reduction.Methods: Hospital designed comparative study. 31 subjects were studied for comparative study design with triplets obtained after infertility treatment (assisted post-IVF). Out of 31, 15 subjects were expectantly managed who refused reduction while 16 subjects chose reduction to twins. Outcomes like prematurity, complications in neonate, birth weight discordance, neonatal mortality and maternal complications were studied.Results: The fetal (triplet) reduction group was associated with significant (p<0.002) higher neonatal birth weight as compared to non-reduced group. The fetal reduction group had significantly lower incidence of prematurity and neonatal complications like hyperbilirubinemia, respiratory distress syndrome and neonatal sepsis. The maternal complications were also higher in nonreduced in terms of PPROM, gestational hypertension, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and gestational hypertension.Conclusions: It is indicated that the reduction of triplet to twins is effective considering more complications with non-reduced group and hence reduction improves favorable pregnancy outcomes.

Evaluation of embryo collection and transfer days on pregnancy rate of Mangalarga Marchador mares during the breeding season / Evaluación de los días de recolección y transferencia de embriones sobre las tasas de preñez en yeguas Mangalarga Marchador durante la estación de monta / Avaliação do dia da colheita e da transferência de embriões equino da raça Mangalarga Marchador durante a estação de monta

Abstract Background: Proper timing for embryo collection and transfer in horses -which is critical for the success of this biotechnology- is still debated. Additionally, there is little information on this technology under tropical conditions. Objective: To determine the best day for collection and transfer of embryos in Mangalarga Marchador mares under Brazilian northeast's conditions. Methods: Donors (n= 30) and recipients (n= 76) in diestrus phase were selected based on both clinical and gynecology examinations. Estrus was induced on both donor and recipient mares by intramuscular injection of 5 mg Dinoprost, aiming to obtain an ovulation interval of -1 to +3 between recipient and donor. Ovulation was induced with buserelin acetate when the largest follicle reached at least 35 mm in diameter. At this time, mares were subjected to artificial insemination at 48-hour intervals until ovulation. The embryos were collected on days 7, 8, and 9 after ovulation. Results: The embryo collection on day 8 was more efficient (p<0.05) than on day 7, but it was not more effective (p>0.05) than day 9, which presented the same efficiency (p>0.05) as day 7. From a total of 76 embryos transferred to the recipients, that were between days 4 and 9 after ovulation, there was no influence (p>0.05) of the day of transfer on pregnancy rate. Conclusions: The embryo collection must be performed on day 8 after ovulation, and transfer can be performed on any day of that interval (4-9) without affecting the pregnancy rate.

Resumen Antecedentes: El momento mas apropiado para la recolección y transferencia de embriones en equinos -que es fundamental para el éxito de esta biotecnología- continua siendo sujeto de estudio. Además, es escasa la información sobre esta tecnología en condiciones tropicales. Objetivo: Determinar el momento mas adecuado para la recolecta y transferencia de embriones en yeguas Mangalarga Marchador, en las condiciones del nordeste Brasileño. Métodos: Donadoras (n= 30) y receptoras (n= 76) en la fase de diestro se seleccionaron con base en los exámenes clínicos y ginecológicos. El estro de las yeguas donadoras y receptoras fue inducido con 5 mg de Dinoprost, vía intramuscular, intentando obtener un intervalo de ovulación de -1 a +3 entre la receptora y la donadora. La ovulación fue inducida con acetato de buserelina cuando el folículo mayor alcanzó 35 mm de diámetro. En ese momento, las yeguas fueron sometidas a inseminación artificial en intervalos de 48 horas hasta la ovulación. Los embriones fueron recolectados en los días 7, 8 y 9 después de la ovulación. Resultados: La recolecta de embriones en el día 8 fue más eficiente (p<0,05) que en el día 7, pero no fue más efectivo (p>0,05) que en el día 9, el cuál presentó la misma eficiencia (p>0,05) que en el día 7. De un total de 76 embriones transferidos a las receptoras, que se encontraban entre el día 4 y 9 después de la ovulación, no se registró influencia (p>0,05) del día de la transferencia en la tasa de preñez. Conclusiones: La recolecta embrionaria debe ser realizada el día 8 después de la ovulación, y la transferencia puede ser realizada en cualquier día de este intervalo (4 a 9) sin que se afecte la tasa de preñez.

Resumo Antecedentes: A importância do momentoda colheita e da transferência do embrião equino para o sucesso dessa biotécnica em equino continua sem ser completamente entendida. Adicionalmente, existe pouca informação sobre essa tecnologia em condições tropicais. Objetivo: Determinar o melhor dia para colheita e para transferência de embriões em eguas manga larga marchador nas condições do nordeste brasileiro. Métodos: Doadoras (n = 30) e receptoras (n = 76) na fase de diestro foram selecionadas com base nos exames clínico e ginecológicos. O estro das éguas doadoras e receptoras foi induzido com 5 mg de Dinoprost administrado por via intramuscular, buscando obter um intervalo de ovulação de -1 a +3 entre a receptora e a doadora. A ovulação foi induzida com acetato de buserelina quando o foliculo maior alcançou o tamanho de 35 mm de diâmetro. Nesse momento, as éguas foram submetidas a inseminação artificial em intervalos de 48 horas até a ovulação. Os embriões foram colhidos nos dias 7, 8 e 9 depois da ovulação. Resultados: A colheita de embriões no dia 8 foi mais eficiente (p<0,05) do que no dia 7, porem não foi mais efetivo (p>0,05) do que o dia 9, o qual apresentou a mesma eficiência (p>0,05) que o dia 7. De um total de 76 embriões transferidos para as receptoras que se encontravam entre os dias 4 e 9 depois da ovulação, não se registrou influência (p>0,05) do dia da transferência sobre a taxa de prenhez. Conclusões: A colheita embrionária deve ser realizada no dia 8 depois da ovulação, e a transferência pode ser realizada em qualquer dia desse intervalo (4-9) sem que a taxa de prenhez seja afetada.

Uma reflexão acerca da terceirização dos cuidados maternos em um contexto perpassado por reprodução assistida e gravidez múltipla / Reflecting on maternal care outsourcing within a context comprising assisted reproduction and multiple / Pregnancy una reflexión sobre la externalización de la atención materna en un contexto de reproducción asistida y embarazo múltiple

Este trabalho teve por objetivo compreender as razões pelas quais uma mãe decidiu terceirizar os cuidados de seus bebês. A pesquisa foi desenvolvida por meio do método Bick de observação de bebês, que ocorreu com uma mãe e seus três filhos trigêmeos. A mãe acompanhada teve sua gestação concebida mediante técnicas de reprodução assistida. As observações ocorreram quinzenalmente, durante o primeiro ano de vida dos bebês, na casa da participante. A observadora destaca ter se deparado com um contexto em que ela se via ao lado da mãe vendo as cuidadoras, babás e enfermeira cuidarem dos bebês. Com base nessa constatação, foi proposta na discussão uma reflexão acerca da terceirização dos cuidados maternos no caso acompanhado, levantando-se três hipóteses que se interligam e estão relacionadas a: reprodução assistida, maternidade trigemelar e o sentimento de vulnerabilidade descrito por Winnicott que muitas mulheres vivem ao se tornarem mães.

The purpose of the present study was to understand the reasons why a mother decided to outsource the care of her babies. This work occurred with a mother and her three children through Bick infant observation method. The subject mother conceived her pregnancy through Assisted Reproduction Techniques. The observations occurred every two weeks during the first year of the babies’ life, at the subject’s home. The observer points out to have faced a context in which she saw herself beside the mother watching the caregivers, babysitters and nurses taking care of the babies. Based on that, it was proposed a reflection on the outsourcing of maternal care in the studied case, raising three hypotheses that are interconnected and are related to: assisted reproduction, triplet maternity and the feeling of vulnerability described by Winnicott, that many women experience when become mothers.

Este estudio tuvo como objetivo comprender las razones por las que una madre decidió externalizar el cuidado de sus bebés. El mismo fue desarrollado a través de Método de Observación del Bebé Bick que se produjo con una madre y sus tres hijos. Esta madre concibió su embarazo a través de Técnicas de Reproducción Asistida. Las observaciones se llevaron a cabo quincenalmente durante el primer año de vida de los bebés, en la casa de la participante. El observador se encontró en un contexto en que estaba junto de la madre observando a los cuidadores y a las enfermeras cuidar a los bebés. A partir de esta observación, se propone una reflexión sobre la externalización de la atención materna acompañada en el caso, con tres hipótesis que están interconectadas y están relacionados con: la reproducción asistida, la maternidad del trío y el sentido de vulnerabilidad descrito por Winnicott.