La responsabilidad subjetiva en los derroteros del deseo de hijo / Subjective Responsibility in the Paths of the Desire for a Child

El presente escrito aborda la cuestión del proyecto monomarental, sus derroteros y periplos singulares. Al tiempo que en ellos se vislumbra un camino muchas veces compartido y repetido. La temática reviste una presencia estadística en aumento a nivel mundial que visibiliza cambios sociales, económicos y de derechos en la agenda femenina. El objetivo central del escrito radica en describir en primera persona las circunstancias que llevaron a Helen a recurrir a la ovodonación como método reproductivo y los duelos que dicho recorrido encierra. En síntesis, en la historia de Helen se vislumbra de modo paradigmático el encuentro con la imposibilidad del propio cuerpo reproductivo y la solución que ofrece la medicina; al tiempo que en otra cuerda, se trasluce la dimensión singular y clínica de las decisiones subjetivas por las que ella deberá responder

This paper addresses the question of the singleparent project, its paths and unique journeys. At the same time that in them a path many times shared and repeated is glimpsed. The issue has a growing statistical presence worldwide that makes visible social, economic and rights changes on the women's agenda. The central objective of the writing lies in describing in the first person the circumstances that led Helen to resort to egg donation as a reproductive method and the duels that this journey entails. In short, in Helen's story, the encounter with the impossibility of the reproductive body itself and the solution offered by medicine is glimpsed in a paradigmatic way; while on another string, the singular and clinical dimension of the subjective decisions for which she will have to answer shines through

'Gift with a price tag': Nigerian egg donors' knowledge, experiences and motivations

Research around the world has indicated that the demand for egg donation has grown considerably among young females. This study qualitatively examines the knowledge, experiences, and motivations of young egg donors at a Nigerian health facility. Indepth interviews were conducted in Igbo and English with consenting thirty-one egg donors attending a fertility clinic in Anambra State, south-eastern Nigeria. Data were collected and analysed to generate themes with the aid of NVivo 10 software. Three themes were identified from the participants' motivations and include (a) monetary (93.6%), (b) altruistic (3.2%), and (c) both monetary and altruistic reasons (3.2%). Findings highlighted that the differences were based on a variety of reasons in Nigeria. All the participants were literate and single, and the majority received payment. The majority (77.4%) of those who received payment mentioned that the payment was not worth the donation program. The participants preferred to be anonymous because they had not discussed their donation with their family members, and the non-acceptance of egg donation program by the Nigerian society. Given that the market for egg donation has become a common method of infertility management in Nigeria, our findings have important implications for practices, policy actions, and future research. (Afr J Reprod Health 2022; 26[6]:64-79).

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.

Clínica Psicoanalítica en la Infertilidad: Epigenética y Duelo / Psychoanalytic Clinic in Infertility: Epigenetics and Duel

En el presente texto nos proponemos analizar de qué manera se juega en las Técnicas de Reproducción humana asistida, los descubrimientos más recientes en relación a la epigenética y su impacto en el atravesamiento del duelo genético. Además, se establecerá, a partir de un caso clínico, qué ofrece el psicoanálisis para propiciar el trabajo del duelo en la clínica de la infertilidad a diferencia de otros tipos de tratamiento psicoterapéutico

In the present text we propose to analyze how, in the assisted human reproduction technology, the most recent discoveries in epigenetics have an impact on the path of genetic dueling. On the other hand, we define from a clinical case, what psychoanalysis offers to favor mourning in the clinic of infertility compared to other types of psychotherapeutic treatments

Representações maternas de gestantes sobre o bebê concebido por ovodoação / Pregnant women's maternal representations about the baby conceived by egg donation / Representaciones maternas de gestantes sobre el bebé concebido por donación de óvulos

Este estudo tem como objetivo investigar as representações maternas de gestantes sobre o bebê concebido por ovodoação. Realizou-se uma pesquisa qualitativo-exploratória, com delineamento de estudo de casos múltiplos. Participaram três gestantes com idades entre 44 e 45 anos, que preencheram uma ficha de dados sociodemográficos e clínicos, responderam à entrevista IRMAG e a uma entrevista sobre reprodução assistida; também foram utilizadas anotações de campo. Os dados foram analisados a partir de dois eixos temáticos, um apoiado em elementos da realidade objetiva e outro em elementos da realidade subjetiva, abordando a ovodoação de forma transversal. Os resultados destacaram as expectativas em torno das características físicas da criança ao nascer, evidenciando a genética, e expectativas sobre a saúde física do bebê vinculadas à doadora. Revelar à criança sua origem genética não é considerado relevante nesse momento pelas gestantes. As representações são comuns às de gestações naturais e a doadora se fez presente nas representações sobre o bebê.

This study had the goal of investigating pregnant women's maternal representations about the baby conceived by egg donation. A qualitative-exploratory research was conducted, with a multicase study design. Three pregnant women aged between 44 and 45 years took part, who filled a sociodemographic and clinical data sheet, answered the IRMAG interview and were interviewed about assisted reproduction; field notes were also used. The data was analyzed along two thematic axes, one based on elements of objective reality, and the other on elements of subjective reality, approaching egg donation transversely. The results highlight the expectations around the physical characteristics of the child to be born, pointing out genetics, and the expectations about the baby's physical health related to the donor. Revealing to the children their genetic origin was not considered relevant by the pregnant women at this moment. The representations are common to natural pregnancies and the donor was present in the representations about the baby.

Este estudio investigó las representaciones maternas de gestantes sobre el bebé concebido por donación de óvulos. Se realizó una pesquisa cualitativo-exploratoria, con delineamiento de estudio de casos múltiples. Participaron tres gestantes entre 44 y 45 años, que llenaron una ficha de datos sociodemográficos y clínicos, respondieron a la entrevista IRMAG y a una entrevista sobre la reproducción asistida; además se utilizaron anotaciones de campo. Los datos fueron analizados a partir de dos ejes temáticos, uno apoyado en elementos de la realidad objetiva y otro apoyado en elementos de la realidad subjetiva, abordando la donación de forma transversal. Los resultados destacaron expectativas en torno a las características físicas del bebé, evidencia de la genética, y las expectativas sobre su salud física, vinculadas a la donadora. La revelación sobre el origen genético para el niño no es considerada relevante en este momento por las gestantes. Las representaciones son comunes a las de gestaciones naturales y la donadora se hizo presente en las representaciones sobre el bebé.

Ovodonación y revelación del origen: representaciones sobre la importancia de comunicar el modo de concepción en psicólogos, médicos y legos / Egg donation and disclosure: social representations of the general public, psychologists and medical doctors concerning the importance of informing the mode of conception

¿Por qué cambia la disposición de los sujetos respecto de comunicar que han recurrido a un tratamiento de ovodonación luego de haber realizado dicho procedimiento? El presente trabajo forma parte de una investigación en curso del Proyecto UBACyT "(Bio)Ética y Derechos Humanos: cuestiones clínico-analíticas" donde se ha propuesto indagar las actitudes y representaciones de los sujetos en general (legos) y de los profesionales de la Salud en particular (psicólogos y médicos), acerca de la importancia de comunicar dicha información. En esta ocasión, se presenta un abordaje descriptivo longitudinal donde se consideran los argumentos y justificaciones que ofrecen los distintos agentes para examinar cuáles son los motivos que priman al momento de sostener la revelación o el ocultamiento del dato. Se considera que dicha circunstancia compromete una situación novedosa, que excede el campo de significaciones disponibles y supone acceder a una dimensión singular mediante un abordaje ético-clínico que contemple la complejidad situacional.

Why do oocyte donation users who were in favor of disclosure change their attitude once they have been through a successful treatment? This study, carried out within the UBACyT "(Bio)Ethics and Human Rights: clinical and analytical issues" research project, aims at examining the attitudes and representations of the general public and health practitioners (psychologists and medical doctors) concerning the importance of the disclosure of such information. The current descriptive longitudinal study analyzes the arguments put forward by the three groups when asked whether this information should be disclosed or remain a secret. We posit that the scenario we present to the subjects cannot be examined solely by drawing on the significations and representations linked to the matter that are already available in the social discourse. Rather, this task begs for an ethical and clinical approach that takes into account the complexity that stems from the situation and the singularity involved in each case.

Ovodonación y subjetividad: aportes clínicos a partir de un estudio teórico empírico / Egg donation and subjectivity: clinical contributions from a theoretical empirical study

Es deseable comunicarle a un niño concebido por ovodonación el procedimiento utilizado para su gestación? ¿Tiene el nacido por esta técnica derecho a conocer a quien ha aportado los gametos? ¿Qué efectos puede tener el modo de revelación de esta información en la estructuración psíquica del niño y en el contexto familiar y social? El nuevo Código Civil y Comercial de la Nación Argentina de entrada a estas cuestiones respecto de la paternidad y la maternidad, en los casos de TRHA con técnicas heterólogas. Este artículo propone una aproximación teórico-empírica al problema. En una primera instancia se analizan las respuestas de usuarios de la técnica de ovodonación, aportadas por una investigación realizada en un centro de reproducción humana asistida. En segundo lugar, se contrastan estos datos con las respuestas de profesionales y legos en materia de temas médicos y/o psicológicos, a quienes se les plantea la situación hipotética de transmitir la información al nacido. Finalmente, se extraen conclusiones, a partir de sistematizar cuatro variantes centrales: derecho a la identidad, edad del niño, fantasías inconscientes, relatos ficcionales. Se busca así suplementar la categoría jurídica de la "voluntad procreacional" a la luz de los aportes del campo de la subjetividad, contribuyendo a su mayor conocimiento y aplicación.

Is it advisable to communicate to a child, conceived by egg donation, the procedure used for its gestation? Does the child born by this technique have the right to know who has provided the gametes? What effects may the information disclosure have on the psychic structuring of the child, the family and the social context? The new Civil and Commercial Code of the Argentine Nation introduced these questions regarding paternity and maternity in cases of Human Reproductive Technology with heterologous techniques. This article proposes a theoretical-empirical approach to the problem. In the first place, the responses of the egg donation technique users, which were obtained through a research who was carried out in an Assisted Human Reproductive Technology Center, are analyzed. Secondly, these data are contrasted with the responses of professionals and laymen in matters of medic and/or psychological issues, to whom the hypothetical situation of communicating the information to the child is raised. Finally, conclusions are drawn systematized by four variants: right to identity, child's age, unconscious fantasies and fictional stories. It seeks to supplement the legal category of "procreational will" from the contributions of the subjectivity field, to promote its greater knowledge and practice.

Mujer con falla ovárica prematura a los 15 años de edad, logra embarazo con ovodonación

Se presenta el caso de una mujer de 22 años de edad, con 3 años de convivencia y búsqueda de embarazo, que acudió por infertilidad, con antecedente de menarquía y falla ovárica prematura (FOP) a los 15 años de edad. Sus caracteres sexuales secundarios eran normales, tuvo FSH de 69 mUI/mL, LH 21,5 mUI/mL, estradiol 5 pg/mL, perfil tiroideo normal, prolactina 0,22 ng/mL, glucosa e insulina dentro de valores normales, con resonancia magnética nuclear de hipófisis sin alteraciones. Cariotipo en sangre 46, XX. La ecografía transvaginal mostró útero hipotrófico de 46 x 20 x 25 mm, endometrio 2,2 mm, ovarios hipotróficos. Se indicó valerato de estradiol/dienogest, con ecografía de control que mostró útero 69 x 22 x 33 mm (al mes) y 72 x 24 x 30 mm (al año). El espermatograma del esposo mostró 55,6 millones de espermatozoides/mL, motilidad progresiva 24%, morfología normal 4%, fragmentación de ADN 14,2%. No se estudió autoinmunidad ni el gen FMR-1. Se realizó ovodonación-ICSI-columna de anexina, obteniéndose 15 ovocitos; fecundaron 12, llegaron a blastocisto 4 embriones, se transfirió 2 embriones y se congeló 2. Se logró embarazo único, actualmente en curso. La frecuencia de casos de falla ovárica prematura a los 15 años se estima en 1/10 000 mujeres menores de 20 años, sin causa aparente.

The case of an infertile 22 year-old woman with 3 years of cohabitation and history of menarche and premature ovarian failure (POF) at age 15 is presented. Secondary sex characteristics were normal, FSH was 69 mIU/mL, LH 21.5 mIU/mL, estradiol 5 pg/mL, normal thyroid profile, prolactin 0.22 ng/mL, glucose and insulin within normal limits; no alterations of the pituitary gland were detected by magnetic resonance. Karyotype was 46, XX. Transvaginal ultrasound showed a 46 x 20 x 25 mm hypothrophic uterus, endometrium 2.2 mm, hypotrophic ovaries. Administration of estradiol valerate/dienogest enlarged uterus to 69 x 22 x 33 mm (in one month) and 72 x 24 x 30 mm (in one year). Husbands sperm count was 55.6 million/mL, progressive motility 24%, normal morphology 4%, and DNA fragmentation 14.2%. Autoimmunity and FMR-1 gene were not studied. Egg donation-ICSI-annexin column were performed obtaining 15 oocytes; fecundation occurred in in 12, and 4 embryos reached blastocyst stage, 2 embryos were transferred and 2 frozen. Single pregnancy was obtained with ongoing pregnancy. The frequency of premature ovarian failure cases at age 15 is estimated at 1/10 000 in women younger than 20 years, without apparent cause.

Ovodoação: a questão do sigilo / Egg donation and the issue of disclosure

O objetivo deste estudo foi identificar a intenção de revelar ou não para o filho, familiares e amigos a ovodoação e os motivos subjacentes. Participaram do estudo dez casais receptores de oócitos do Programa de Ovodoação da Universidade Federal de São Paulo. Foram realizadas entrevistas individuais, e os dados foram analisados segundo o método qualitativo. A maioria dos participantes relatou que não havia contado sobre a ovodoação para outras pessoas, assim como não tinha a intenção de contar para o filho. Foram alegados diversos motivos, acompanhados de temores relacionados às possíveis reações das crianças. O sigilo sobre a doação de gametas é uma questão complexa, que não deve ser respondida com regras simples e gerais, devendo-se considerar as especificidades de cada família e o contexto em que vivem.

The aim of this study was to identify the intention among parents to disclose conception via egg donation to their child, relatives and friends and the underlying reasons. The study considered ten couples to have received oocytes via the Egg Donation Programme at the Federal University of São Paulo. Most couples preferred not to disclose their conception via egg donation to friends or relatives and did not intend to inform their child. Various reasons were reported, as well as fears over the future child's potential reaction. Disclosure regarding gamete donation is a complex issue and approaches should not apply simple and general rules, but rather take into consideration each family's specific circumstances and context.