Intervención psicológica, desde el enfoque de la psicología positiva, en parejas infértiles que están en proceso de inseminación artificial

Fundamento: desde la mirada de la psicología positiva, el trabajo con la pareja infértil, que se insemina, permite potenciar las emociones positivas que favorecen el tratamiento y fortalecer en ellos la capacidad resiliente que les conduce a un mayor bienestar psicológico para enfrentar este proceso. Objetivo: aplicar una estrategia de intervención psicológica en parejas infértiles en proceso de inseminación artificial. Métodos estudio prospectivo, de enfoque mixto, que incluyó once parejas bajo tratamiento de inseminación artificial, atendidas en el Centro de Reproducción del Hospital Abel Santamaría, en Pinar de Río, desde diciembre de 2021 hasta abril de 2022. La vía esencial para la localización y accesibilidad de la muestra objeto de estudio fue la consulta propia de psicología dentro de la comisión multidisciplinaria que estudia estas parejas. Se realizaron entrevistas clínicas, observación participante y test psicométricos. Se aplicó una estrategia de intervención psicológica basada en la psicología tradicional y la psicología positiva. Se midió la resiliencia de las parejas antes y después de la intervención. Resultados: la intervención elevó a valores medios-altos la resiliencia de las parejas infértiles que se inseminan. Promovió el desarrollo de pensamientos y estados emocionales positivos, así como la identificación de fortalezas personales y de las parejas. Conclusiones: una estrategia de intervención psicológica basada en la psicología tradicional y la positiva contribuye a elevar la resiliencia de parejas infértiles en proceso de inseminación artificial.

Foundation: from the positive psychology point of view, working with the infertile couple, who is inseminated, allows to enhance the positive emotions that favor the treatment and strengthen their resilient capacity that leads to greater psychological well-being to face this process. Objective: to apply a psychological intervention strategy in infertile couples during the artificial insemination process. Methods: prospective study, with a mixed approach, which included eleven couples undergoing artificial insemination treatment, treated at the Abel Santamaría Hospital Reproduction Center, in Pinar de Río, from December 2021 to April 2022. The essential route for localization and accessibility of the sample under study was the psychology consultation within the multidisciplinary commission that studies these couples. Clinical interviews, participant observation and psychometric tests were carried out. A psychological intervention strategy based on traditional psychology and positive psychology was applied. The resilience of the couples was measured before and after the intervention. Results: the intervention raised the resilience of infertile couples that are inseminated to medium-high values. It promoted the development of positive thoughts and emotional states, as well as the identification of personal and couple strengths. Conclusions: a psychological intervention strategy based on traditional and positive psychology contributes to increasing the infertile couples's resilience in the artificial insemination process.

Inseminação artificial homóloga póstuma: análise bioética do planejamento familiar / Posthumous homologous artificial insemination: a bioethical analysis of family planning / Inseminación artificial homóloga póstuma: un análisis bioético de la planificación familiar

Resumo Este artigo trata de questões relacionadas à inseminação artificial homóloga post mortem. Tomando como referência normas éticas que asseguram a livre escolha do casal no planejamento familiar, objetivou-se descobrir de que forma tais regulamentações influenciariam na concretização desse projeto parental. A partir do método hipotético-dedutivo, realizou-se revisão de literatura em bioética e biodireito, além de pesquisa documental no sítio eletrônico do Conselho Federal de Medicina. Refletiu-se, então, sobre o princípio de autonomia dos pacientes submetidos às técnicas de reprodução assistida, levando em conta algumas das repercussões dessa técnica sobre o direito de família e sucessões. Por fim, descreveu-se o método de casuística clínica, utilizado pelas clínicas como parâmetro para tomar decisões e aconselhar o cônjuge sobrevivente acerca da problemática da concepção póstuma.

Abstract This article discusses issues related to post mortem homologous artificial insemination. Taking as reference ethical norms that ensure the couple's free choice in family planning, the objective was to understand how such regulations would influence the accomplishment of this parental project. Using the hypothetical-deductive method, a literature review on bioethics and biolaw was carried out, in addition to a documentary research on the website of the Federal Council of Medicine. Then, reflections on the principle of autonomy of patients undergoing assisted reproduction techniques were made, considering some of the repercussions of this technique on family and succession law. Finally, a description of the method of clinical casuistry is presented, being used by clinics as a parameter to make decisions and advise the surviving spouse about the problem of posthumous conception.

Resumen Este artículo trata aspectos relacionados a la inseminación artificial homóloga post mortem. Con base en la normativa ética que garantiza la libre elección de la pareja en la planificación familiar, el objetivo fue identificar la influencia de la legislación en la realización de este proyecto parental. A partir del método hipotético-deductivo, se realizó una revisión bibliográfica sobre bioética y bioderecho, además de una búsqueda documental en el sitio web del Consejo Federal de Medicina. Con esto, se reflexionó sobre el principio de autonomía de los pacientes sometidos a técnicas de reproducción asistida, teniendo en cuenta algunas de las repercusiones de esta técnica en el derecho de familia y de sucesiones. Por último, se describió el método de la casuística clínica utilizado por las clínicas como parámetro en la toma de decisiones y asesoramiento al cónyuge sobreviviente en el tema de la concepción póstuma.

Assisted reproductive technology: prevalence and associated factors in Southern Brazil

ABSTRACT OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.

Application of light invasive treatment of endometrial in husband sperm intrauterine insemination patients / 中国医师进修杂志

Objective To discuss the effect of light invasive treatment of endometrial in husband sperm intrauterine insemination outcomes.Methods A total of 248 patients receiving husband sperm intrauterine insemination were divided into two groups by random digits table method.The patients in light invasive treatment of endometrial group (138 cases with 246 cycles) were performed with light invasive treatment of endometrial,and the patients in control group (110 cases with 201 cycles) were not perfomed with light invasive treatment of endometrial.Human chorionic gonadotropin day of endometrial thickness,intrauterine insemination tube placed successfully or not,whether fertilization tube bloody and clinical pregnancy rates and so on were compared between two groups.Results There was no significant difference in human chorionic gonadotropin day of endometrial thickness between two groups (P ＞ 0.05).The success rate of intrauterine insemination tube placement in light invasive treatment of endometrial group was 78.5％ (193/246),which was higher than that in control group (65.2％,131/201),and there was significant difference (P ＜ 0.05).The intrauterine insemination tube bloody rate in light invasive treatment of endometrial group was 13.4％ (33/246),which was lower than that in control group (34.8％,70/201),and there was significant difference (P ＜ 0.05).The pregnancy rate in light invasive treatment of endometrial group was 31.9％ (44/138),which was higher than that in control group (18.2％,20/110),and there was significant difference (P ＜ 0.05).There were no significant differences in ectopic pregnancy rate and abortion rate between two groups (P ＞ 0.05).Conclusion Through light invasive treatment of endometrial the husband sperm intrauterine insemination outcomes can be improved.

The influence of processed total motile sperm count on clinical pregnancy rate of intrauterine insemination / 重庆医学

Objective To investigate the influence of processed total motile sperm (PTMS) count of husband on clinical pregnan-cy rate of intrauterine insemination(IUI) .Methods We retrospectively analyzed a total of 229 cycles of IUI among 131 patients in our hospital during the past three years .The cycles were divided into 5 groups according to the PTMS count :group A(0 .05) among five groups .Conclusion Ideal clinical pregnancy can be achieved when the PTMS count is between 3 × 106 and 5 × 106 .

Inseminação artificial heteróloga: implicações bioéticas e jurídicas / Heterologous artificial insemination: bioethical and legal implications

Objetivo: Enfocar as implicações bioéticas e jurídicas sobre a inseminação artificial heteróloga, em especial, no que concerne ao conflito entre o direito à identidade genética daquele que foi concebido e o direito à privacidade do doador de material genético. Material e Métodos: Trata-se de uma pesquisa de natureza bibliográfica consubstanciada na literatura pertinente ao tema investigado. Resultados: A incidência de problemas de fertilidade é comum na população. Tais dificuldades geram sofrimento àqueles que desejam ser pais, mas não podem conceber filhos pelo método natural. A inseminação artificial heteróloga constitui um tipo de reprodução assistida, em crescente uso, a qual traz repercussões bioéticas e jurídicas. A partir do levantamento bibliográfico, verificou-se que, diante dos desafios éticos e morais oportunizados pela técnica de reprodução assistida heteróloga, o direito brasileiro encontra-se superado, pois não consta do ordenamento jurídico átrio, uma lei específica para regulamentar a situação dos envolvidos no processo: pais sociais, genitores e a pessoa nascida, com base no princípio da dignidade da pessoa humana. Conclusão: O estudo evidencia que juridicamente, a paternidade constrói-se e firma-se na afetividade e não na hereditariedade genética, assim, a pessoa nascida nesse processo fica ausente da possibilidade de conhecer suas origens.

Objective: To focus on the bioethical and legal implications of heterologous artificial insemination, especially regarding to conflicts between the right to the genetic identity of that who was conceived and the right to privacy of the donor of genetic material. Material and Methods: This is a research of bibliographic nature consubstantiated in the literature concerning the investigated theme. Results: The incidence of fertility problems is common in the population. These difficulties cause suffering to those who wish to be parents, but cannot conceive children by the natural method. Heterologous artificial insemination constitutes a type of assisted reproduction in increased use, which brings bioethical and legal impacts. From the bibliographic survey, it was found that given the ethical and moral challenges offered by the technique of heterologous assisted reproduction, Brazilian law is overcome, because it is not in the law court a specific law to regulate the situation of those involved in the process: social parents, parents and the born person, based on the principle of human dignity. Conclusion: The study shows that, legally, fatherhood is constructed and stands in affection and not in genetic inheritance. This way, a person that was born in this process is missing the opportunity to know their origins.

Predictive value of sperm motility characteristics assessed by computer-assisted sperm analysis in intrauterine insemination with superovulation in couples with unexplained infertility / 대한생식의학회지

OBJECTIVE: To determine whether characteristics of sperm motility obtained by computer-assisted sperm analysis (CASA) could predict pregnancy after intrauterine insemination (IUI) in couples with unexplained infertility. METHODS: Three hundred eighty-three cycles of intrauterine insemination with superovulation were retrospectively analyzed. Semen analysis was performed with CASA before and after swim-up and the parameters were compared between pregnant and non-pregnant women. RESULTS: The pregnancy rate per cycle was 14.1%. Pregnant and non-pregnant women were comparable in terms of age, infertility duration, the number of dominant follicles. While sperm concentration, motility, and parameters such as average path velocity (VAP) and percentage rapid (RAPID) before semen preparation were significantly different between the pregnancy and non-pregnancy groups, there were no differences in sperm parameters when comparing the two groups after preparation. Using a receiver operating characteristic curve to measure sensitivity and specificity, the optimal threshold value for the predictors of pregnancy was revealed to be a concentration of > or =111x10(6)/mL, a motility of > or =51.4%, and RAPID > or =30.1% before preparation for IUI. CONCLUSION: Sperm parameters including concentration, motility, and RAPID before sperm preparation could have predictive value for pregnancy outcome after intrauterine insemination with superovulation in couples with unexplained infertility, and would be helpful when counseling patients before they make the decision to proceed with IVF/ICSI-ET.

Predictive value of sperm motility characteristics assessed by computer-assisted sperm analysis in intrauterine insemination with superovulation in couples with unexplained infertility / 대한생식의학회지

OBJECTIVE: To determine whether characteristics of sperm motility obtained by computer-assisted sperm analysis (CASA) could predict pregnancy after intrauterine insemination (IUI) in couples with unexplained infertility. METHODS: Three hundred eighty-three cycles of intrauterine insemination with superovulation were retrospectively analyzed. Semen analysis was performed with CASA before and after swim-up and the parameters were compared between pregnant and non-pregnant women. RESULTS: The pregnancy rate per cycle was 14.1%. Pregnant and non-pregnant women were comparable in terms of age, infertility duration, the number of dominant follicles. While sperm concentration, motility, and parameters such as average path velocity (VAP) and percentage rapid (RAPID) before semen preparation were significantly different between the pregnancy and non-pregnancy groups, there were no differences in sperm parameters when comparing the two groups after preparation. Using a receiver operating characteristic curve to measure sensitivity and specificity, the optimal threshold value for the predictors of pregnancy was revealed to be a concentration of > or =111x10(6)/mL, a motility of > or =51.4%, and RAPID > or =30.1% before preparation for IUI. CONCLUSION: Sperm parameters including concentration, motility, and RAPID before sperm preparation could have predictive value for pregnancy outcome after intrauterine insemination with superovulation in couples with unexplained infertility, and would be helpful when counseling patients before they make the decision to proceed with IVF/ICSI-ET.

Influence of the human sperm abnormalities on conventional in-vitro fertilization therapy outcome / 中华泌尿外科杂志

Objective To observe the influence of the sperm abnormalities on conventional invitro fertilization therapy outcome. Methods Sperm of 105 infertile husband's semen was analyzed. The patients were divided into three groups according to the sperm morphology observed Using Kruger 's criteria: normal sperm morphology group (sperm normal morphology ≥ 15 % ), mild sperm abnormalities group( sperm normal morphology 10%- 15%), middle sperm abnormalities group (sperm normal morphology 5 % - 10 % ). Fertilization rate, cleavage rate, good quality embryo rate, implantation rate, clinical pregnancy rate and abortion rates were compared to study the influence of the sperm abnormalities on conventional IVF outcome. Results ①Fertilization rate(79.4 % vs 78.3 % ), cleavage rate(104. 6% vs98. 6%), good quality embryo rate(58. 1% vs 53. 9%), implantation rate (31.7% vs 30. 8%), clinical pregnancy rate(48.1% vs 42. 3%)and abortion rates(13.0% vs 18. 2%)were not significantly different between normal sperm morphology group and mild sperm abnormalities group(P>0. 05). ②The fertilization rate (79.4% vs 63.9%), good quality embryo rate(58. 14% vs 48.23%), implantation rate (31.7% vs 16. 7%) and clinical pregnancy rate(48.1%vs24.0%) of the normal sperm morphology group were higher than middle sperm abnormalities group(P<0.05). The abortion rates(13.04% vs 28. 57%) and cleavage rates(104.6% vs 102.9%) were not significantly different(P>0. 05). ③The fertilization rate (78.3% vs 63.9%), good quality embryo rate (53. 9%vs 48. 2%) of the mild sperm morphology group were higher than middle sperm abnormalities group(P <0.05). Implantation rate (30.8% vs 16. 7%) , clinical pregnancy rate(42.3% vs 24.0%) , abortion rates(13. 0% vs 28. 6%) and cleavage rates(104.6% vs 102.9%) were not significantly different (P>0. 05). Conclusions There is a significant influence of middle sperm abnormalities on IVF fertilization rate, good quality embryo rate, implantation rate and clinical pregnancy rate. However, it could not be influenced on mild sperm abnormalities.

Explore the security in HBV carried infertility patients during the in-vitro-fertilization procedure / 中国医师杂志

Objective To study the security in HBV carried infertility patients during the in-vitro-fertilization procedure. Methods Serologic testing of HBV infection (HBsAg, HBsAb, HBeAg, anti-HBe, anti-HBc-IgG) of blood, follicle fluid/sperm and fertilization culture medium/post-washing sperm in female/male carried patients were detected by ELISA on the day of oocytes collection. Results In 18 female patients who were seropositive for HBsAg, HBeAg and anti-HBc-lgG, the same antigen and antibody could be detected in all 18 folli-cle-fluid and fertilization culture medium(100%, 100%). In 131 female patients who were sernpesitive for HBsAg, anti-HBe, anti-HBc-IgG, the same antigen and antibody could be detected in 84 follicle-fluid(64. 1%), and 8 fertilization culture medium(6. 1%). If the patients'follicle-fluld was negative for all the markers, their fertilization culture medium remained negative. In 23 male patients who were sero-positive for HBsAg , HBeAg,and anti-HBc-lgG, the same antigen and antibody could be detected in only 6 sperm (26. 1%), all the postwashing sperm were exhibited negative. In 121 nude patients who were seropositive for HBsAg, anti-HBe, anti-HBc-lgG, the same antigen and antibody could be detected in only 7 sperm (5. 8%), and all the post-washing sperm were negative. Conclusion In IVF-ET procedures, the risk of HBV transmission by follicle-fluid and fertilization culture medium in those female patients who showed serepesitive for HBsAg , HBeAg, and anti-HBc-lgG can not be decreased. The risk in those female patients who showed seropositive for HBsAg, anti-HBe, anti-HBe-lgG and male patients in IVF-ET procedures can be decreased.

Analysis of 1540 neonates with birth defects related to different assisted reproductive technique / 中华妇产科杂志

Objective To investigate the incidence of and clinical factors influencing neonatal birth defects from different assisted reproductive technology. Methods Between October 1998 and December 2006,1271 newborns from mothers treated by in vitro fertilization techniques [ including in vitro fertilization (IVF), intracytoplasmic sperm injection (1CSI) and thaw embryo transfer (Thaw-ET) ] matched with 269 newborns from mothers treated by artificial insemination were enrolled in Reproductive Medicine Center in First Hospital Affiliated to Zhengzhou University. Their medical information was analyzed retrospectively to compared neonatal characteristics, the incidence of birth defect and anomalous organs involved between in vitro fertilization group and artificial insemination group. Results In group of in vitro fertilization, those newborns with low birth weight from IVF, ICSI and Thaw-ET were 20. 0% ( 134/671 ), 22. 4% (92/410), 18.9% (36/190)respectively, which were more than 11.5% (31/269) cases in group of artifical semination with statistical significance (P < 0. 05 ). The rates of multiple pregnancy of 23.8% ( 160/671 ), 25.4% (104/410) ,21.1% (40/190) in subgroup of 1VF, ICSI and Thaw-ET were significantly higher than 10. 0% ( 27/269 ) in group of artifical insemination( P < 0. 05 ). The rate of macrosomia in group of in vitro fertilization was significantly lower than that of artificial insemination group (3.9% vs 8. 2%, P <0.05). However, the incidence of birth defect involved in various organs did not show significant difference between two groups ( P>0.05 ). Conclusions The incidence of multiple pregnancy demonstrated obviously increasing trends born with various In Vitro Fertilization techniques, which pave the way to high risk pregnancy. However, the incidence of newborn birth defect was not increased significantly. Thus, to lower occurrence of multiple pregnancy was the key approach to obtain neonates health.