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.

Aspectos emocionais em reprodução humana assistida: uma revisão integrativa da literatura / Emotional aspects in assisted human reproduction: an integrative literature review

O objetivo deste trabalho foi analisar os aspectos emocionais presentes no processo de reprodução humana assistida (RHA), por meio de uma revisão interativa da literatura. As bases de dados utilizadas foram PubMed, BVS e Periódicos Capes, com os descritores "infertility" AND "reproductive techniques" AND "emotions". Foram incluídos e analisados 24 artigos dos últimos cinco anos (2015 a 2020). Os resultados indicam que existem diversos sentimentos negativos que permeiam os casais infé rteis, especialmente quando existem falhas no tratamento. O apoio social durante o tratamento em RHA melhora a qualidade de vida do casal e diminui o sofrimento emocional. As estratégias de enfrentamento utilizadas pelos casais inférteis e as intervenções terapêuticas também foram avaliadas como positivas para o manejo do estresse, da ansiedade e da depressão. As diferenças de gênero apareceram nos estudos e reiteram a relevância das relações de gênero, indicando a necessidade de intervenções diferentes para homens e mulheres.(AU)

The aim of this work was to analyze the emotional aspects present in the assisted human reproduction (RHA) process, through an interactive literature review. The databases used were PUBMED, BVS and CAPES journals, with the descriptors "infertility" AND « reproductive techniques" AND "emotions." 24 articles from the last five years (2015 to 2020) were included and analyzed. The results indicate that there are several negative feelings that permeate infertile couples, especially when treatment failures, social support during RHA treatment improves the couple's quality of life and reduces emotional distress. The coping strategies used by infertile couples and interventions therapeutics were also evaluated as positive for the management of stress, anxiety and depression. The gender differences appeared in the studies and reiterate the relevance of gender relations, indicating the need for different interventions for men and women.(AU)

Casais inférteis e a busca pela parentalidade biológica: uma compreensão das experiências envolvidas / Infertile couples and the pursuit of biological parenthood: an understanding of the experiences involved

O diagnóstico da infertilidade atinge atualmente cerca de 20% da população em idade reprodutiva. É, principalmente, a partir desse diagnóstico que os casais buscam alternativas que visem à realização do desejo de serem pais biológicos. Este trabalho investigou as vivências envolvidas no diagnóstico de infertilidade. Realizou-se uma pesquisa qualitativa, através da realização de entrevistas semiestruturadas com três casais que buscaram o serviço de reprodução assistida em uma clínica de reprodução humana do interior do estado do Rio Grande do Sul. Os dados coletados foram submetidos a análise de conteúdo. Os resultados revelam vivencias similares em relação as dificuldades relacionadas, principalmente, a pressão social ainda presente na vida de casais para exercer a parentalidade biológica. Além disso, indicam as dificuldades relacionadas aos procedimentos de reprodução assistida bem como a conjugalidade.(AU)

The diagnosis of infertility reaches approximately 20% of the population in reproductive age. It is mainly because of this diagnosis that couples seek alternatives aimed at achieving the desire to be biological parents. This study investigated experiences involved in the diagnosis of infertility. For this purpose, we carried out a qualitative research by conducting semi-structured interviews with three couples who have sought assisted reproduction service in a clinic of human reproduction in the state of Rio Grande do Sul/Brazil. The collected data were submitted to a content analysis. The results reveal similar livings in relation the difficulties associated mainly to social pressure still present in the lives of couples to exercise biological parenting. Also, indicate the difficulties related to assisted reproduction and conjugality.(AU)

Calidad de vida de parejas infértiles en el sector público de Chile / Quality of life of infertile couples in the public health sector in Chile

Background It is widely known that infertility and its treatment have a negative impact on patients' well-being, yet not much is known about patients' satisfaction with the quality of reproductive care. Purpose To assess the quality of life (QoL) of patients receiving medical care under the Chilean public health system. Materials and Methods The FertiQoL international questionnaire was applied to 260 patients (both sexes) referred from rural and urban areas to undergo in vitro fertilization at a major university public hospital. FertiQol evaluates QoL as a product of psychosocial well-being and treatment experience. Demographic and reproductive data were collected. Results QoL due to treatment factors was significantly lower than psychosocial well-being. Couples from lower-density areas showed markedly worse medical satisfaction than patients treated in Chile's capital. No effects on QoL were observed as a function of age, education, or type of infertility. QoL was mostly affected by duration of infertility (inverse association) and geographical zone. Marital satisfaction was the component that most contributed to personal well-being. Conclusions QoL decreased more due to extrinsic factors, particularly lack of access to reproductive care, poor organization of medical services, and deficient clinical interaction, than due to psychosocial distress. These findings call for a revision of the delivery of public fertility care to satisfy patients' needs and improve their QoL.

The Subrogacy Trap

En el presente nos dedicamos a analizar el tema de la “maternidad subrogada” y los avatares para las dos partes involucradas en el marco de una relación que se regula mediante la firma de un contrato comercial. La acción nos deja abierta la posibilidad de cuestionar el impacto de la Maternidad Subrogada sobre la función materna, el deseo materno, partiendo de la premisa de que la llamada Industria de la Fertilidad cuenta con un poder capaz de instituir un nuevo tipo de subjetividad al interior de la misma, desdoblándola al someter a los cuerpos deseantes a la lógica impuesta desde el mercado a través de su agente: el consumidor...

In this paper, we address the issue of the "Surrogate Motherhood", by analyzing the film "The Subrogacy Trap". Using it as "empirical evidence" we analyze the complexity of the phenomenon and its impact on the two parties involved in a context that is that of a relationship regulated by the signing of a commercial contract: the "contracting parents", and the "surrogate mother". The action of the film opens up to us the possibility of questioning the impact of this particular practice on key human symbolic institutions, like the "maternal function", and the "maternal desire", but also over the bodies, the material and symbolic body of a person. We based our conclusions on the premise that the so called "Fertility Industry " has the power to impact directly on them by establishing new kinds of subjectivities inside these symbolic institutions. Also, this same power tends to subdue the desiring bodies, transforming them into commodities, with the help of coercive technologies/tools, imposed from a logic that answers that of the global political-economy of our time, through his main agent: the consumer.

comparison of anxiety and depression rate between medical staff of infertility centers and obstetrics and gynecology centers of Yazd, Shiraz, Isfahan and Kerman hospitals

Regarding the close and continuous interaction of infertility staff with hopeless infertile couples and in the contrary the atmosphere of happiness especially in obstetric wards make a sense that considering anxiety and depression it would be a difference between these two wards. The objective of this study is the comparison of the rate of depression and anxiety between the two wards of infertility and obstetrics and gynecology. This study is a descriptive-correlation study based on cross-sectional method. 199 individuals who were the staff of infertility and obstetrics and gynecology wards in four provinces enrolled in this study through stratified sampling. Data collection was done by demographic questionnaire, Spiel Berger and Beck depression inventory tests. Data were analyzed by SPSS software using ANOVA test. The result showed the rate of anxiety in obstetrics and gynecology staff of Isfahan center [54.69 +/- 13.58] and depression rate had increased level in infertility staff of Shiraz center [14.94 +/- 10.87]. Overall, there was significant correlation between anxiety, depression and work place [p=0.047, 0.008 respectively]. According to ANOVA test, the mean value of anxiety level was higher in the staff of four obstetrics and gynecology centers and one infertility center. As long as we know that infertile couples have little chance for success rate and obstetrics and gynecology wards patients have little risk of failure in treatment, it could be mentioned that the anxiety and depression in the staff are not correlated with the client illness

El deseo de hijo en las parentalidades actuales: infertilidad y técnicas reproductivas / [The desire for a child in today parenthood: Infertility and reproductive techniques].

The advances in reproductive medicine have unprecedentedly expanded the possibilities to form a family. Today we can speak of a diversity of ways to access to parenthood. The paradigm of family formations has also changed following the diversity of parenting projects: heterosexual couples, blended families (post-divorce), couples formed by lesbians and gays and single parenting. The vicissitudes of "desire for a child" under current parenthood lead us to think about their scope in clinical reproductive disorders or infertility and new family configurations. One of the destinies of the desire for a child in women is the "passion for a child", the child at any cost. Thinking of the changes in parenthood in this field involves not only the desire to have a child in a woman, a man or a couple, but also the history of the origins in children. Especially with some of the reproductive techniques used, such as surrogacy and the donation of gametes-eggs (ovum and sperm). In these cases we are dealing with new articulations of blood ties, kinship and parenthood.

Psicanálise e medicina reprodutiva: possíveis colaborações e indesejáveis armadilhas / Psychoanalysis and reproductive medicine: possible collaborations and undesirable traps / Psychanalyse et médecine reproductive: possibles collaborations et indésirables pièges / Psicoanálisis y medicina reproductiva: posibles colaboraciones y indeseables trampas

A partir de sua experiência como psicanalista colaboradora em dois Serviços de Reprodução, a autora discrimina no presente artigo três diferentes ordens de demanda feitas pelos médicos aos psicanalistas no que concerne a sua atuação nos tratamentos de infertilidade humana: 1) abordagem da causalidade inconsciente da infertilidade sem causas orgânicas detectadas; 2) auxílio na construção da parentalidade nos casos em que se faz necessário o recurso a doadores de sêmen, óvulos ou embriões ou ainda a úteros de substituição; 3) ajuda à equipe médica na tomada de decisões diante de situações complexas do ponto de vista bioético, ou seja, ante demandas que implicam a montagem de arranjos familiares que contradizem o que é aceito socialmente ou viável naturalmente. Cada uma dessas ordens de demanda comporta uma armadilha própria para o psicanalista. A abordagem dessas armadilhas constitui, junto com a explicitação das ordens de demanda referidas, o objetivo do artigo...

Based on her experience as a collaborator psychoanalyst in two Reproduction Services, the author in this paper distinguishes three different orders of demands from physicians to psychoanalysts in relation to their activities in the context of treatments of human infertility: 1) approach of the unconscious causation of infertilities without detected organic causes; 2) aid in the construction of parenthood in cases where it is necessary the use of donors of semen, eggs or embryos or even replacement wombs; 3) help to the medical staff in making decisions in face of complex situations from a bioethical point of view, i.e., concerning demands involving the assembly of family arrangements that contradict what is socially accepted or naturally feasible. Each of these orders of demands includes a trap for the psychoanalyst. The approach of these traps is, along with the explanation of demand orders referred above, the purpose of the article...

A partir de son expérience comme psychanalyste collaborant dans deux Services de Reproduction, l’auteur discrimine dans le présent article trois différents ordres de demande faites par les médecins aux psychanalystes en ce qui concerne leur actuation dans le cadre des traitements d’infertilité humaine: 1) tenir compte de la causalité inconsciente des infertilités sans cause organique décelée; 2) favoriser la construction de la parentalité dans les cas où il y a participation de donneurs de sperme, d’ovule ou d’embryons ou encore de mères porteuses; 3) aider l’équipe médicale a prendre des décisions face à des situations complexes du point de vue bioéthique, c’est-à-dire, face à des demandes qui impliquent le montage d’arrangements familiaux qui contredisent ce qui est accepté socialement ou possible naturellement. Chacun de ces ordres de demande comporte un piège particulier pour le psychanalyste. L’examen de ces pièges constitue, avec l’explicitation des ordres de demande ci-dessus indiquées, l’objectif de l’article...

A partir de su experiencia como psicoanalista colaboradora en dos Servicios de Reproducción, la autora discrimina en este artículo tres diferentes órdenes de demandas hechas por los médicos a los psicoanalistas con respecto a su desempeño en el contexto de los tratamientos de infertilidad humana: 1) enfoque de la causalidad inconsciente de la infertilidad sin causas orgánicas detectadas; 2) auxilio en la construcción de la parentalidad en los casos que se hace necesario el recurso de donantes de esperma, óvulos o embriones o el reemplazo del vientre; 3) ayuda al equipo médico en las decisiones delante de situaciones complejas de punto de vista bioético, es decir, delante de las demandas que involucran el montaje de arreglos familiares que contradicen lo que es socialmente aceptable o viable naturalmente. Cada uno de estos órdenes de demanda contiene una trampa propia para el psicoanalista. El enfoque de estas trampas compone, junto a la explicitación de los órdenes de demanda dichas anteriormente, el objetivo del artículo...

El modelo de la adaptación ante la infertilidad de la pareja / Model of adaptation in the face of couple infertility

Introducción: los modelos conceptuales constituyen un marco de referencia para la práctica de enfermería y para tratar la pareja infértil el modelo de la adaptación de Sor Callixta Roy permite que los profesionales utilicen como herramienta el Proceso de Atención de Enfermería para ofrecer un cuidado de excelencia. Objetivo: diseñar la propuesta de actuación de enfermería ante parejas infértiles a través del modelo de la adaptación de Sor Callixta Roy. Método: se realizó estudio descriptivo y retrospectivo con las parejas tratadas en el Centro territorial de atención a la pareja infértil de la provincia de Cienfuegos tributarias de fertilización invitro; de un universo de 251 parejas se seleccionó una muestra de 92 (36.6 por ciento) historias clínicas con el método aleatorio simple de las que se llevaron a un formulario las variables necesarias. Los datos fueron procesados con SPSS versión 15.0 y los resultados se muestran en tablas. Resultados: predominan los factores de riesgo para las infecciones de transmisión sexual así como la realización de gran número de abortos provocados los cuales constituyen causas de infertilidad. Se evidencian otros factores que permiten afirmar que muchos casos se pueden evitar y la mayoría puede resolver su situación. Conclusiones: se realiza propuesta de actuación de enfermería ante las parejas infértiles a través del modelo de la adaptación de Sor Callixta Roy(AU)

Introduction: the conceptual models are a reference framework for nursing practice, and in this regard, the Sor Callixta Roy's model of adaptation allows the professionals to use Process of Nursing Care as a tool to provide care of excellence to the infertile couple. Objective: to design the proposal of nursing intervention to deal with infertile couples, based on the Sor Callixta Roy's model of adaptation. Method: a retrospective and descriptive study of couples attended to at the territorial center for care of the infertile couple and scheduled for in vitro fertilization in Cienfuegos province. From a universe of 251 couples, a sample of 92 (36.6 percent) medical records was selected by the simple randomized method and the required variables were transferred to a specific form. Data were then processed with SPSS 15.0 version and the results were shown in tables. Results: risk factors for sexually transmitted infections as well as high number of abortions- a direct cause of infertility- predominated. There were also other factors that allow us to state that most of these cases are avoidable and can be solved. Conclusions: A proposal of nursing intervention to deal with infertile couples through the Sor Callixta Roy's model of adaptation was presented(AU)

Prevalence of depression among infertile couples in Iran: a meta-analysis study

Several studies have been conducted in Iran in order to investigate the prevalence of depression among infertile couples. However, there is a remarkable diversity among the results. This meta-analysis was conducted to estimate an overall prevalence rate of depression among infertile couples in Iran. International and national electronic databases were searched up to June 2011 including MEDLINE, Science Citation Index Expanded, Scopus, SID, MagIran, and IranMedex as well as conference databases. Furthermore, reference lists of articles were screened and the studies' authors were contacted for additional references. Cross-sectional studies addressing the prevalence of depression among infertile couples were included in this meta-analysis. We assessed 12 separate studies involving overall 2818 participants of which 1251 had depression. Overall prevalence rate of depression among infertile couples was 0.47 [95% CI: 0.40, 0.55]. The prevalence rate of depression was 0.44 [95% CI: 0.32, 0.56] during 2000 to 2005 and 0.50 [95% CI: 0.43, 0.57 during 2006 to 2011. The prevalence rate of depression was 0.46 [95% CI: 0.39, 0.53] among women and 0.47 [95% CI: 0.40, 0.54] among men. Not only the prevalence of depression in infertile couples was high but also had increasing growth in recent years. Furthermore, despite many studies conducted addressing the prevalence of depression in infertile couples, there is however a remarkable diversity between the results. Thus, one can hardly give a precise estimation of the prevalence rate of depression among infertile couples in Iran now

Enquanto a maternidade não vem: a infertilidade e a pressão social como pano de fundo para a adoção / While the motherhood doesn't come: infertility and social pressure as a background for adoption

Este trabalho trata da espera pela maternidade no contexto da adoção, enfocando aspectos sociais envolvidos na situação de impossibilidade biológica de gestar. Objetiva compreender alguns significados da maternidade para mulheres que aguardam a adoção do primeiro filho, assim como compreender fatores contextuais envolvidos no fenômeno. Realizou-se uma pesquisa de caráter qualitativo, com a participação de oito mulheres que estavam na fila de espera pela adoção, há pelo menos seis meses, na Comarca de uma cidade do Rio Grande do Sul /RS. Os dados foram submetidos à análise de conteúdo. As análises permitiram constatar que as participantes apresentam concepções tradicionais relacionadas à maternidade e à gestação, como aquela que realiza a mulher. Constatou-se também que as participantes sofrem duplamente, primeiro por que enfrentam a infertilidade e segundo por que precisam conviver com a pressão social por parte da família e dos amigos para tornarem-se mãe, sendo frequentes as críticas frente à impossibilidade biológica de gerar um bebê. Essa pressão social parece fazer com que elas continuem na espera pelo filho adotivo...

This work deals with the hopes for motherhood in the context of adoption, focusing on the social aspects involved in the situation of the biological impossibility of gestating. It aims to understand some meanings of motherhood forwomen who are waiting to adopt their first child, as wellunderstand the contextual factors involved in this phenomenon. We have conducted a qualitative research study, which has included the participation of eight women who have been on the waiting list for adoption, at least six months, the County in a city of Rio Grande do Sul/RS. The data were subjected to content analysis. The collected datarevealed that participants have traditional views regardingmotherhood and pregnancy, as that which makes thewoman. It was also found that participants suffer doubly, first by facing infertility and second, because they need to live with the social pressure from family and friends to become a mother, and are often criticized about thebiological impossibility of conceiving a child. This social pressure seems to make them continue in the struggle tohold the adoptive child...

Efeitos da infertilidade no relacionamento dos cônjuges / The effects of infertility on the spouses' relationship / Efectos de la infertilidad en la relación de los cónyuges

Trata-se de um estudo sobre os efeitos da infertilidade no relacionamento dos cônjuges, com os objetivos de descrever o perfil da população de estudo e analisar os efeitos da infertilidade na vida emocional, sexual e conjugal. Para tal, foi realizado um estudo transversal e prospectivo em instituição especializada. A amostra foi constituída por 50 casais inférteis com seis anos de infertilidade em média. As mulheres manifestaram sentimentos negativos perante a infertilidade, enquanto os homens assumiram uma postura de suporte e apoio. Os efeitos na vida sexual foram mais expressivos nas mulheres, e o tratamento da infertilidade levou a mudanças positivas para ambos os cônjuges. Ao comparar os efeitos da infertilidade sobre os indivíduos que haviam realizado mais de um tratamento com aqueles no primeiro tratamento, observamos que não houve diferenças entre as mulheres; entre os homens houve diferenças no aspecto emocional (frustração e alívio) e no relacionamento conjugal (fortalecimento e amadurecimento).

The present study investigated the effects of infertility on the spouses' relationship, with the objectives to describe the profile of the studied population, and analyze the effects of infertility on their emotional, sexual and marital life. To do this, a cross-sectional and prospective study was performed in a specialist institution. The sample consisted of 50 infertile couples with a mean of six years of infertility. The women manifested negative feelings in view of the infertility, while the men assumed an attitude of support. The effects on the couples' sexual life were more pronounced in women, and the infertility treatment resulted in positive changes for both spouses. No differences were found regarding the effects of infertility between the women who had undergone more than one treatment and those undergoing treatment for the first time; between the men there were differences in the emotional aspect (frustration and relief) and in the marital relationship (strengthening and maturing).

Estudio sobre los efectos de la infertilidad en la relación de los cónyuges, objetivando describir el perfil de la población estudiada y analizar los efectos de la infertilidad en la vida emocional, sexual y conyugal. Se realizó estudio transversal prospectivo en institución especializada. Muestra constituida por 50 parejas infértiles con seis años de infertilidad en promedio. Las mujeres manifestaron sentimientos negativos ante la infertilidad, mientras que los hombres asumieron una postura de soporte y apoyo. Los efectos en la vida sexual fueron más expresivos en las mujeres, el tratamiento de la infertilidad derivó en cambios positivos para ambos cónyuges. Al compararse los efectos de la infertilidad en individuos que habían realizados más de un tratamiento con la de aquellos en el primero, observamos que no hubieron diferencias entre las mujeres; entre los hombres existieron diferencias en aspectos emocionales (frustración y alivio) y en la relación conyugal (fortalecimiento y maduración).

Perspectives on access to in vitro fertilization in Portugal / Perspectivas sobre o acesso aos tratamentos de fertilidade em Portugal / Visión de los utilizadores sobre el acceso a los tratamientos de fertilidad en Portugal

OBJECTIVE: To analyze users' reasons for choosing in vitro fertilization treatment in public or private services and to identify their suggestions for improving fertility treatment. METHODS: A qualitative study using an interpretative approach was conducted. Fifteen semi-structured interviews were conducted with patients undergoing in vitro fertilization treatment (nine women, one man and five couples) at home or at their workplace in the districts of Viana do Castelo, Braga, Porto and Lisbon, Portugal, between July 2005 and February 2006. RESULTS: Users evaluated access to in vitro fertilization treatment in public and private services based mainly on their individual experiences and called for more access to less costly, faster and friendlier care with suitable facilities, appropriate time management and caring medical providers. These perceptions were also associated with views on the need for fighting stigmatization of infertility, protecting children's rights and guaranteeing sustainability of health care system. Interviewees sought to balance reduced waiting time and more attentive care with costs involved. The choice of services depended on the users' purchase power and place of residence and availability of attentive care. CONCLUSIONS: Current national policies on in vitro fertilization treatment meet user's demands of promoting access to, and quality, availability and affordability of in vitro fertilization treatment. However, their focus on legal regulation and technical-scientific aspects contrasts with the users' emphasis on reimbursement, insurance coverage and focus on emotional aspects of the treatment. The study showed these policies should ensure insurance coverage, participation of user representatives in the National Council for Assisted Reproductive Technology, promotion of infertility research and certification of fertility laboratories.

OBJETIVO: Analisar as motivações para escolha de tratamentos de fertilização in vitro em serviços públicos e privados, bem como identificar propostas que melhorem a qualidade desses. MÉTODOS: Estudo qualitativo e interpretativo, baseado em 15 entrevistas semiestruturadas com pessoas que tentaram conceber por meio de técnicas de procriação medicamente assistida em Portugal (nove mulheres, um homem e cinco casais). As entrevistas foram realizadas entre julho de 2005 e fevereiro de 2006 nos distritos de Viana do Castelo, Braga, Porto e Lisboa, em casa ou no local de trabalho dos entrevistados. RESULTADOS: Os usuários avaliaram o acesso aos tratamentos de fertilidade no serviço público ou privado sobretudo com base nas suas experiências individuais, reclamando acesso mais barato, rápido e amigável, em espaços adequados, com gestão apropriada dos tempos de espera e serviços médicos atenciosos. Tais percepções foram associadas a visões sobre a necessidade de combater a estigmatização da infertilidade e defender os direitos da criança e a sustentabilidade do sistema de saúde. Os entrevistados procuraram equilibrar a redução do tempo de espera e cuidados mais atenciosos com os custos envolvidos. A escolha dos serviços dependeu da renda e do local de residência dos usuários, além da existência de cuidados atenciosos. CONCLUSÕES: As atuais políticas nacionais vão ao encontro das expetativas dos utilizadores ao promover o acesso aos tratamentos de fertilidade e a sua qualidade, mas distanciam-se delas ao enfatizarem a regulação jurídico-legal e a dimensão técnico-científica da qualidade na procriação medicamente assistida em detrimento do acionamento de seguros de saúde e da valorização de aspetos emocionais. As políticas a implementar passam pela cobertura obrigatória dos tratamentos pelos seguros de saúde, pela inclusão de um representante dos usuários no Conselho Nacional de Procriação Medicamente Assistida, pela promoção da investigação sobre infertilidade em Portugal e pela certificação dos laboratórios que realizam testes de fertilidade.

OBJETIVO: Analizar las motivaciones de usuarios para escogencia de tratamientos de fertilización in vitro en servicios públicos y privados e identificar propuestas que mejoren la calidad de los mismos. MÉTODOS: Estudio cualitativo con abordaje interpretativa, basado en 15 entrevistas semi-estructuradas con personas que intentaron concebir por medio de técnicas de procreación con asistencia médica en Portugal (nueve mujeres, un hombre y cinco matrimonios). Las entrevistas fueron realizadas entre julio de 2005 y febrero de 2006 en los distritos de Viana do Castelo, Braga, Porto y Lisboa, en casa o en el lugar de trabajo de los entrevistados. RESULTADOS: Los usuarios evaluaron el acceso a los tratamientos de fertilidad en el servicio público o privado principalmente con base en sus experiencias individuales, reclamando acceso más barato, rápido y amigable, en espacios adecuados, con gestión apropiada de los tiempos de espera y servicios médicos atentos. Tales percepciones fueron asociadas a visiones sobre la necesidad de combatir la estigmatización de infertilidad y defender los derechos del niño y la sustentabilidad del sistema de salud. Los entrevistados buscaron equilibrar la reducción del tiempo de espera y cuidados más atentos con los costos financieros involucrados. La escogencia de los servicios dependió del capital económico y del lugar de residencia de los utilizadores y de la existencia de cuidados atentos CONCLUSIONES: Las actuales políticas nacionales van en paralelo con las expectativas de los utilizadores al promover el acceso a los tratamientos de fertilidad y su calidad, pero se separan de ellas al enfatizar la regulación jurídico-legal y la dimensión técnico-científica de la calidad en la procreación con asistencia médica en detrimento de la activación de seguros de salud y de la valorización de aspectos emocionales. Las políticas a implementar pasan por la cobertura obligatoria de los tratamientos por los seguros de salud, la inclusión de un representante de los utilizadores en el Consejo Nacional de Procreación Con Asistencia Médica, la promoción de la investigación sobre infertilidad en Portugal y la certificación de los laboratorios que realizan pruebas de fertilidad.

Aspectos bioéticos da reprodução assistida no tratamento da infertilidade conjugal / Bioethical issues of assisted reproduction in infertility treatment

A aspiração à reprodução é tida como um objetivo essencial de vida, legítimo e incontestável. A infertilidade acarreta para muitas pessoas uma crise vital prolongada e o estresse resultante frequentemente leva à morbidade emocional e a problemas interpessoais. Um entre cada seis casais apresenta infertilidade e, para 20% deles, o único caminho para obter gestação e, consequentemente, filhos é a reprodução assistida. Este texto discute os aspectos bioéticos da fertilização in vitro no tratamento da infertilidade, com o objetivo de contribuir para a reflexão e o debate desta temática pela comunidade científica. Abordamos as questões relacionadas ao casal, ao embrião e ao nascituro, considerando também o uso de gametas doados e de cessão temporária do útero

The aspiration for reproduction is considered as a crucial, legitimate and unquestionable goal in life. For many people, infertility leads to a prolonged life crisis, and the resulting stress often leads to emotional morbidity and interpersonal problems. One in six couples suffers from infertility, and for 20% of them, the only way to achieve pregnancy and have children is Assisted Reproduction. This paper discusses the bioethical aspects of IVF treatment for infertility, so as to contribute to the reflection and discussion of this topic by the scientific community. We address issues concerning the couple, the embryo and the unborn child, also addressing the use of donated gametes and surrogate uterus

¿Qué sabemos hoy sobre las relaciones entre estrés e infertilidad? / What we know today about the relationship between stress and infertility?

El objetivo de este artículo es sintetizar los resultados de la investigación acerca de la relación entre factores psicológicos, particularmente el estrés, e infertilidad. Los primeros estudios basados en casos clínicos, exploraron las características psicológicas o conflictos intrapsíquicos que pueden ser causa de infertilidad. Posteriormente la investigación puso el acento en describir las consecuencias emocionales más frecuentes de la infertilidad y sus tratamientos. Además se describieron las diferencias en la respuesta emocional de hombres y mujeres. Estos estudios aportaron a relevar la importancia de un abordaje integral de la infertilidad que integre los aspectos emocionales.En base a las teorías sobre el estrés y la incidencia de los estilos psicológicos de enfrentamiento del estrés, se caracterizó el estrés específico asociado a la infertilidad y los tratamientos (ámbito personal, de relación de pareja y social) y se desarrollaron instrumentos de evaluación. Se estudió qué tipo de enfrentamiento produce una mejor adaptación tanto en hombres como en mujeres. En los años 90 se han realizaron varias investigaciones siguiendo parejas infértiles, que demostraron que el nivel de estrés experimentado afecta significativamente la calidad de la relación de pareja, la adherenciaa los tratamientos y la respuesta a los mismos expresada en tasa de embarazo y número de ciclos de tratamiento para lograr una gestación. De la investigación surgen conclusiones que orientan la metodología y el contenido de la intervención psicosocial para que ésta sea una contribución efectiva en la salud mental de las personas, su adherencia al tratamiento y el resultado de los mismos.

The aim of this article is to summarize the results of research concerning psychological factors, particularly stress, in relation to infertility. The first studies based on clinical cases, explored the psychological characteristics or intrapsychic conflicts associated to infertility. Subsequently, studies placed emphasis on describing the most frequent emotional consequences and their treatment. The differences in the emotional response from men and women were also described. These studies contributed to highlight the importance of an integral approach to infertility which includes emotional aspects. Based on the stress theories and the incidence of psychological coping styles, it was possible to characterize stress associated specifically to infertility and its treatment (personal, for couple and social relationships), the type of approach which produces better adaptation, both in women and men, and also to develop methods of evaluation. In the 90´s various studies involving infertile couples, demonstrated that the level of stress experienced has considerable effect on the quality of couple relationships, adherence to treatment and the efficacy of the treatments themselves, expressed in terms of pregnancy rates and the number of cycles needed to achieve a pregnancy. Findings from these studies have helped to orient the methodology and content of psychosocial intervention, thus helping to contribute positively to the mental health of couples, their adherence to infertility treatment and the results, themselves.

Infertility. A clinical approach

Infertility was, is and will be a serious problem for married couples. This review paper is intended to focus on clinical, social, and psychological problems in infertility. Infertility is a clinical problem which denotes the inability of a couple to give birth to child after a year of marriage. There exist a number of possible factors of male infertility, these are pathological infertility, physiological, genetically, and sexually transmitted infections. Attempt has been made to uncover the ignorance among the masses, who turn to pirs and mazars for a cure, and lack of will among medical professionals to find a scientific solution which has further aggravated the issue

Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria

Objective: To determine the psychosocial and clinical factors that are associated with psychiatric morbidity among women with infertility attending a Nigerian gynaecology clinic. Method: Over a four month period, 320 respondents (160 in the study group and 160 in the control group) were interviewed using a proforma (designed by the authors) and a screening instrument, General Health Questionnaire version 30 (GHQ-30). All probable cases with a score of 5 or more on GHQ-30 were interviewed using the Present State Examination (PSE). Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10). Results: The infertility rate among the study group was found to be 25.8% with primary and secondary infertility rates constituting 21.9% and 78.1% respectively. The prevalence of psychiatric morbidity among women with infertility (48.8%) was significantly more than that in the control group (11.2%) (c2 = 51.80, p < 0.0001). Lack of support from husband (c2 = 15.31, p < 0.001), lack of support from husband's relatives (c2 = 39.60, p < 0.0001), discrimination (c2 = 69.91, p < 0.0001) and history of induced abortion (c2 = 30.40, p < 0.0001) were found to be significantly associated with psychiatric morbidity among patients with infertility when compared with the fertile control population. There was no significant difference in the rate of psychiatric morbidity between women with primary infertility and those with secondary infertility (c2 =0.03; p = 0.87). Conclusion: Psychiatric morbidity is significantly more common among patients with infertility as compared with those without. There was a significant association between psychiatric morbidity and absence of support from husband and his relations, presence of discrimination, and a history of induced abortion. We suggest more public enlightenment on the need for moral/ psychosocial support to women with infertility. In addition, more efforts should be made towards early screening and identification of cases of psychiatric morbidity among patients with infertility

Os filhos da ciência: sobre a maternidade na reprodução assistida / Science children: assisted reproductive motherhood

Este artigo propõe a diferença conceitual entre ser mãe, segundo a Biologia e ser mãe, para a Psicanálise. A experiência clínica com mulheres ditas inférteis, no Centro de Reprodução Assistida do ICHC-FMUSP, indica que a demanda pela gestação pode não corresponder, necessariamente, à demanda de ser mãe. Dessa experiência conclui-se que ser mãe é ocupar um lugar psíquico, ainda que a gestação possa ser crucial para a construção da função materna; que a impossibilidade de ser mãe pode estar relacionada com a dificuldade de ter filhos; e que a atenção a elementos inconscientes diminui o risco do nascimento dos filhos da Ciência.

This article proposes to analyze the conceptual difference between being a mother, according to Biology and Psychoanalysis. The clinical experience with infertile women, at the ICHC-FMUSP-Assisted Reproduction Center indicates that the demand for pregnancy may not necessarily correspond to that of being a mother. It leads to the conclusion that being a mother is to fill a psychic place, despite the fact that pregnancy might be crucial for the construction of the nurturing function; that the impossibility of being a mother may be related to the difficulty of having children; and that attention to unconscious elements decreases the risk of producing Science children.

Depression in infertile couples

Impaired fertility effects approximately 80 million people from all parts of the world. It is estimated that approximately one in ten couples have either primary or secondary infertility. Infertile women have significantly higher level of depressive symptoms and twice the prevalence of depressive symptoms relate to fertile women. Depression may be recognized as major or minor. The study was conducted on couples attending outpatient department of Baqai Institute of Reproduction and Developmental Science between January to December 2007. A questionnaire was designed for personal interview with these couples. Informed consent was taken from each couples before the interview. The survey was conducted on those couples who sought first time evaluation for fertility. The survey contained general questions regarding their age, years with partner, education, race, religion, reproductive history and infertility treatments as per five-item Geriatric Depression Scales [GDS]. The questionnaire was completed by interviewing 106 couples confidentially. According to this study, females were common victims of depression but males were also sufferers. In summary, the psychological status of infertile patients should be assessed in order to help patients and to relieve their distress

A Abordagem do casal infértil / The infertile couple assessment

As escolhas que definem a pesquisa e o tratamento da infertilidade fazem parte de um desenvolvimento sistemático de procedimentos. Em breve revisão, procurou-se identificar as melhores opções disponíveis entre dados da Medicina Baseada em Evidências. A partir da definição da infertilidade, foram identificadas as situações causais que permitem o início da pesquisa, assim como justificam sua antecipação temporal. Buscaram-se considerações sobre a etiologia e o diagnóstico; a importância dos principais exames utilizados; a infertilidade sem causa aparente; o casal infértil e a reprodução assistida; e o direito dos casais de receber informações claras e objetivas sobre os procedimentos, participando das decisões de terapêuticas. De forma geral, embora se tenha ganhado exames e procedimentos, a indicação de alguns, outrora considerados clássicos e indispensáveis, hoje não encontra mais sustentação, enquanto outros, novos, ainda permanecem sem níveis de evidência definidos.

The infertile couple routine assessments include a wide range of exams. In this review we look for the best options following the criteria of Evidenced Based Medicine. We review the definition of infertility and the data from anamnesis and physical exam that can lead to the investigation. Situations in which exams are anticipated are discussed. The most common ethiology and diagnosis are reviewed, as well as the most significant tests. In addition, unexplained infertility, the infertile couple and the assisted reproductive techniques, the right of the couples to be informed and to participate of the therapeutical decisions about their fertility were discussed. Classical exams like the post coital test and the endometrium biopsy are almost useless, while many available new tests based on technology, remain without defined strength on evidence levels.