ABSTRACT
Introducción: La infertilidad es una enfermedad presente en el 17.5% de la población adulta. La COVID-19 provocó sobrecargas en atención de salud, generando un impacto incierto en unidades de salud reproductiva que realizan terapias de reproducción asistida. Objetivos: Comparar características clínicas y tiempos de atención de pacientes sometidas a fertilización in vitro de la Unidad de Medicina Reproductiva del Hospital Gustavo Fricke entre los periodos 2017-2019 y 2020-2022. Método: Estudio observacional descriptivo, utilizando base de datos anonimizada de la Unidad de Medicina Reproductiva del Hospital Gustavo Fricke con 82 pacientes sometidas a fertilización in vitro. Resultados: La media de edad fue de 34.2 ± 4.2 años. El tiempo de infertilidad fue de 5.1 ± 4.3 años. Los factores de infertilidad más frecuentes son el tuboperitoneal (59,8%) y masculino (46,3%). Durante los primeros 20 meses en prepandemia hubo mayor tendencia a derivación precoz al Centro de Reproducción Humana de la Universidad de Valparaíso (odds ratio: 3.84). Conclusiones: En pandemia se evidenció un aumento en el tiempo de infertilidad, mediana de gestaciones, abortos previos y frecuencia de factor masculino. No hubo cambios significativos en tiempos de derivación a fertilización in vitro, no obstante, durante la pandemia disminuyeron las derivaciones precoces.
Introduction: Infertility is a disease present in the 17.5% of the adult population. COVID-19 caused overload in health centers, producing an unclear impact in the reproductive health units that perform assisted reproduction therapies. Objectives: To compare clinical characteristics and the attention times of patients subjected to in vitro fertilization in the Reproductive Medicine Unit of the Gustavo Fricke Hospital between the 2017-2019 and 2020-2022 periods. Method: Descriptive observational study in which an anonymized database of 82 patients subjected to in vitro fertilization in the Reproductive Medicine Unit of the Gustavo Fricke Hospital was used. Results: The average age was 34.2 ± 4.2 years old. The infertility time was 5.1 ± 4.3 years. The most frequent infertility factors were tuboperitoneal (59.8%) and male factors (46.3%). During the first pre-pandemic 20 months, there was a higher tendency towards early referral to the Center for Human Reproduction of the Valparaiso University (odds ratio: 3.84). Conclusions: In the course of the pandemic, there was an increase of the infertility time, the pregnancies median, prior abortions, and male factor frequency. On the other hand, there were not considerable changes when it comes to referral times to in vitro fertilization, however, early referrals decreased during the pandemic.
Subject(s)
Humans , Female , Adult , Fertilization in Vitro/statistics & numerical data , COVID-19 , Infertility, Female , Referral and Consultation , Time Factors , Reproductive Techniques, Assisted/statistics & numerical data , Kaplan-Meier Estimate , Pandemics , Hospitals, Public , Infertility, MaleABSTRACT
@#Some women may not be able to carry their own children even when capable of conceiving biological offspring. In-vitro fertilization and embryo-transfer (IVF-ET) through surrogacy can now make this possible for these women. Surrogacy however, is still considered unacceptable in the Philippines due to moral and legal issues. This article will explore the need and acceptability of surrogacy in this age of IVF-ET in a country where the prevailing social norms and religious values still disapprove of third-party assisted reproductive technology (ART). Medical indications that would benefit from gestational surrogacy were enumerated and briefly discussed. The differentiation between traditional and gestation surrogacy, as well as commercial and altruistic surrogacy were defined. IVF with gestational surrogacy is a feasible solution to a number of medical difficulties in the carrying of a gestation. Strictly regulating the practice and restricting its use only to cases with legitimate medical indications will prevent its misuse and exploitation. Moral issues, admittedly will still remain an issue particularly for commercial surrogacy. However, limiting these only to altruistic and gestational surrogacy in some cases may be an acceptable compromise.
Subject(s)
Child , Fertilization in Vitro , Reproductive Techniques, AssistedABSTRACT
BACKGROUND: Infertility affects fifteen percent of couples who wish to conceive. The mainstay of artificial re-productive technologies is in vitro fertilization and embryo transfer (IVF-ET), in which aspirated oocytes are fertilized, followed by the trans cervical replacement of an embryo(s) into the uterine cavity. However, the practice of assisted reproductive technology is loaded with short- and long-term complications. Complications may occur during the course of stimulation, ovum pickup, or embryo transfer. Ample studies are done on in vitro fertilization, but the frequency and im-portance of complications of IVF in low-resource settings where the treatment itself is not widely available are not well known. OBJECTIVE: This study aimed to determine the rate of ovarian hyper stimulation syndrome (OHSS) and asso-ciated factors among women who underwent controlled ovarian stimulation and IVF in a public IVF center in Ethiopia. METHODOLOGY: A retrospective cohort study was conducted to review the medical records of women who have undergone ovarian stimulation and IVF treatment at the Saint Paul's Hospital Center for Repro-ductive Medicine and IVF. RESULTS: A total of 428 clients had controlled ovarian stimulation and IVF. The mean age of the partici-pants was 33 years. Among 428 couples who had IVF, majority 245 (57%) had IVF for female fac-tor infertility, followed by male factor infertility 89 (20%), and unexplained causes 53 (12%). The incidence of OHSS in our IVF population was 19 (4.4%) out of 428 women. Out of the 19 patients with OHSS, 17 (89%) developed mild and moderate symptons,and 2 out of 19 (10 %) had severe OHSS. The odds of developing OHSS was 6 times higher among those with PCOS, OR 5.78 CI (1.19, 28.22), p value of 0.03. CONCLUSIONS AND RECOMMENDATIONS: The overall rate of ovarian hyper stimulation syndrome is higher in our IVF population. Emphasis should be given on thorough counseling and risk minimizing measures when women with PCOS undergo controlled ovarian stimulation.
Subject(s)
Ovulation Induction , Therapeutics , Fertilization in Vitro , Prevalence , Reproductive Medicine , Reproductive Techniques, Assisted , Embryonic Structures , InfertilityABSTRACT
Resumo Este estudo é um relato de experiência referente a um acompanhamento psicoterápico realizado com um menino de 9 anos, gerado por meio das tecnologias reprodutivas e que desconhece sua concepção. As discussões apresentadas emergiram durante as supervisões de estágio supervisionado em um serviço-escola de psicologia no período de maio a novembro de 2019. Durante as sessões, a criança trazia conteúdos a respeito de mitologia, natureza, filmes e jogos que, ao serem explorados em setting analítico, desvelaram o seu interesse em questões da sexualidade, da origem dos bebês e de sua própria concepção. Por meio deste relato, espera-se colaborar com reflexões sobre a omissão da concepção, em específico a reprodução assistida, e, ainda, possibilitar um aumento e uma atualização de estudos sobre a clínica psicanalítica com crianças no Brasil, de forma que venha a promover novas perspectivas de análise e contribuições.
Abstract This experience report refers to a psychotherapeutic counseling attended by a nine-year-old boy conceived through reproductive technologies and unaware of his conception. The discussions presented here emerged during a supervised internship at a Psychology School Service from May to November 2019. During the sessions, the child alluded to mythology, nature, movies and games contents which when explored in an analytical setting unveiled his interest in issues of sexuality, the origin of babies, and his own conception. We expect this report to collaborate with reflections on the omission of conception, especially in the context of assisted reproduction, and to increase and update child psychoanalytic research in Brazil, as to promote new perspectives of analysis.
Resumen Este estudio presenta un reporte de experiencia sobre un seguimiento psicoterapéutico de un niño de 9 años, generado mediante tecnologías reproductivas y que no conoce su concepción. Las discusiones presentadas surgieron durante las prácticas supervisadas en un Servicio Escolar de Psicología en el período de mayo a noviembre de 2019. Durante las sesiones, el niño trajo contenido sobre mitología, naturaleza, películas y juegos, que cuando se exploraba en un entorno analítico reveló su interés en temas de sexualidad, de origen de los bebés y de su propia concepción. Se espera mediante este reporte colaborar con las reflexiones sobre la omisión de la concepción, específicamente a la reproducción asistida, y también permitir un aumento y actualización de estudios de la clínica psicoanalítica infantil en Brasil, para que así se promuevan nuevas perspectivas de análisis y contribuciones.
Résumé Ce rapport d'expérience fait référence à un suivi psychothérapeutique réalisé avec un garçon de neuf ans conçu par des technologies de la reproduction et n'ayant pas conscience de sa conception. Les discussions présentées ici ont émergé lors d'un stage supervisé dans un service scolaire de psychologie de mai à novembre 2019. Au cours des séances, l'enfant a fait allusion à des informations sur la mythologie, la nature, les films et les jeux qui, lorsqu'il ont été explorés dans un cadre analytique, ont dévoilé son intérêt pour les questions de sexualité, l'origine des bébés et sa propre conception. Nous espérons que ce rapport collaborera avec les réflexions sur l'omission de la conception, en particulier dans le contexte de la procréation assistée, et qu'il augmentera et mettra à jour la recherche psychanalytique sur l'enfant au Brésil, afin de promouvoir de nouvelles perspectives d'analyse et de contributions.
Subject(s)
Humans , Male , Child , Psychotherapy, Brief , Truth Disclosure , Reproductive Techniques, Assisted , Oedipus Complex , Child , Family RelationsABSTRACT
This summary addresses the use of reproduction technologies in swine farming, with an emphasis on artificial insemination (AI). Brazilian swine farming has been growing significantly and seeks new technologies to achieve high productive indices sustainably and competitively. Pigs present favorable characteristics such as high prolificacy, fertility, rapid growth, feed efficiency, and carcass yield, which has led to intensive development of the activity with advanced genetic selection. AI is widely employed to disseminate genetic material among different regions and farms. Several AI techniques are used in modern swine farming: intrauterine insemination (IUI) allows semen deposition in the uterine region, reducing costs; fixed-time insemination (FTAI) synchronizes estrus in various females, facilitating management and increasing efficiency; deep intrauterine insemination (DIUI) deposits semen in the uterine horns, obtaining better results; and cervical insemination (CI), a traditional technique widely used, although it may be more time-consuming and present higher reflux rates. The success of AI is related to knowledge of the reproductive cycle of sows, proper nutrition, and genetic and environmental factors. Semen quality is essential, requiring collection by trained professionals and evaluation of sperm motility and morphology. Although it is a consolidated technique, there are issues to be further explored to optimize its application, defining the exact moment for insemination, reducing reflux, and adopting effective protocols. AI is an essential tool for the growth of Brazilian swine farming, but it requires continuous studies to maximize its efficiency and results, considering the farm's production goal and the size of the enterprise to achieve high reproductive and productive indices.
Este resumo aborda o uso de tecnologias de reprodução na suinocultura, com ênfase na inseminação artificial (IA). A suinocultura brasileira vem crescendo significativamente e busca novas tecnologias para alcançar altos índices produtivos de maneira sustentável e competitiva. Os suínos apresentam características favoráveis, como alta prolificidade, fertilidade, rápido crescimento, eficiência alimentar e rendimento de carcaça, o que levou ao desenvolvimento intensivo da atividade com seleção genética avançada. A IA é amplamente empregada para disseminar material genético entre diferentes regiões e granjas. Diversas técnicas de IA são utilizadas na suinocultura moderna: a inseminação intrauterina (IAIU) permite a deposição do sêmen na região uterina, reduzindo custos; a inseminação em tempo fixo (IATF) sincroniza o estro em várias fêmeas, facilitando o manejo e aumentando a eficiência; a inseminação intrauterina profunda (IAUP) deposita o sêmen nos cornos uterinos, obtendo melhores resultados; e a inseminação cervical (IAC), técnica tradicional amplamente utilizada, embora possa ser mais demorada e apresentar maiores taxas de refluxo. O sucesso da IA estar relacionado ao conhecimento do ciclo reprodutivo das matrizes, à nutrição adequada e aos fatores genéticos e ambientais. A qualidade do sêmen é essencial, exigindo coleta por profissionais treinados e avaliação da motilidade e morfologia dos espermatozoides. Apesar de ser uma técnica consolidada, há questões a serem aprofundadas para otimizar sua aplicação, definindo o momento exato para a realização da inseminação, a redução do refluxo e adoção de protocolos eficazes. A IA é uma ferramenta essencial para o crescimento da suinocultura brasileira, mas requer estudos contínuos para maximizar sua eficiência e resultados, considerando o objetivo produtivo da granja e o tamanho do empreendimento para alcançar altos índices reprodutivos e produtivos.
Este resumen aborda el uso de tecnologías de reproducción en la producción porcina, con énfasis en la inseminación artificial (IA). La producción porcina brasileña ha crecido significativamente y busca nuevas tecnologías para alcanzar altos índices de productividad de manera sostenible y competitiva. Los cerdos presentan características favorables, como alta prolificidad, fertilidad, rápido crecimiento, eficiencia alimentaria y rendimiento de la canal, lo que ha llevado al desarrollo intensivo de la actividad con selección genética avanzada. La IA se utiliza ampliamente para difundir material genético entre diferentes regiones y granjas. Diversas técnicas de IA son utilizadas en la producción porcina moderna: la inseminación intrauterina (IAIU) permite la deposición del semen en la región uterina, reduciendo costos; la inseminación a tiempo fijo (IATF) sincroniza el estro en varias hembras, facilitando el manejo y aumentando la eficiencia; la inseminación intrauterina profunda (IAUP) deposita el semen en los cuernos uterinos, obteniendo mejores resultados; y la inseminación cervical (IAC), técnica tradicional ampliamente utilizada, aunque puede ser más demorada y presentar mayores tasas de reflujo. El éxito de la IA está relacionado con el conocimiento del ciclo reproductivo de las hembras, la nutrición adecuada y los factores genéticos y ambientales. La calidad del semen es esencial, requiriendo la recolección por profesionales capacitados y la evaluación de la motilidad y morfología de los espermatozoides. A pesar de ser una técnica consolidada, hay aspectos que deben ser profundizados para optimizar su aplicación, como la definición precisa del momento de la inseminación, la reducción del reflujo y la adopción de protocolos eficaces. La IA es una herramienta esencial para el crecimiento de la producción porcina brasileña, pero requiere estudios continuos para maximizar su eficiencia y resultados, considerando el objetivo productivo de la granja y el tamaño del emprendimiento para alcanzar altos índices reproductivos y productivos.
Subject(s)
Animals , Sperm Motility , Swine/physiology , Insemination, Artificial/veterinary , Reproductive Techniques, Assisted/veterinary , Semen Analysis/veterinaryABSTRACT
Abstract Objective To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). Conclusion Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO CRD42023449655
Subject(s)
Humans , Female , Pregnancy , Prednisolone , Fertilization in Vitro , Cyclosporine , Reproductive Techniques, Assisted , Immunosuppressive AgentsABSTRACT
Objetivo: examinar la relación entre éxito en la carrera y ambiente de trabajo con enfermeras actuantes en tecnología de reproducción asistida (TRA), e identificar factores que afectan su éxito en la carrera. Método: estudio transversal realizado en 53 centros de fertilidad de 26 provincias en la China Continental. Datos recolectados utilizando cuestionario de datos demográficos, un Cuestionario de Competencias de TRA para Enfermeras Especializadas, la Career-Success Scale (Escala de éxito profesional) y la Nursing Work Environment Scale (Escala del entorno de trabajo de enfermería). Se aplicó estadística inferencial y descriptiva. Resultados: 597 enfermeras actuantes en TRA participaron en nuestra encuesta, entregando 555 cuestionarios válidos. Los puntajes generales promedio de éxito en la carrera y ambiente de trabajo fueron 3,75 (desviación estándar, [DE]=1,01) y 3,42 (DE=0,77) respectivamente. Se observó fuerte correlación positiva entre éxito en la carrera y ambiente de trabajo (r=0,742; p<0,01). La regresión múltiple mostró que la concurrencia a conferencias académicas, atención psicológica, desarrollo profesional, apoyo y cuidado, salario y bienestar constituyeron factores significantes con influencia en el éxito en la carrera. Conclusión: la concurrencia a conferencias académicas, atención psicológica y ambiente de trabajo guardan relación positiva con el éxito en la carrera. Los gestores deberían considerar formas de abordar tales factores.
Objective: to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. Method: a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. Results: 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. Conclusion: attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.
Objetivo: examinar a relação entre o sucesso profissional e o ambiente de trabalho de enfermeiros da área de tecnologia de reprodução assistida e identificar os fatores que afetaram tal sucesso. Método: estudo transversal conduzido em 53 centros de fertilidade em 26 províncias da China Continental. Os dados foram coletados por meio de um questionário demográfico, um questionário sobre competências de enfermagem especializada em tecnologias de reprodução assistida, da Career-Success Scale (Escala de Sucesso Profissional) e da Nursing Work Environment Scale (Escala do Ambiente de Trabalho na Enfermagem). Aplicaram-se análises de estatística descritiva e inferencial. Resultados: participaram do estudo 597 enfermeiros da área de tecnologia de reprodução assistida, e 555 questionários válidos foram coletados. As pontuações globais médias para o sucesso profissional e o ambiente de trabalho foram 3,75 [desvio padrão (DP) = 1,01] e 3,42 (DP = 0,77), respectivamente. Verificou-se forte correlação positiva entre o sucesso profissional e o ambiente de trabalho (r = 0,742; p < 0,01). A análise de regressão múltipla mostrou que a participação em eventos acadêmicos, a assistência psicológica, o desenvolvimento profissional, o apoio e os cuidados, e o salário e o bem-estar foram fatores que influenciaram significativamente o sucesso profissional. Conclusão: a participação em eventos acadêmicos, a assistência psicológica e o ambiente de trabalho mostraram correlação positiva com o sucesso profissional. Os gestores deveriam considerar formas de abordar esses fatores.
Subject(s)
Humans , China , Cross-Sectional Studies , Reproductive Techniques, Assisted , Job Satisfaction , NursesABSTRACT
Professional development, the search for economic stability and personal fulfillment have been some of the reasons why an increasing number of women have decided to delay pregnancy beyond the third decade of life. By definition, a pregnancy of advanced maternal age is considered to be those over 35 years of age, and it is known that this age group faces a higher risk of complications during pregnancy, intrapartum and postpartum, in addition to perinatal morbidity and mortality that is usually associated with chromosomal abnormalities. In Chile, pregnancies over 35 years of age or late pregnant women have increased significantly in recent decades, however there are no statistical data at a local level. The objective of this study is to evaluate the prevalence of pregnancies of advanced maternal age and their most frequent complications in the Maule Region with data obtained between 2017 - 2022 at the Regional Hospital of Talca (RHT).
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications , Maternal Age , Pregnancy Outcome , Cross-Sectional Studies , Retrospective Studies , Diabetes, Gestational , Pregnancy, High-Risk , Reproductive Techniques, Assisted , Electronic Health Records , Hospitals, Public/statistics & numerical dataABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Social Support , Reproductive Techniques, Assisted , Infertility/psychology , Family , Mental Health , Social Stigma , Sociodemographic Factors , Interview, PsychologicalABSTRACT
Las técnicas de reproducción médicamente asistida no escapan de la nueva tendencia de automatización de los procesos médicos debido a los vertiginosos avances de la bioingeniería. El objetivo principal de automatizar la fertilización in vitro es poder realizar muchos más tratamientos a menor costo. Además, a mejores resultados son menos los ciclos a los que deben someterse los pacientes. Una cuestión que emerge en el campo de la medicina reproductiva es que las aplicaciones de Inteligencia Artificial (IA) podrían rápidamente comenzar a ser operadas por personas que no tienen conocimientos específicos en esta rama de la medicina. A su vez, podría verse disminuida la cantidad de biólogos especializados en embriología necesarios en los laboratorios, quienes llegarían a perder su trabajo si no se capacitan en el uso de la IA. Es probable que el mercado ocupacional se redireccione y los nuevos graduados se vuelquen más a ese tipo de formación. Sin embargo, el factor humano sigue siendo un valor importante por la confianza que deposita el paciente en el profesional médico que lo asesora y tranquiliza. Recordemos que en los tratamientos de fertilidad asistida esto es llevado a cabo más por los médicos especialistas en medicina reproductiva que por los embriólogos.
The medically assisted reproduction techniques do not escape the new tendency to automate medical processes due to the vertiginous advances of bioengineering. The main objective of automating in vitro fertilization is to be able to perform many more treatments at a lower cost. In addition, to better results are less the cycles to which patients should be submitted. An issue that emerges in the field of reproductive medicine is that artificial intelligence applications (AI) could quickly begin to be operated by people who have no specific knowledge in this branch of medicine. In turn, the number of biologists specialized in embryology necessary in laboratories could be diminished, who would lose their job if they are not trained in the use of AI. It is likely that the occupational market will be redirect and the new graduates turn more to that type of formation. However, the human factor remains an important value for the trust that the patient deposits in the medical professional who advises and reassures him. Recall that in assisted fertility treatments this is carried out more by doctors specializing in reproductive medicine than by embryologists
Subject(s)
Humans , Male , Female , Artificial Intelligence , Reproductive Techniques, Assisted , BioengineeringABSTRACT
Transgênero (trans) é um termo que alberga toda a diversidade de gênero. A incongruência de gênero faz parte desse espectro e refere-se à pessoa cuja identidade de gênero é oposta ao sexo que lhe foi atribuído no nascimento. A terapia hormonal de afirmação de gênero, bem como a cirurgia de afirmação de gênero, é necessária para adequar o corpo ao gênero ao qual a pessoa se identifica. Os homens trans necessitam da terapia com testosterona, que visa reduzir as concentrações de estradiol e incrementar a testosterona circulante para níveis fisiológicos masculinos, resultando em masculinização. A mulher trans receberá o estradiol, associado ou não a um antiandrogênico, visando reduzir a testosterona e incrementar o estrogênio para níveis femininos, resultando em feminização. A cirurgia de afirmação de gênero é, frequentemente, requerida para completar as modificações fenotípicas para o homem e a mulher trans. O ginecologista e obstetra tem um papel crucial no provimento de cuidados a essa população. O presente artigo visa sistematizar algumas ações que o ginecologista e obstetra pode oferecer e que têm potencial para melhorar a qualidade de vida dos homens e mulheres trans. (AU)
Transgenero (trans) is an umbrella term that encompasses all gender diversity. Gender Incongruity is part of this spectrum and refers to the person whose gender identity is opposed to the sex assigned to them at birth. Gender-affirming hormone therapy as well as gender-affirming surgery are necessary to adapt the body to the gender to which the person identifies. Trans men require testosterone therapy to reduce estradiol concentrations and increase circulating testosterone to male physiological levels resulting in masculinization. Trans women will receive estradiol associated or not with an antiandrogenic to reduce testosterone and increase estrogen to female levels resulting in feminization. gender-affirming surgery is often required to complete phenotypic modifications for trans men and women. The gynecologist and obstetrician plays a crucial role in to provide care to this population. This article aims to systematize some actions that the gynecologist and obstetrician can offer to improve the quality of life of trans men and women. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Delivery of Health Care/ethics , Gynecology , Prostatic Neoplasms/prevention & control , Testosterone/administration & dosage , Breast Neoplasms/prevention & control , Contraception , Reproductive Techniques, Assisted , Estradiol/administration & dosage , Estrogens/administration & dosage , Venous Thromboembolism/prevention & control , Gynecologists , ObstetriciansABSTRACT
INTRODUCCIÓN: El síndrome de hiperestimulación ovárica es una respuesta exagerada del ovario a los tratamientos hormonales para estimular la formación de óvulos. OBJETIVO: Describir el caso clínico de una mujer con síndrome de hiperestimulación ovárica; revisar el abordaje, manejo, tratamiento y cómo prevenirlo. CASO CLÍNICO: Paciente femenina de 37 años, multigesta, en tratamiento con metformina por Síndrome de ovario poliquístico , que presenta infertilidad secundaria a factor tubárico, que desarrolló un cuadro moderado de síndrome de hiperestimulación ovárica como consecuencia de la aplicación de las técnicas de fertilización in vitro (Folitropina alfa humana recombinante (GONAL-F®) y Cetrolerelix (CETROTIDE®); al cuarto día del procedimiento de aspiración folicular presenta dolor pélvico intenso, disuria, deposiciones diarreicas, ecografía abdominal y vaginal evidencia líquido libre en cavidad alrededor de 1000cc, además de ovarios tanto derecho e izquierdo con volumen de 102 mL y 189 mL respectivamente. Paciente es ingresada para realizar tratamiento hidratación parenteral, Enoxaparina 40mg subcutánea, Cabergolina 0.5mg vía oral, alta a las 72 horas. DISCUSIÓN: Las claves para la prevención del síndrome de hiperestimulación ovárica son la experiencia con la terapia de inducción de la ovulación y el reconocimiento de los factores de riesgo para el síndrome de hiperestimulación ovárica. Los regímenes de inducción de la ovulación deberían ser altamente individualizados, monitorizados cuidadosamente y usando dosis y duración mínimas del tratamiento con gonadotropinas para conseguir la meta terapéutica. CONCLUSIONES: El síndrome de hiperestimulación ovárica constituye la complicación más temida durante el uso de inductores de la ovulación; el conocimiento de factores de riesgo, puede prevenir o evitar que llegue a ser de un caso severo, lo cual puede causar mayor morbilidad o hasta mortalidad. La vitrificación se convierte en la técnica que permite prevenir el síndrome de hiperestimulación ovárica, junto con esta técnica hay 2 alternativas: la inducción con análogo de la hormona liberadora de gonadotropina o el uso de agonistas dopaminérgicos.
INTRODUCTION: Ovarian hyperstimulation syndrome is an exaggerated response of the ovary to hormonal treatments to stimulate egg formation. OBJECTIVE: To describe the clinical case of a woman with ovarian hyperstimulation syndrome; to review the approach, management, treatment and how to prevent it. CLINICAL CASE: 37-year-old female patient, multigestation, under treatment with metformin for polycystic ovary syndrome, presenting infertility secondary to tubal factor, who developed a moderate picture of ovarian hyperstimulation syndrome as a consequence of the application of in vitro fertilization techniques (recombinant human follitropin alfa (GONAL-F®) and Cetrolerelix (CETROTIDE®); On the fourth day of the follicular aspiration procedure she presents intense pelvic pain, dysuria, diarrheic stools, abdominal and vaginal ultrasound shows free fluid in the cavity of about 1000cc, in addition to right and left ovaries with a volume of 102 mL and 189 mL respectively. Patient was admitted for parenteral hydration treatment, Enoxaparin 40mg subcutaneous, Cabergoline 0.5mg orally, discharged after 72 hours. DISCUSSION: The keys to prevention of ovarian hyperstimulation syndrome are experience with ovulation induction therapy and recognition of risk factors for ovarian hyperstimulation syndrome. Ovulation induction regimens should be highly individualized, carefully monitored, and using minimal doses and duration of gonadotropin therapy to achieve the therapeutic goal. CONCLUSIONS: Ovarian hyperstimulation syndrome constitutes the most feared complication during the use of ovulation inducers; knowledge of risk factors, may prevent or avoid it from becoming a severe case, which may cause increased morbidity or even mortality. Vitrification becomes the technique that allows preventing ovarian hyperstimulation syndrome, along with this technique there are 2 alternatives: induction with gonadotropin-releasing hormone analog or the use of dopaminergic agonists.
Subject(s)
Humans , Female , Pregnancy , Fertilization in Vitro , Ovarian Hyperstimulation Syndrome , Pelvic Pain , Follicle Stimulating Hormone , Gonadotropins , Ovarian Follicle , Ovulation , Ovulation Induction , Polycystic Ovary Syndrome , Pregnancy , Reproductive Techniques, Assisted , Ecuador , Dysuria , Gynecology , ObstetricsABSTRACT
CONTEXTO CLÍNICO O câncer ginecológico afeta diretamente a fertilidade, pois o tratamento consiste na remoção cirúrgica do sistema reprodutor e/ou na sua exposição a agentes gonadotóxicos. Entretanto, pacientes em estádios iniciais e que estejam dentro de critérios estabelecidos podem ser tratadas com cirurgias conservadoras da fertilidade, com resultados oncológicos equivalentes aos dos tratamentos tradicionais. As técnicas de preservação da fertilidade, como criopreservação de oócitos, embriões e tecido ovariano, também podem ser oferecidas em algumas situações. A American Society of Clinical Oncology (ASCO) publicou recomendações sobre a preservação de fertilidade, com o objetivo de aumentar a conscientização sobre o tema, e, juntamente com a American Society for Reproductive Medicine (ASRM), recomenda que pacientes em idade fértil com câncer passem por aconselhamento reprodutivo. Essas pacientes apresentam menores taxas de arrependimento, mesmo quando optam por desistir do tratamento conservador. O interesse na preservação da fertilidade aumentou nas últimas décadas, tanto pelo fato de as mulheres postergarem a gestação como pelo aumento da incidência de câncer em jovens. A taxa de incidência de todos os cânceres aumentou 29% entre 1973 e 2015 em adolescentes e adultos jovens de ambos os sexos. O câncer de colo uterino, em mulheres de 20-29 anos, aumentou anualmente em uma média de 10,3% entre 2000 e 2009. A omissão em orientar pacientes com câncer sobre as possibilidades de preservação da fertilidade pode gerar questionamentos futuros; em alguns países. isso já se configura má prática médica.
Subject(s)
Humans , Female , Fertility Preservation/methods , Genital Neoplasms, Female , Pregnancy Trimesters , Reproductive Techniques, Assisted , Reproductive Rights/ethics , Conservative Treatment/methods , Genital Neoplasms, Female/diagnostic imaging , Hormones/therapeutic useABSTRACT
Abstract Objective To understand the impact of the coronavirus disease 2019 pandemic on in vitro fertilization (IVF) clinical pregnancy rates and analyze factors that may have influenced their outcome. Methods This was a retrospective observational study conducted at a tertiary-care Brazilian fertility center. All fresh IVF and embryo warming cycles performed from March 11 to December 31, 2018-2021 were analyzed, and their data were used to calculate fertilization, embryo cleavage, cycle cancellation, embryo transfer (ET), and clinical pregnancy rates. Statistical tests were used to evaluate the alterations found. Logistic regression models were used to explore the association of the categorical variables with the observed clinical pregnancy rates. Data from 2018 and 2019 (prepandemic) and 2020 and 2021 (pandemic) were grouped. Results A total of 756 cycles were analyzed (n = 360 prepandemic and n = 396 pandemic). The age group of the patients, fertilization rates, and cleavage rates did not have significant differences (p > 0.05). There was a reduction in the percentage of fresh IVF and an increase in embryo warming cycles (p = 0.005) during the pandemic. There was also an increase in fresh cycle cancellations (p < 0.001) and a reduction in ET rates (p < 0.001). The pandemic had a negative impact on clinical pregnancy rates (p < 0.001) especially due to the increase in fresh cycle cancellations (p < 0.001). Conclusion Embryo warming cycles with subsequent frozen-thawed ET were presented as a viable alternative to continue assisted reproductive treatments against pandemic restrictions on fresh cycles, ensuring clinical pregnancy, albeit at a lower rate than that of the prepandemic period.
Resumo Objetivo Compreender os impactos da pandemia de COVID-19 nas taxas de gravidez clínica em fertilização in vitro (FIV) e analisar fatores que possam ter influenciado seu resultado. Métodos Foi realizado um estudo observacional retrospectivo em um centro brasileiro de reprodução assistida. Todos os ciclos de FIV com embriões frescos e descongelados realizados entre 11 de março e 31 de dezembro, 2018-2021 foram analisados, e seus dados utilizados para cálculo das taxas de fertilização, clivagem embrionária, cancelamento de ciclos, transferência de embriões (TE) e gravidez clínica. Testes estatísticos avaliaram significância das alterações encontradas e modelos de regressão logística exploraram associação das variáveis categóricas estudadas com as taxas de gravidez clínica observadas. Os dados de 2018 e 2019 (pré-pandemia) e 2020 e 2021 (pandemia) foram agrupados. Resultados Foram analisados um total de 756 ciclos (n = 360 na pré-pandemia e n = 396 na pandemia). A faixa etária das pacientes e as taxas de fertilização e de clivagem não tiveram alterações significativas (p > 0,05). Na pandemia, houve redução da porcentagem de ciclos de FIV com embriões frescos e aumento dos com descongelamento (p = 0,005). Também foi notado aumento das taxas de cancelamentos de ciclos com embriões frescos (p < 0,001) e redução do número de TEs (p < 0,001). A pandemia exerceu impacto negativo na taxa de gravidez clínica (p < 0,001), especialmente devido ao aumento de cancelamentos dos ciclos a fresco (p < 0,001). Conclusão Frente às limitações pandêmicas impostas aos ciclos com embriões frescos, os ciclos de descongelamento de embriões se apresentaram como alternativa viável à continuidade dos ciclos de FIV, garantindo gravidez clínica ainda que em taxas inferiores às do período pré-pandêmico.
Subject(s)
Humans , Female , Pregnancy , Fertilization in Vitro , Reproductive Techniques, Assisted , COVID-19ABSTRACT
OBJECTIVES@#To explore the association between assisted reproductive technology (ART) and birth weight discordance in twins (BWDT).@*METHODS@#A retrospective analysis was conducted on twin infants born between January 2011 and December 2020 at the Third Affiliated Hospital of Guangzhou Medical University, with complete basic birth data. The impact of ART on the occurrence of BWDT was identified by the multivariate logistic regression analysis.@*RESULTS@#A total of 3 974 pairs of twins were included, with 1 431 conceived naturally and 2 543 through ART. Neonates in the ART group had higher birth weights than those in the naturally conceived group (P<0.001). The incidence of BWDT was lower in the ART group compared to the naturally conceived group (16.17% vs 21.09%, P<0.001). The multivariate logistic regression analysis, adjusting for confounding factors such as maternal age, parity, pre-pregnancy body mass index, gestational diabetes, hypothyroidism, gestational age, and chorionic properties, showed no significant difference in the risk of BWDT between the ART and naturally conceived groups (P>0.05).@*CONCLUSIONS@#ART is not associated with the risk of BWDT.
Subject(s)
Pregnancy , Infant, Newborn , Female , Humans , Birth Weight , Pregnancy Outcome , Infant, Premature , Infant, Low Birth Weight , Pregnancy, Multiple , Premature Birth/epidemiology , Retrospective Studies , Population Surveillance , Reproductive Techniques, Assisted/adverse effects , Pregnancy ComplicationsABSTRACT
Advanced paternal age has been overlooked, and its effect on fertility remains controversial. Previous studies have focused mainly on intracytoplasmic sperm injection (ICSI) cycles in men with oligozoospermia. However, few studies have reported on men with semen parameters within reference ranges. Therefore, we conducted a retrospective cohort study analyzing the reproductive outcomes of couples with non-male-factor infertility undergoing in vitro fertilization (IVF) cycles. In total, 381 cycles included were subgrouped according to paternal age (<35-year-old, 35-39-year-old, or ≥40-year-old), and maternal age was limited to under 35 years. Data on embryo quality and clinical outcomes were analyzed. The results showed that fertilization and high-quality embryo rates were not significantly different (all P > 0.05). The pregnancy rate was not significantly different in the 35-39-year-old group (42.0%; P > 0.05), but was significantly lower in the ≥40-year-old group (26.1%; P < 0.05) than that in the <35-year-old group (40.3%). Similarly, the implantation rate significantly decreased in the ≥40-year-old group (18.8%) compared with that in the <35-year-old group (31.1%) and 35-39-year-old group (30.0%) (both P < 0.05). The live birth rate (30.6%, 21.7%, and 19.6%) was not significantly different across the paternal age subgroups (<35-year-old, 35-39-year-old, and ≥40-year-old, respectively; all P > 0.05), but showed a declining trend. The miscarriage rate significantly increased in the 35-39-year-old group (44.8%) compared with that in the <35-year-old group (21.0%; P < 0.05). No abnormality in newborn birth weight was found. The results indicated that paternal age over 40 years is a key risk factor that influences the assisted reproductive technology success rate even with good semen parameters, although it has no impact on embryo development.
Subject(s)
Pregnancy , Infant, Newborn , Female , Humans , Male , Adult , Paternal Age , Retrospective Studies , Semen , Fertilization in Vitro , Reproductive Techniques, Assisted , OligospermiaABSTRACT
OBJECTIVE@#To explore the factors for the failure of non-invasive prenatal testing (NIPT) through multifactorial unconditional Logistic regression analysis.@*METHODS@#A total of 3 410 pregnant women who had visited Dalian Women and Children Medical Group from July 2019 to June 2020 were selected as the study subjects and divided into first success NIPT group (n = 3 350) and first failed group (n = 60). Clinical data including age, weight, body mass index (BMI), gestational week, type of pregnancy (singleton/twin), history of delivery, heparin treatment, and conception method [natural conception/assisted reproductive technology (ART)] were collected. Independent sample t-test and Chi-square test were carried out for comparing the two groups, and multi-factorial unconditional Logistic regression analysis was carried out to explore the factors for the failure of NIPT, and receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnosis and predictive effects.@*RESULTS@#Among the 3 410 pregnant women, 3 350 were assigned to the first success NIPT group, and 60 were assigned to the first failed group, and the first-time failure rate was 1.76% (60/3 410). No significant difference was found in age, weight, BMI and method of conception between the two groups (P > 0.05). Compared with first success group, first failed group had lower sampling gestational weeks, lower proportion of women with previous history of delivery, and higher proportion of twin pregnancies and heparin treatment (P < 0.05). Multi-factorial unconditional Logistic regression analysis indicated that sampling gestational week (OR = 0.931, 95%CI: 0.845 ~ 1.026, P < 0.001) and history of heparin use (OR = 8.771, 95%CI: 2.708 ~ 28.409, P < 0.001) are independent factors for first failed NIPT. One-way unconditional Logistic regression analysis for sampling gestational weeks indicated that the regression equation for NIPT screening failure was Logit (P) = -9.867 + 0.319 × sampling gestational week, with the area under the ROC curve being 0.742, a Jordan index of 0.427, and a cutoff value of 16.36 weeks.@*CONCLUSION@#Gestational week and heparin treatment are independent factors for the first failed NIPT. A regression equation has been established and determined the optimal sampling gestational week to be 16.36 weeks, which may provide a reference for the timing of NIPT screening.
Subject(s)
Child , Pregnancy , Female , Humans , Logistic Models , Prenatal Diagnosis/methods , Pregnancy, Twin , Reproductive Techniques, AssistedABSTRACT
Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)
This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)
Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)
Subject(s)
Humans , Male , Female , Pregnancy , Adult , Middle Aged , Child Health Services , Mental Health , Humanization of Assistance , Fetal Death , Pain , Parents , Pediatrics , Perinatology , Placenta Diseases , Prejudice , Prenatal Care , Psychology , Psychology, Medical , Public Policy , Quality of Health Care , Reproduction , Syndrome , Congenital Abnormalities , Torture , Uterine Contraction , Birth Injuries , Maternity Allocation , Labor, Obstetric , Trial of Labor , Adaptation, Psychological , Abortion, Spontaneous , Child Care , Maternal-Child Nursing , Refusal to Treat , Women's Health , Patient Satisfaction , Parenting , Parental Leave , Health Care Quality, Access, and Evaluation , Privacy , Depression, Postpartum , Credentialing , Affect , Crying , Curettage , Reproductive Techniques, Assisted , Access to Information , Ethics, Clinical , Humanizing Delivery , Abortion, Threatened , Denial, Psychological , Prenatal Nutritional Physiological Phenomena , Parturition , Labor Pain , Premature Birth , Prenatal Injuries , Fetal Mortality , Abruptio Placentae , Violence Against Women , Abortion , User Embracement , Ethics, Professional , Stillbirth , Evaluation Studies as Topic , Nuchal Cord , Resilience, Psychological , Reproductive Physiological Phenomena , Fear , Female Urogenital Diseases and Pregnancy Complications , Fertility , Fetal Diseases , Prescription Drug Misuse , Hope , Prenatal Education , Courage , Psychological Trauma , Professionalism , Psychosocial Support Systems , Frustration , Sadness , Respect , Psychological Distress , Obstetric Violence , Family Support , Obstetricians , Guilt , Health Services Accessibility , Hospitals, Maternity , Obstetric Labor Complications , Labor, Induced , Anger , Loneliness , Love , Midwifery , Mothers , Nursing CareABSTRACT
Abstract Physical and emotional burdens during the journey of infertile people through assisted reproductive technologies are sufficient to justify the efforts in developing patient-friendly treatment strategies. Thus, shorter duration of ovarian stimulation protocols and the need for less injections may improve adherence, prevent mistakes, and reduce financial costs. Therefore, the sustained follicle-stimulating action of corifollitropin alfa may be the most differentiating pharmacokinetic characteristic among available gonadotropins. In this paper, we gather the evidence on its use, aiming to provide the information needed for considering it as a first choice when a patient-friendly strategy is desired.
Resumo O desgaste físico e emocional durante a jornada de pessoas inférteis pelas tecnologias de reprodução assistida é suficiente para justificar esforços no desenvolvimento de estratégias de tratamento compassivas. Desta forma, a menor duração dos protocolos de estimulação ovariana e a necessidade de menos injeções podem melhorar a adesão, prevenir erros e reduzir custos financeiros. Portanto, a estimulação folicular sustentada da alfacorifolitropina parece ser a característica farmacocinética que melhor a diferencia das gonadotrofinas atualmente disponíveis no mercado. No presente artigo, reunimos evidências sobre seu uso, com o objetivo de fornecer as informações necessárias para considerá-la como primeira escolha quando se deseja uma estratégia amigável ao paciente.
Subject(s)
Humans , Female , Ovulation Induction , Reproductive Techniques, AssistedABSTRACT
En la actualidad nos encontramos en un escenario social y económico totalmente diferente que hace 30 o 40 años, el acceso de las mujeres a la educación universitaria, su inserción en los diferentes ámbitos profesionales, e incluso el ritmo de vida que llevan hace que cada vez más mujeres decidan postergar sus proyectos parentales. Lo problemático aparece cuando deciden abordar el deseo de ser madres y aparecen cuestiones ligadas a lo biológico que no van a la par de los tiempos del deseo. Ante esta perspectiva, ¿con qué herramientas cuentan las mujeres para evitar de algún modo la hiancia que aparece entre deseo y biología? ¿Podemos pensar en las TRHA como nexo entre el deseo de hijo y las limitaciones biológicas del cuerpo? ¿Hay modo de evitar los emergentes psicológicos negativos que surgen ante los diagnósticos de infertilidad? En el siguiente trabajo se tomará el caso de la Doctora Helen Sharpe, personaje ficticio perteneciente a la serie New Amsterdam, con el fin de poder abordar los interrogantes planteados, y pensar como las TRHA funcionan no solo como nexo del deseo y la biología sino como un agente salutogénico, evitando o reduciendo los emergentes psicológicos negativos ante diagnósticos de infertilidad
Nowadays we find ourselves in a totally different social and economic scenario than 30 or 40 years ago, the access of women to university education, their insertion in different professional fields, and even the rhythm of life they lead makes more and more women decide to postpone their parental projects. The problem arises when they decide to address the desire to become mothers and issues related to the biological aspect appear that do not go hand in hand with the times of desire. In this perspective, what tools do women have to avoid the gap that appears between desire and biology? Can we think of ART as a link between the desire for a child and the biological limitations of the body? Is there a way to avoid the negative psychological emergents that arise in the face of infertility diagnoses? In the following paper we will take the case of Dr. Helen Sharpe, a fictional character from the series "New Amsterdam", in order to address the questions raised and to think about how the ART works not only as a link between desire and biology but also as a salutogenic agent, avoiding or reducing the negative psychological emergents in the face of infertility diagnoses