Celebrating 30 years of ART in Latin America; and the 2018 report.

RESEARCH QUESTION: What are the trends in patient characteristics, effectiveness and safety of assisted reproductive technology (ART) performed in Latin America over the past three decades, as well as the detailed outcomes of procedures initiated in 2018? DESIGN: Retrospective collection of multinational data including epidemiology and outcomes of ART performed between 1990 and 2018. RESULTS: Over these 30 years we report 955,117 initiated cycles, 191,191 deliveries and 238,045 live births. In 1990, 66.5% of women were ≤34 years and 8.7% ≥40 years; in 2018, 26.4% of women were ≤34 years and 32.0% were ≥40 years. In 1990, 60.4% of transfers included ≥3 embryos, falling to 13.5% in 2018, and single embryo transfer (SET) increased from 13.8% to 30.4% between 1990 and 2018. Delivery rate per fresh transfer increased from approximately 17% in the 1990s to 25% in 2018, with a meaningful drop in high-order multiples, from 5-9% in the 1990s to 0.4% in 2018. This drop is associated with increasing use of frozen embryo transfer (FET) (57% in 2018) compared with 10% in 2000. In 2018, delivery rate in FET was 28.3%, reaching 31.2% in freeze-all cycles; and the cumulative live birth rate (fresh + FET) was 41.9%. Elective SET also increased, from 0.9% in 2010 to 10% in 2018. The delivery rate in elective SET (31.7%) was only 5.4% lower than elective double embryo transfer (DET) (37.1%); however, multiple births increased from 2.1% to 25.5% twins and 0.4% triplets in elective DET. CONCLUSION: The Latin American Registry of Assisted Reproduction (RLA) celebrates 30 years of voluntary reporting from a total of nearly 200 centres in 15 countries. This South-South Cooperation network has proven to be an efficient and safe system for technological transfer and regional growth.

Thirty years of assisted reproductive technology in the domestic cat: A selected summary / Trinta anos de tecnologia de reprodução assistida no gato doméstico: Um resumo selecionado

The first kittens to be born after embryo transfer (ET) in the cat (Schriver and Kraemer, 1978) were reported four decades ago. The births of kittens after in vitro fertilization (IVF)/ET (Goodrowe et al., 1988) and after embryo cryopreservation/ET (Dresser et al., 1988) were described 10 years later. In an early report it was established that embryo donors had the ability ot exhibit repeated ovarian stimulatory response to multiple gonadotropin treatments (porcine FSH; Dresser et al., 1987). After studies on gonadotropin-induced hyperstimulation of follicular development for recovery and ET of fresh and cryopreserved in vivo derived uterine stage embryos from mated donors (Dresser et al., 1988; Pope et al., 1989), we transitioned into developing methods for in vitro production of domestic cat embryos for the purpose of applying the technology to support conservation of threatened and endangered felid species (Pope et al., 1993). Since then, techniques for the in vitro production of cat embryos have been developed sufficiently to allow births of kittens after transfer of embryos derived by an assortment of in vitro techniques, including cryopreservation (Pope et al., 1994; Gómez et al., 2003a; Pope et al., 2012a, b; Galiguis et al., 2014), intracytoplasmic sperm injection (ICSI; Pope et al., 1998; Gómez et al., 2000; Pope et al., 2012a), gender selection (Pope et al., 2009) and somatic cell nuclear transfer (SCNT) (Gómez et al., 2004; 2008; 2009).

Thirty years of assisted reproductive technology in the domestic cat: A selected summary / Trinta anos de tecnologia de reprodução assistida no gato doméstico: Um resumo selecionado

The first kittens to be born after embryo transfer (ET) in the cat (Schriver and Kraemer, 1978) were reported four decades ago. The births of kittens after in vitro fertilization (IVF)/ET (Goodrowe et al., 1988) and after embryo cryopreservation/ET (Dresser et al., 1988) were described 10 years later. In an early report it was established that embryo donors had the ability ot exhibit repeated ovarian stimulatory response to multiple gonadotropin treatments (porcine FSH; Dresser et al., 1987). After studies on gonadotropin-induced hyperstimulation of follicular development for recovery and ET of fresh and cryopreserved in vivo derived uterine stage embryos from mated donors (Dresser et al., 1988; Pope et al., 1989), we transitioned into developing methods for in vitro production of domestic cat embryos for the purpose of applying the technology to support conservation of threatened and endangered felid species (Pope et al., 1993). Since then, techniques for the in vitro production of cat embryos have been developed sufficiently to allow births of kittens after transfer of embryos derived by an assortment of in vitro techniques, including cryopreservation (Pope et al., 1994; Gómez et al., 2003a; Pope et al., 2012a, b; Galiguis et al., 2014), intracytoplasmic sperm injection (ICSI; Pope et al., 1998; Gómez et al., 2000; Pope et al., 2012a), gender selection (Pope et al., 2009) and somatic cell nuclear transfer (SCNT) (Gómez et al., 2004; 2008; 2009).(AU)

Desafios e atualidades no emprego de técnicas de reprodução assistida em aves selvagens / Challenges and current developments in the use of assisted reproduction techniques in wild birds

As aves são únicas entre os vertebrados e durante seu processo evolutivo sofreram inúmeras adaptaçõesque culminaram em algumas particularidades em sua fisiologia reprodutiva. Consequentemente, algumastécnicas de reprodução assistida (TRAs) comumente empregadas na conservação de mamíferos ainda não sãoaplicáveis às aves, por exemplo o congelamento de oócitos e embriões devido à grande quantidade de vitelo, e acriopreservação de sêmen que resulta em baixas taxas de fecundidade (<2%). Portando, novas abordagens têmsido utilizadas com o intuito de melhorar o desempenho reprodutivo, com o intuito de melhorar a variabilidadegenética das populações cativas de espécies de aves ameaçadas. Dessa maneira, nosso objetivo é descreveralgumas singularidades reprodutivas atribuídas as aves selvagens, apontando os desafios e as principais técnicasde reprodução assistida exploradas na conservação deste grupo.

Birds are unique among vertebrates since they undergone several adaptations during the evolutionaryprocess that ended up in some peculiarities in their reproductive physiology. Therefore, assisted reproductiontechniques (ARTs) usually employed in mammal conservation are not applicable in avian species as for example,oocyte and embryo freezing (due to the large amounts of egg yolk) and semen cryopreservation (which culminatein reduced post-thawing fertility – < 2%). Such circumstances demand new approaches aiming to improvereproductive performance in captivity and, in turn, to increase genetic variability of ex situ populations ofendangered birds. Thus, our goal is to describe some reproductive features exhibited by wild birds, highlightingchallenges and techniques used in the preservation of these vertebrates.

Desafios e atualidades no emprego de técnicas de reprodução assistida em aves selvagens / Challenges and current developments in the use of assisted reproduction techniques in wild birds

As aves são únicas entre os vertebrados e durante seu processo evolutivo sofreram inúmeras adaptaçõesque culminaram em algumas particularidades em sua fisiologia reprodutiva. Consequentemente, algumastécnicas de reprodução assistida (TRAs) comumente empregadas na conservação de mamíferos ainda não sãoaplicáveis às aves, por exemplo o congelamento de oócitos e embriões devido à grande quantidade de vitelo, e acriopreservação de sêmen que resulta em baixas taxas de fecundidade (<2%). Portando, novas abordagens têmsido utilizadas com o intuito de melhorar o desempenho reprodutivo, com o intuito de melhorar a variabilidadegenética das populações cativas de espécies de aves ameaçadas. Dessa maneira, nosso objetivo é descreveralgumas singularidades reprodutivas atribuídas as aves selvagens, apontando os desafios e as principais técnicasde reprodução assistida exploradas na conservação deste grupo.(AU)

Birds are unique among vertebrates since they undergone several adaptations during the evolutionaryprocess that ended up in some peculiarities in their reproductive physiology. Therefore, assisted reproductiontechniques (ARTs) usually employed in mammal conservation are not applicable in avian species as for example,oocyte and embryo freezing (due to the large amounts of egg yolk) and semen cryopreservation (which culminatein reduced post-thawing fertility < 2%). Such circumstances demand new approaches aiming to improvereproductive performance in captivity and, in turn, to increase genetic variability of ex situ populations ofendangered birds. Thus, our goal is to describe some reproductive features exhibited by wild birds, highlightingchallenges and techniques used in the preservation of these vertebrates.(AU)

Tecnologias de reprodução assistida no Brasil: opções para ampliar o acesso / Assisted reproductive technologies in Brazil: options to improve access

Resumo Este artigo revisita o padrão de assimilação e difusão das tecnologias de reprodução assistida (TRA) no Brasil, caracterizado por altíssima concentração desta tecnologia no setor privado da medicina e baixíssima regulação na aplicação destas técnicas. Este padrão gerou enormes dificuldades e barreiras ao acesso a essas técnicas, basicamente por razões econômicas. A partir da apresentação do panorama da história das TRA, o artigo focaliza dois casos que podem configurar propostas de solução para a excessiva exclusão ao acesso, ainda que não se modifique a mesma lógica privatizante que marca a RA no país, uma vez que o problema das infertilidades não foi priorizado, até o momento, no Sistema Único de Saúde. A primeira, trazida pela indústria farmacêutica, consiste em um programa de compras subsidiadas de medicamentos pelos usuários no chamado Programa Acesso. A segunda proposta, conhecida como doação compartilhada de óvulos, implica a troca, entre duas mulheres, de material reprodutivo biologicamente escasso (ovócitos). Esta troca ocorre, em geral, entre uma mulher que tem óvulos e não pode custear seu tratamento e outra que, não tendo mais óvulos para se reproduzir, custeia o tratamento da doadora. Ambas as propostas se difundem num quadro legal bastante mal regulado em termos da aplicação das TRA, mas que veda práticas não admitidas na Constituição Federal e criminalizadas na lei penal, como a comercialização de órgãos e tecidos humanos em geral, bem como pagamento a voluntários de testes para pesquisa, pela Resolução nº 466 (CNS, 2012). Em termos metodológicos, o artigo assume caráter monográfico e de debate da literatura, mas está baseado também na coleta de dados secundários recentes, assim como em inúmeras pesquisas empíricas realizadas ao longo dos últimos 25 anos pelas autoras.

AbstractThis article revisits the pattern of assimilation and dissemination of assisted reproductive technologies (ART) in Brazil, characterized by extreme concentration of this technology in the private medical sector and very low setting in the application of these techniques. This pattern has generated enormous difficulties and barriers to access to these techniques, basically for economic reasons. From the presentation of the overview of the history of ART, the article focuses on two cases that may propose solutions for excessive exclusion access, although it does not modify the same privatization logic that marks RT in the country, since the problem of infertility was not prioritized, so far, by the Unified Health System. The first, brought by the pharmaceutical industry, consists of a subsidized purchasing program of drug users by the so-called Programa Acesso. The second proposal, known as shared ovules donation, implies the exchange between two women, of biologically scarce reproductive materials (oocytes). This exchange occurs, in general, from a woman who has ovules and cannot afford treatment and another who has no ovules to reproduce, and pays for the treatment of the donor. Both proposals diffuse a legal framework rather poorly regulated in terms of the application of ART, but prohibit practices not authorized in the Constitution and criminalized in penal law such as the sale of human organs and tissues in general, as well as volunteers to payment tests for research. In terms of methodology, the article assumes monographic character and literary debate, but is also based on the collection of recent secondary data, as well as numerous empirical studies conducted over the last 25 years by the authors.

Retrospectiva de la tecnología de laboratorio en reproducción asistida / Retrospective on laboratory technology in assisted reproduction

Se revisa la secuencia evolutiva de la tecnología de laboratorio en reproducción asistida. Desde los primeros intentos de manipular embriones preimplantacionales recuperados de oviductos animales, en 1912, las transferencias directas o con breves periodos de incubación a madres receptoras, el complejo proceso bioquímico de preparación y suplementación de los medios de cultivo a partir de soluciones salinas químicamente definidas, la etapa de transición de esta tecnología a los humanos en la que se trabajo básicamente la maduración de ovocitos y la selección de espermatozoides motiles in vitro, hasta los procedimientos que culminaron con la primera aplicación clínica descrita en 1980.

We review the evolutionary sequence of laboratory technology in assisted reproduction. From the first attempts to manipulate preimplantational embryos recovered from animal oviducts in 1912; the direct transfers or with short incubation periods for receptor mothers; the complex biochemical process of preparation and supplementation of culture media from saline solutions chemically defined; the transition of this technology to humans basically in vitro oocyte maturation and selection of motile sperm; to proceedings ending with the first clinical application described in 1980.

SBTE historical and scientific perspective on reproductive biotechnologies

Background: During the past 25 years SBTE has organized and held annual meetings. Such events have been proven essential to demonstrate how important Brazilian scientific activities are in the context of reproductive biotechnologies. The consolidation of a wide range of distinct research groups, usually supported by graduate programs mostly at federal universities, has allowed the qualification of a large number of M.Sc. and Ph.D. professionals in the field of animal reproduction. The demand by the Brazilian agribusiness, supported by the new frontiers in cattle production, such as the regions of the Midwest and the vast periphery of the Amazon basin, where currently more than 60% of the national cattle herd is maintained, allowed the successful use of reproductive biotechnologies to spread superior genetics to herds, mainly focused on Zebu breeds. Review: The use of reproductive biotechnologies in developed countries during the 50s and 60s of last century quickly attracted the interest of Brazilian reproductive physiologists, who were interested in the cryopreservation of semen and in the artificial insemination of domestic animals. During the 70s, important advancement attained in procedures involving the physiology of the female made possible the use of bovine embryo transfer technology in a large-scale. Then, in 1974, the organization known as International Embryo Transfer Society (IETS) was founded in the U.S.A. The IETS emerged as one of the main global forum for discussions on reproductive biotechnologies. The annual meetings of the IETS enabled the participation of a keen group of young Brazilian veterinarians and animal reproduction specialists who were interested in knowing and applying new knowledge on that specific area. The support of private sponsors, associated with a new scenario in graduate academic training, funded mostly by CAPES and CNPq, enabled the training of Brazilian colleagues in universities and research centers in the U.S.A. and countries in Western Europe, in particular in Germany and France. The use of embryo transfer in Brazil, funded by private enterprise, has achieved success in 1979 with the birth of the first calf in the State of São Paulo, in the city of Sorocaba. The calf was named EUREKA by our colleague Jorge Nicolau. In the 80s, the participation of Brazilian colleagues in the annual events of the IETS in the U.S.A. increased significantly. In July 1985, during the Brazilian Congress on Animal Reproduction, in Belo Horizonte, a first meeting of the recent created organization known as Brazilian Embryo Transfer Society (SBTE) was held by its pioneering members, with the election of the Society´s first board at that time. Conclusion: This paper present a historical and scientific perspective of activities undertaken by SBTE, mainly through the themes and discussions carried out in their annual meetings.

[Contemporaneous history: complex techniques of assisted reproduction]. / Historia contemporánea: las técnicas complejas de reproducción asistida.

The work begins with historical considerations about the development of embryology at the beginning of the twentieth century and the vast advance obtained to the arriving of complex assisted reproductive techniques. Afterwards it is reviewed the development of variants and possibilities of the techniques. Finally, it is proposed four historic periods regarding the development of complex assisted reproductive technologies.