Serum progesterone measurement on the day of fresh embryo transfer and its correlation with pregnancy success rates: A prospective analysis.

Studies regarding serum Progesterone (P4) concentration and Clinical Pregnancy Rates (CPR) in fresh Embryo Transfer (ET) after Controlled Ovarian Stimulation Cycles (COS) remain inconclusive. To find a P4 cutoff point on fresh ET day associated with higher CPR, and to identify predictive factors of CPR and P4, the authors conducted a prospective cohort of 106 patients who underwent COS at a public IVF center. The luteal phase was supported with vaginal micronized progesterone (200 mg, 8/8h), beginning on oocyte retrieval day. The primary outcome was CPR beyond the 8th week of pregnancy. A ROC curve was constructed to identify the best cutoff point correlated with higher CPR. Multivariate analysis evaluated predictive variables of CPR and P4 concentration. P4 levels showed no significant differences between pregnant and non-pregnant patients (67.12 ± 31.1 ng/mL vs. 64.17 ± 61.76, p = 0.7465). The cutoff point correlated with higher CPR was P4 ≥ 28.9 ng/mL (AUC 0.5654). Women's age (OR = 0.878; 95 % CI 0.774-0.995) and top-quality embryo transfer (OR = 2.89; 95 % CI 1.148-7.316) were associated with CPR. Women's age ≥ 40 years (OR = 0.0956; 95 % CI 0.0156-0.5851), poor response to COS (OR = 0.0964; 95 % CI 0.0155-0.5966), and follicles ≥ 10 mm (OR = 1.465; 95 % CI 1.013-2.117) were associated with the cutoff point. As the ROC curve was unsatisfactory, P4 ≥ 28.9 ng/mL should not be used to infer gestational success. In fresh ET, P4 concentration may merely reflect a woman's age and individual response to COS rather than being a reliable CPR predictor.

40 years of AETE: the contribution of scientists and practitioners to the progress of reproductive biotechnologies in Europe.

This conference celebrates the 40th anniversary of AETE. Over the past 40 years, AETE has served as a forum for scientists, practitioners, and students working in assisted animal reproduction in livestock species. AETE conferences have reflected developments in the field, from basic to applied science, as well as regulatory changes in assisted animal reproduction practices. Europe has led the way in these developments for many years, progressing from artificial insemination, embryo transfer, and cryopreservation to semen sexing, in vitro production of embryos, cloning by nuclear transfer, genomic selection, and the rescue of highly endangered species. These significant contributions were made possible by the support of funding agencies, both at the national and European levels, promoting cooperation between scientists and practitioners. Assisted reproduction, and animal breeding more generally, face opposition from various groups, including animal rights activists, vegetarians, proponents of organic farming, environmentalists, certain political parties, and increasing regulatory burdens. These challenges seriously affect funding for scientific research, the work of practitioners, and the breeding industry as a whole. It is crucial to invest time and resources in communication to remind the public, politicians, and regulators of the achievements in this field and the contributions made to the food supply chain and the care of the rural and natural environment.

Sperm Incubation in Biggers-Whitten-Whittingham Medium Induces Capacitation-Related Changes in the Lizard Sceloporus torquatus.

Sperm capacitation involves biochemical and physiological changes that enable sperm to fertilize the oocyte. It can be induced in vitro under controlled conditions that simulate the environment of the oviduct. While extensively studied in mammals, its approach in lizards remains absent. Understanding the mechanisms that ensure reproduction is essential for advancing the implementation of assisted reproductive technologies in this group. We aimed to perform a sperm analysis to determine if capacitation-related changes were induced after incubation with capacitating media. Fifteen males of Sceloporus torquatus were collected during the early stage of the reproductive season. The sperm were isolated from the seminal plasma and then diluted up to a volume of 150 µL using BWW medium to incubate with 5% CO2 at 30 °C for a maximum duration of 3 h. A fraction was retrieved hourly for ongoing sperm assessment. The sperm analysis included assessments of its motility, viability, the capacitation status using the chlortetracycline (CTC) assay, and the acrosome integrity with the lectin binding assay to detect changes during incubation. We found that total motility was maintained up to 2 h post incubation, after which it decreased. However, sperm viability remained constant. From that moment on, we observed a transition to a deeper and less symmetrical flagellar bending in many spermatozoa. The CTC assay indicated a reduction in the percentage of sperm showing the full (F) pattern and an increase in those exhibiting the capacitated (B) and reactive (RA) patterns, accompanied by an elevation in the percentage of damaged acrosomes as revealed by the lectin binding assay. In mammals, these changes are often associated with sperm capacitation. Our observations support the notion that this process may also occur in saurian. While sperm analysis is a valuable method for assessing certain functional changes, additional approaches are required to validate this process.

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.

Imaginários Morais no Discurso Midiático Sobre o Uso da Inseminação Caseira por Mulheres Lésbicas / Moral Imaginaries on the Media Discourse on the Use of Homemade Insemination by Lesbian Women / Imaginarios Morales en el Discurso Mediático Sobre Uso de la Inseminación Domiciliaria por Mujeres Lesbianas

O presente artigo objetiva refletir sobre o discurso moral midiático produzido em torno da Inseminação Caseira e seu uso como tecnologia reprodutiva por casais de mulheres lésbicas. Esta é uma modalidade reprodutiva autônoma, que consiste em uma autoinseminação de baixo custo, feita com o uso de material biológico de doador não anônimo. Para esta reflexão, utilizou-se cinco obras midiáticas produzidas por canais de comunicação de grande alcance no cenário nacional, analisadas sob a ótica da análise do discurso. Foram traçadas cinco categorias analíticas: apresentação textual-imagética das obras; narrativa das mulheres tentantes; discursos promovidos pelos ditos especialistas; e representação da figura do doador. Conclui-se pela necessidade de estímulo ao debate acerca da inseminação caseira realizada por mulheres lésbicas, de modo que tanto profissionais da área da saúde como a sociedade de uma forma geral não se baseiem apenas em discursos morais condenatórios ditos científicos, como aqueles propagados pela grande mídia em relação à Inseminação Caseira. Soma-se a isso a importância em garantir visibilidade para os relatos das mulheres que estão se submetendo à inseminação caseira, compreendendo-as enquanto protagonistas da produção de sua saúde sexual e reprodutiva e projetos parentais e que, por isso, devem ter seus discursos e experiências legitimados.

The present article aims to reflect on the media moral discourse produced around Homemade Insemination and its use as a reproductive technology by lesbian couples. This is an autonomous reproductive modality, which consists in a low-cost self-insemination performed with the use of biological material from a non-anonymous donor. This reflection was made using five media works produced by communication channels of great reach in the Brazilian scenario, analyzed from the point of view of discourse analysis. Five analytical categories were drawn: textual-imagetic presentation of the works; narrative of women trying to conceive; speeches promoted by the so-called experts; and representation of the donor figure. We conclude that it is necessary to stimulate the debate about homemade insemination performed by lesbian women, so that both health professionals and society in general do not rely only on condemning moral speeches called scientific, such as those propagated by the media in relation to Homemade Insemination. Added to that it is important to ensure visibility of the reports of women who are submitting themselves to homemade insemination, understanding them as protagonists of the production of their sexual and reproductive health and parental projects and that, therefore, they must have their speeches and experiences legitimated.

Este artículo pretende reflexionar sobre el discurso moral mediático producido sobre la Inseminación Domiciliaria y su uso como tecnología reproductiva por parejas lesbianas. Se trata de una modalidad reproductiva autónoma, que consiste en una autoinseminación de bajo coste realizada con el uso de material biológico de donante no anónimo. Para esta reflexión, se utilizaron cinco obras mediáticas producidas por canales de comunicación de gran alcance en Brasil analizadas desde la perspectiva del análisis del discurso. Se trazaron cinco categorías analíticas: presentación textual-imagen de las obras; narración de las mujeres que intentan; discursos promovidos por los llamados especialistas; y representación de la figura del donante. Se concluye por la necesidad de estimular el debate sobre la Inseminación Domiciliaria realizada por mujeres lesbianas, de manera que tanto los profesionales de salud como la sociedad en general no se basen apenas en los discursos morales condenatorios de los científicos, como los propagados por la gran prensa sobre Inseminación Domiciliaria. A esto se suma la importancia de garantizar la visibilidad de los relatos de las mujeres que hacen la Inseminación Domiciliaria, entendiéndolas como protagonistas de la producción de su salud sexual y reproductiva y de sus proyectos parentales y debe tener sus discursos y experiencias legitimados.

Critical Analysis of The Changes in CFM Resolution 2294/21 And Its Impacts on Assisted Human Reproduction.

The Brazilian Federal Board of Medicine (CFM) issued resolution number 2294/21, which regulates human reproduction procedures in Brazil, bringing significant changes to clinical practice in assisted human reproduction, and it raised ethical, bioethical, and legal discussions between professionals and patients. This study aims to analyze these changes in different aspects, especially because some of them are controversial. Evidence-based knowledge resources were used to support the analyses of crucial points that were impacted by this change. A literature review was carried out to obtain information about guidelines and laws, as well as articles that contemplate ethical discussions on assisted reproduction. The search sites used were BVS, Pub Med, LILACS and Google Scholar. The keywords used were law, legislation, bioethics, reference guide and assisted human reproduction. Relevant official documents from the Brazilian State were also found and included in the survey. The new resolution regarding the use of assisted reproduction techniques brought important changes, with clinical implications for couples who wish to become pregnant, and there is a need for a broad discussion concerning these repercussions from clinical, ethical, bioethical, and legal points of view.

Técnicas de reproducción asistida en personas del mismo sexo y solas por opción: realidad en Chile 2021 / Assisted reproduction techniques in people of the same sex and alone by option: reality in Chile 2021

Resumen El concepto de familia ha cambiado con los años y la constitución de los hogares en Chile ya no es la misma que hace un siglo. Las familias diversas en nuestro país han existido durante toda la vida, pero el conocimiento de cómo se han constituido y la existencia de un catastro en Chile son escasos. El objetivo de esta revisión es mostrar cómo se han constituido las familias diversas en Chile, cómo ha sido el acceso de estas a las técnicas de reproducción asistida, cuál ha sido la política del Estado y las aseguradoras de salud (Fonasa e Isapres) en las coberturas, y qué ha pasado con la legislación a lo largo de los años que ha facilitado la constitución de nuevas familias. Por otra parte, se pretende mostrar cuáles son las barreras al acceso por parte de las familias diversas y la necesidad de una ley de reproducción asistida que permita el acceso a todas las personas independientemente de su estado civil, orientación sexual o identidad de género, y que proteja a todos los nacidos chilenos por igual.

Abstract The image of a typical family has changed in recent years, as the makeup of households in Chile is no longer the same as decades ago. While gender and sexual diverse families in our country have always existed, there is a scarcity of reliable data. We review the evolution of the makeup of these diverse families in Chile and their access to assisted reproduction techniques. We also review national policies and health insurance coverage by both governmental and private carriers (Fonasa and Isapres) and how changes in legislation over the years have facilitated the constitution of these families. We outline barriers to access assisted reproduction techniques and the need for further legislative action to guarantee access to all citizens regardless of their marital status, sexual orientation, or gender identity.

As inconstitucionalidades da Resolução CFM nº 2294/2021 sobre a utilização das técnicas de reprodução assistida / The unconstitutionalities of Resolution CFM nº 2294/2021 on the use of assisted reproduction techniques

O Conselho Federal de Medicina acaba de editar a Resolução nº 2.294/2021, publicada em 15 de junho de 2021, que aponta normas para a utilização das técnicas de reprodução assistida. Apesar de o propósito ser o aperfeiçoamento das práticas e a observância aos princípios éticos e bioéticos para trazer maior segurança e eficácia a tratamentos e procedimentos médicos, repete inconstitucionalidades das normatizações pretéritas e impõe mais restrições ao sonho das pessoas de ter filhos. Desse modo, mais do que avanços, o novo regramento provoca um retrocesso que não se coaduna com a garantia constitucional e legal que assegura o livre planejamento familiar.(AU)

The Brazilian Federal Council of Medicine has just edited the Resolution nº 2.294/2021, published on June 15, 2021, which sets out rules for the use of assisted reproduction techniques. Although the purpose is to improve practices and observe ethical and bioethical principles to bring greater safety and efficacy to medical treatments and procedures, it repeats the unconstitutionalities of past regulations and imposes more restrictions on people's dreams of having children. In this way, more than advances, the new regulation provokes a setback that is not consistent with the constitutional and legal guarantees of free family planning.(AU)

Affordability and quality of cross-border reproductive care from the perspective of surrogacy mediating agencies in Spain / Asequibilidad y calidad de la atención reproductiva transfronteriza desde la perspectiva de las agencias mediadoras de gestación por sustitución en españa

RESUMEN La gestación por sustitución contribuye a la transformación de las concepciones sociales de la filiación y los cambios en las estrategias reproductivas de las familias. En la presente contribución se relaciona la teoría de la atención reproductiva transfronteriza con las teorías posmodernas de la vida familiar, con el propósito de explorar qué temáticas, elementos y contenidos utilizan las agencias intermediarias de gestación por sustitución que tienen por destinatarios a las madres y padres de intención españoles. Se utiliza la metodología cualitativa y la técnica de análisis de contenido temático tras el registro de la información online recogida de las agencias. Los resultados evidencian el papel de estas agencias mediadoras en los procesos de gestación por sustitución en España, además de generar conocimiento en el área de las nuevas formas familiares constituidas mediante técnicas de reproducción asistida.

ABSTRACT Substitution pregnancy contributes to the transformation of social conceptions of filiation and changes in the reproductive strategies of families. This contribution relates the theory of cross-border reproductive care with post-modern theories of family life in order to explore which themes, elements and contents are used by intermediary surrogate pregnancy agencies which target Spanish mothers and fathers. The qualitative methodology and the technique of thematic content analysis after registration of the online information collected from the agencies is used. The results show the role of these intermediary agencies in the process of gestation by substitution in Spain, as well as generating knowledge in the area of new family forms constituted by assisted reproduction techniques.

Implementación de técnicas de reproducción asistida en el Centro de Reproducción Humana de la Universidad de Valparaíso: resultados del primer trienio (2015 - 2017) / Implementation of assisted reproduction techniques at the Center of Human Reproduction of the Universidad de Valparaíso: results of the first triennium (2015 - 2017)

INTRODUCCIÓN Y OBJETIVOS: La infertilidad es una enfermedad altamente prevalente que afecta aproximadamente a un 8-10% de las parejas en edad reproductiva. Las Técnicas de Reproducción Asistida (TRA) han experimentado un importante incremento en el número de tratamientos realizados, no obstante, el acceso en Chile sigue siendo limitado y centralizado. El presente estudio resume la experiencia y los resultados de TRA del primer trienio del Centro de Reproducción Humana de la Universidad de Valparaíso (CRHUV). MÉTODOS: Estudio de cohorte retrospectiva de las pacientes sometidas a TRA en el CRHUV desde 1 de enero de 2015 a 31 diciembre 2017. Se realizó un análisis descriptivo e inferencial. La distribución de variables fue analizada con la prueba de Shapiro-Wilk. Para variables cualitativas se usó la prueba exacta de Fisher. RESULTADOS: Se iniciaron un total de 581 ciclos. Para un total de 340 ciclos en fresco con ovocitos propios, la tasa de embarazo (TE) y de parto (TP) por ciclo aspirado fue de 43,5% y 36,7% respectivamente. En el mismo grupo, la TE y TP por transferencia embrionaria fue de un 48,4% y un 40,9% respectivamente, siendo superior al comparar transferencia doble con un embrión (p < 0,05). También se observó un aumento de TE en menores de 35 años (p < 0,05). La TE y TP por transferencia embrionaria fue semejante en transferencia de embriones frescos y congelados. Al transferir embriones producto de ovocitos donados se observó un incremento significativo de la TE y TP con tasas de 73,1% y 61,5% respectivamente. Las tasa globales y estratificadas de embarazo y parto fueron comparables en el trienio estudiado con los resultados de la REDLARA. CONCLUSIÓN: La exitosa implementación del CRHUV se respalda en los resultados comparables a lo reportado por literatura internacional.

INTRODUCTION AND OBJECTIVES: Infertility is a highly prevalent disease that affects approximately 8-10% of couples in reproductive age. Assisted reproduction techniques (ART) have experienced a significant increase in the number of treatments performed, however, access in Chile remains limited and centralized. This study summarizes the experience and results of the first triennium of the Center for Human Reproduction of the Universidad de Valparaíso (CRHUV). METHODS: Retrospective cohort study of patients undergoing ART at the CRHUV from January 1, 2015 to December 31, 2017. A descriptive and inferential analysis was performed. The distribution of the variables was analyzed with the Shapiro-Wilk test. For qualitative variables, Fisher's exact test was used. RESULTS: A total of 581 cycles were started. For a total of 340 fresh cycles with own oocytes, the pregnancy (RP) and delivery (DR) rate per oocyte retrival was 43.5% and 36.7%. In the same group, PR and DR per embryo transfer was 48.4% and 40.9%, being higher when comparing double with a single embryo transfer (p <0.05). A higher PR was also observed in < 35 years patients (p <0.05). The PR and DR per embryo transfer was similar using fresh and frozen embryo. In oocytes donation, a significant increase in PR and RD per embryo transfer was observed with rates of 73.1% and 61.5%, respectively. The global and stratified rates of pregnancy and delivery were comparable in the studied triennium compared to the results of REDLARA. CONCLUSION: The successful implementation of the CRHUV is supported by results comparable to those reported by international literature.

Use of clomiphene citrate protocol for controlled ovarian stimulation impairs endometrial maturity.

INTRODUCTION: Despite recent advances in assisted reproduction techniques and recent knowledge regarding embryo and endometrium quality, implantation and birth rates remain low. The objective of this study was to investigate whether clomiphene citrate alters endometrial maturation in infertile patients. METHODS: In a prospective self-matched cohort study, we assessed the ovulation of women in spontaneous and stimulated cycles (with clomiphene citrate). We determined the ovulation day by ultrasound scanning. In both cycles, we took four blood samples (BS1 - at early proliferative phase, BS2 - at mid proliferative phase, BS3 - after ovulation and BS4 - at mid luteal phase) to determine the serum concentrations of FSH, LH, estradiol and progesterone. We retrieved an endometrial biopsy five days after ovulation, followed by blinded analysis and classification according to Noyes criteria, in both cycles. RESULTS: Twenty-two participants completed the study. There were significant differences in FSH BS3 (p=0.001), in LH BS3 and BS4 (p<0.001 and p=0.049, respectively), in estradiol BS2, BS3 and BS4 (p<0.001, p=0.024 and p<0.001, respectively) and in progesterone BS3 and BS4 (p=0.028 and p<0.001, respectively). Considering Noyes criteria, there was a one-day delay when comparing the stimulated cycle with the spontaneous cycle (p=0.004), and a two-day delay when comparing the stimulated cycle with the biopsy day. CONCLUSION: This study indicates that ovarian stimulation with clomiphene citrate delays the endometrial maturity, and could possibly impair the implantation process due to asynchrony.

Analysis of a Preimplantation Genetic Test for Aneuploidies in Embryos from Colombian Couples: A Report of Cases.

BACKGROUND: Assisted reproduction techniques (ARTs) and the preimplantation genetic test for aneuploidies (PGT-A) help couples with fertility problems to achieve a healthy live birth around the world. The aim of this study was to determine the rate of whole chromosomal copy number variations in embryos from couples undergoing ART and PGT-A, associations of chromosomal variations with embryo morphological parameters, and their relationship to maternal age. METHODS: This study included a retrospective analysis of the number of whole chromosomal copies identified by aCGH in embryos from couples undergoing ART. RESULTS: Seventy-six embryos from 29 couples using their own gametes were analyzed, of which 25 (32.9%) were chromosomally normal, and 51 (67.1%) were abnormal. Eleven embryos were evaluated from the group of couples with donated gametes, of which 5 (45.4%) embryos were chromosomally normal, and 6 (54.5%) embryos were abnormal. The main aneuploidies observed were trisomy X (7.8%), trisomy 21 (5.9%), trisomy 9 (3.9%), monosomy 11 (3.9%), monosomy 13 (3.9%) and monosomy X (3.9%), and the principal chromosomes affected were 19, X and 13. A significant association was found between the quality of the embryo and the genetic condition: embryos with euploidy and aneuploidy (p=0.046). CONCLUSION: The rate of aneuploidies from couples with their own gametes was 67.1% (51/76) and from couples with donated eggs and/or sperm was 54.5% (6/11). The quality of the embryo determinated by the morphological parameters was not associated with the embryo genetic status, and also there was no association between maternal age and aneuploidy rate.

Análise crítica sobre a evolução das normas éticas para a utilização das técnicas de reprodução assistida no Brasil / Critical analysis on the evolution of ethical norms for the use of assisted reproduction techniques in Brazil

Resumo O Conselho Federal de Medicina (CFM) publicou em 1992 a resolução CFM nº 1.358/1992 com o objetivo de adotar normas éticas para utilização das técnicas de Reprodução Assistida (TRA). Esta resolução foi atualizada em 2010 (CFM nº 1.957/2010), em 2013 (CFM Nº 2.013/13) e teve sua última atualização 2015 (CFM nº 2.121/2015). O objetivo desse artigo é fazer uma análise crítica sobre a evolução das normas éticas propostas pelo CFM para a utilização de TRA no Brasil. Foi realizada uma análise documental do texto das quatro Resoluções publicadas onde estão descritas as normas éticas para utilização das TRA. Foi observado que a resolução evoluiu em relação aos direitos dos homossexuais, adotou medidas mais permissivas em relação a criopreservação, doação de gametas e embriões e cessão de útero e por fim autorizou alguns procedimentos em TRA como a reprodução post mortem, doação e gestação compartilhada. A partir de 2013 a resolução ganhou um caráter liberal estando atualizada com a prática clínica. Para as próximas atualizações seria interessante incluir procedimentos em TRA os quais não foram abordados como a transferência nuclear e citoplasmática. A frequência de atualização (a cada dois anos) deve ser mantida para as normas éticas que norteiam a TRA continuar evoluindo juntamente com o avanço da ciência.

Abstract The Federal Medical Council (FMC) published FMC Resolution No. 1,358/1992 with the aim of adopting ethical standards for the use of Assisted Reproduction Techniques (ART). This resolution was updated in 2010 (CFM No. 1957/2010), in 2013 (CFM No. 2,013/13) and the last update was in 2015 (CFM No. 2.121/2015). The scope of this article is to conduct a critical analysis of the evolution of the ethical norms proposed by FMC for the use of ART in Brazil. A documentary analysis of the text of the four published Resolutions was carried out, in which the ethical standards for the use of ART were described. It was observed that the resolution evolved in relation to the rights of homosexuals, adopted more permissive measures regarding cryopreservation, donation of gametes and embryos and uteruses on loan and lastly authorized some procedures in ART such as postmortem reproduction, donation and shared gestation. From 2013 onwards the resolution gained a liberal character being updated in terms of clinical practice. For the next updates it would be interesting to include procedures in ART not previously addressed such as nuclear and cytoplasmic transfer. The update frequency (every two years) should be kept to the ethical standards enabling the ART to continue evolving together with the advancement of science.

Twinning Rates in Uruguay Between 1999 and 2015: Association with Socioeconomic and Demographic Factors.

Twinning is rare among humans, but there is much variability among populations. Several studies show that certain demographic and socioeconomic factors, such as maternal age, mother's educational level and income, influence twinning rate. There is no background of analytical studies of twins in Uruguay. To the best of our knowledge, this is the first study that has focused on describing and analyzing Uruguayan twinning rates over a period of 17 years (1999-2015). The birth data were collected from the website of Uruguay's Ministry of Public Health. Economic data were obtained from Uruguay's Instituto Nacional de Estadísti's website for the period 2001-2013, since these variables are defined specifically for that period of time. The statistical software R (The R Project for Statistical Computing) was used. The twinning rate varied from 8.51 to 13 in the studied period. Montevideo has the highest median and the smallest variability in comparison with the other departments. In Uruguay (1999-2015), the highest twinning rate (28.94%) was observed in women aged 45 and older. The analysis also showed a relationship between twin birth rates and the mother's educational level. In three regions of the country (West, Center and East), twin births show a random pattern but in the other two (North and Metropolitan), there is an increasing trend in the number of twins over time. In conclusion, this study recognizes social, economic and demographic factors that influence in the rate of twin births in Uruguay.

Características demográficas de las madres e hijos sometidos a técnicas de reproducción asistida en el Hospital Español de México en 2016 / Demographic characteristics of mothers and children undergoing assisted reproduction techniques at Hospital Español de México in 2016

Resumen Introducción La infertilidad es una enfermedad caracterizada por la incapacidad de lograr un embarazo después de 12 meses o más de relaciones sexuales no protegidas. En México, la reproducción asistida se encuentra a la par de cualquier país, siendo la tercera nación de Latinoamérica con mayor número de centros de reproducción. Objetivo Determinar las características demográficas de las madres e hijos sometidos a técnicas de reproducción asistida (TRA) en el Hospital Español de México en 2016. Material y métodos Se trata de un estudio descriptivo, retrospectivo que incluyó a los recién nacidos producto de TRA del Hospital Español de México en 2016. Se obtuvo información sobre el método de interrupción del embarazo, el número de productos, las semanas de gestación al nacimiento, peso y talla al nacimiento y si requirieron ingreso a la UCIN, así como las complicaciones presentadas. Resultados Se incluyeron 292 pacientes sometidas a TRA. De las complicaciones maternas asociadas, las más prevalentes fueron las infecciones durante el embarazo. Se obtuvieron datos de 373 recién nacidos. Se describen las complicaciones en estos pacientes; las más frecuentes fueron las respiratorias. Conclusiones Las TRA son tratamientos cada vez más utilizados. Hay que ser cuidadosos a la hora de informar a los futuros padres acerca de las complicaciones asociadas, teniendo en cuenta la variabilidad de datos disponibles.

Abstract Introduction Infertility is a disease characterized by the inability to achieve a pregnancy after 12 months or more of unprotected sex. In Mexico, assisted reproduction is on par with any country, being the third nation in Latin America with the largest number of reproduction centers. Objective To determine the demographic characteristics of mothers and children undergoing assisted reproduction techniques (ART) at the Hospital Español de México in 2016. Material and methods This is a descriptive, retrospective study that included newborns product of ART performed in the Hospital Español de México in 2016. Information was obtained on the method of delivery, number of products, weeks of gestation at birth, birth weight and height, and if they required admission to the NICU, as well as the complications presented. Results 292 patients undergoing ART were included. Of the associated maternal complications, the most prevalent were infections during pregnancy. Data were obtained from 373 newborns. The complications in these patients are described, the most frequent being respiratory. Conclusions ART are increasingly used treatments. Care must be taken when informing prospective parents about associated complications, taking into account the variability of the available data.

Proteomics in Human Reproduction.

BACKGROUND: Assisted Reproduction Techniques (ART) have significantly advanced since the first successful In Vitro Fertilization (IVF). However, most in vitro-produced embryos fail to implant. Key steps in ART are the correct infertility diagnosis, in order to manage the individualised treatments, and the assessment of gamete and embryo viability, to identify the embryo with the best implantation potential. OBJECTIVE: The goal for this manuscript was to present a brief review of proteomics in Assisted Reproduction Technologies (ART) and raises the question of whether proteomics is a good alternative for the future of ART. METHODS: A literature review concerning proteomics and assisted reproduction was conducted. RESULTS: Non-invasive approaches to correctly diagnose infertility and to access embryo development potential have the advantages of increasing our knowledge about embryo physiology, therefore allowing the development of methods to predict developmental competence and viability. These approaches include proteomic profiling and other omics technologies. CONCLUSION: The use of proteomics in clinical practice goes beyond the identification of the oocytes and embryos with the best developmental potentials, it may add to the diagnosis of both male and female infertility and in the future, it may be a laboratory tool that will contribute to the birth of a healthy child.

Consecuencias perinatales de embarazos logrados mediante reproducción asistida versus embarazos espontáneos / Perinatal results of pregnancy achieved by assisted reproduction therapy versus spontaneous pregnancy

Resumen OBJETIVO: Describir y comparar las consecuencias perinatales de los embarazos logrados por reproducción asistida versus espontáneos. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y analítico. Se incluyeron pacientes que terminaron el embarazo en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes; se excluyeron las embarazadas con expediente clínico incompleto, terminación del embarazo antes de las 22 semanas. Se analizaron y compararon las principales consecuencias perinatales en ambos tipos de embarazos. El análisis de asociación entre terapia de reproducción asistida y complicaciones perinatales se hizo mediante una regresión logística simple y ajustada por variables confusoras. RESULTADOS: De 448 ciclos iniciados, se analizaron 98 embarazos únicos logrados por reproducción asistida; menor probabilidad para recién nacido pretérmino (p < 0.05) e ingreso a la unidad de cuidados intensivos neonatales (p <0.05) y embarazos múltiples; una probabilidad significativa de amenaza de parto pretérmino versus embarazos espontáneos (p < 0.05). CONCLUSIONES: Se registraron menos complicaciones perinatales en embarazos únicos por reproducción asistida y en embarazos múltiples mayor probabilidad de amenaza de parto pretérmino sin mayor prevalencia de recién nacido pretérmino. La adecuada atención multidisciplinaria previa a la concepción tiene mayor peso en las repercusiones perinatales que la técnica de fertilización asistida por sí misma.

Abstract BACKGROUND: As demand for assisted reproduction techniques has increased, so have concerns about associated perinatal outcomes and whether they are different from spontaneously achieved pregnancies. OBJECTIVE: to describe and compare perinatal outcomes of pregnancies achieved by assisted reproduction versus spontaneous pregnancies. MATERIALS AND METHODS: Observational, cross-sectional, retrospective, analytical study. Pregnancies with resolution within the institute were included; those with an incomplete clinical record, termination of pregnancy before 22 weeks were excluded. The main perinatal results in both types of pregnancies were analyzed and compared. The analysis of the association between assisted reproduction therapy and perinatal complications was made by a simple logistic regression and adjusted for confounding variables. RESULTS: Of 448 cycles initiated, 98 pregnancies achieved by assisted reproduction were analyzed, observing in single pregnancies; lower probability for preterm newborns (p <0.05) and admission to the neonatal intensive care unit (p <0.05) and in multiple pregnancies; a significant probability to present threat of preterm delivery versus spontaneous pregnancies (p <0.05). CONCLUSIONS: There were fewer perinatal complications in single pregnancies for assisted reproduction and in multiple pregnancies a greater probability of threat of preterm delivery without a higher prevalence of preterm newborn, concluding that having an adequate preconceptional multidisciplinary management has a greater weight in perinatal outcomes than Fertilization technique assisted by itself.

Effect of follicular flushing on reproductive outcomes in patients with poor ovarian response undergoing assisted reproductive technology.

PURPOSE: The purpose of this study is to investigate the impact of follicular flushing on the number of oocytes retrieved, oocyte maturity, fertilization rate, embryo development, and pregnancy rate of poor ovarian responders (POR). METHODS: Retrospective study of 524 cycles of 384 patients with POR submitted to assisted reproductive technology (ART) and who had follicular flushing during oocyte retrieval was used in the study. We included patients with <5 oocytes at oocyte retrieval (POR group) and matching the Bologna criteria. RESULTS: POR patients had a mean age of 38.2 ± 4.2 years. A total of 1355 follicles (mean = 3.5 ± 1.6) were aspirated and 1040 oocytes recovered, with 709 (68.2%) obtained by direct aspiration and 331 (31.8%) by follicular flushing. We found a difference between the total number of oocytes and the number of aspirated oocytes. Overall pregnancy rate was 22%. Association was observed between pregnancy rate and the number of oocytes retrieved, the number of MII oocytes, and the number of embryos transferred. The patients matching the Bologna criteria had a mean age of 38.9 ± 3.9 years. A total of 309 follicles were aspirated (mean = 3.1 ± 1.5) and 242 oocytes recovered, with 156 (64.5%) obtained by direct aspiration and 86 (35.5%) by follicular flushing. There was a significant difference between the total number of oocytes and the number of aspirated oocytes. Overall pregnancy rate was 12.1%. There was no association between the pregnancy rate and the number of oocytes retrieved, the number of MII, and the number of embryos. CONCLUSIONS: Follicular flushing might be a suitable alternative to increase the number of oocytes and pregnancy rates in patients with POR.

Prevalencia de autoinmunidad tiroidea en mujeres subfértiles / Prevalence of thyroid autoimmunity in subfertile women

Resumen OBJETIVO: estimar la prevalencia de enfermedad tiroidea autoinmunitaria en pacientes subfértiles y saber si existe asociación entre enfermedad tiroidea autoinmunitaria aislada en mujeres eutiroideas y los resultados en técnicas de reproducción asistida. MATERIALES Y MÉTODOS: estudio observacional, transversal, ambispectivo, que evaluó mujeres de 18 a 43 años de edad atendidas en el servicio de Reproducción Humana del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes que tuvieran una determinación del perfil tiroideo con anticuerpos antitiroideos en la primera consulta de infertilidad. RESULTADOS: la prevalencia de enfermedad tiroidea autoinmunitaria en mujeres infértiles fue de 19%. El 48% tuvieron seropositividad para anticuerpos antitiroideos, 32% para anticuerpos antitiroglobulina más anticuerpos antiperoxidasa y 20% restante solo para anticuerpos antitiroglobulina. En el grupo de pacientes con enfermedad tiroidea autoinmunitaria se observó una prevalencia de hipotiroidismo clínico de 8% y subclínico de 48%. La media de TSH para las mujeres con enfermedad tiroidea autoinmunitaria fue de 4.6 μUI/L. Las mujeres con enfermedad tiroidea autoinmunitaria aislada eutiroideas representaron 8.3% de la población y tuvieron una alta tasa de abortos espontáneos previos (45.5%) y de fracaso en técnicas de reproducción asistida (70%). CONCLUSIÓN: la determinación de la autoinmunidad tiroidea debe ralizarse de manera rutinaria en la población de mujeres.

Abstract OBJECTIVE: To estimate the prevalence of autoimmune thyroid disease in subfertile patients who come to the Human Reproduction service of the National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico city. MATERIAL AND METHODS: A retrospective, cross-sectional, observational, ambispective study evaluating 18- to 43-year-old women from the INPer "Isidro Espinosa de los Reyes" human reproduction service with a thyroid profile determination with anti-thyroid antibodies in The first consultation of infertility. RESULTS: The prevalence of TEE in the population of infertile women is 19%. 48% have seropositivity for Ac-TPO, 32% for Ac-tiroglobulina plus Ac-TPO and the remaining 20% only for Ac-tiroglobulina. A prevalence of clinical hypothyroidism of 8% and subclinical of 48% was observed in the group of patients with ATE. The mean TSH for women with ATE was 4.6 μUI/L. Women with isolated euthyroid ETA represent 8.3% of the population and have a high rate of previous spontaneous abortions (45.5%) as well as failure in assisted reproduction techniques (70%). CONCLUSION: Determination of thyroid autoimmunity should be routinely performed in the female population.

Significados de la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida / Meanings of lived experience of pregnancy and labor of a woman with infertility diagnosis who did conceive through assisted reproduction techniques

OBJETIVO: Develar la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida. MÉTODO: Se trata de un estudio de caso con diseño fenomenológico. Se seleccionó una mujer portadora del fenómeno en estudio que accedió a compartir su experiencia mediante una entrevista en profundidad. La pregunta que guió el estudio fue ¿Cómo se muestra la experiencia vivida del proceso de embarazo y parto de una mujer con diagnóstico de infertilidad que logra concebir mediante técnicas de reproducción asistida? El análisis fue realizado de acuerdo a Streubert(1). Los pasos a seguir fueron: obtener la descripción de la participante, separar los supuestos del investigador ("bracketing"), leer la transcripción hecha "verbatim", revelar esencias, comprender las unidades de significado, desarrollar las descripciones, devolver a la participante para su validación, revisar literatura relevante, y compartir los resultados con la comunidad de enfermería. RESULTADOS: Destacan unidades de significado sobre sufrimiento por el tratamiento y las múltiples pérdidas que enfrenta la entrevistada. Se contraponen felicidad y angustia durante el embarazo, y esperanza al lograr el objetivo de vida planteado con su pareja. Surge el fortalecimiento del vínculo con su esposo, y finalmente miedo ante el verse enfrentada a la maternidad. Como conclusión se permite comprender que las mujeres enfrentadas a TRA tienen necesidades de cuidado únicas, por lo que el rol de enfermería es fundamental, sobre todo de acompañamiento. Se debe seguir estudiando este fenómeno en mujeres chilenas, e involucrar la perspectiva del padre.

OBJECTIVE: Reveal the lived experience of pregnancy and delivery of a woman diagnosed with infertility who did conceive through assisted reproduction techniques. METHOD: This is a case study with a qualitative health research design of phenomenology. The participant was a woman who is carrier of the phenomenon understudy and that agreedto share her experience through an in-depth interview. The study base question was ¿How the pregnancy and delivery process lived experience of a woman with infertility diagnosis who did conceive through assisted reproduction techniques is shown?. According to Streubert(1),the phenomenological analysis process steps are: to obtain the participant's description, to separate the assumptions of the researcher ("bracketing"), to read the transcript made "verbatim". Reveal essences, understand the units of meaning, develop the descriptions, return the participant for validation, review relevant literature, and share the results with the nursing community. RESULTS: There are significant units of meaning of suffering due to the treatment and the multiple losses that the interviewee faces. There is also the contrast between happiness and anguish in the course of pregnancy, and hope for having achieved the goal of life raised with her partner. The strengthening of the bond with her husband arises, and finally fears of being confronted with motherhood. As a conclusion, it is possible to understand that women facing ART have unique care needs, so the role of nursing is fundamental, especially accompaniment. This phenomenon should continue to be studied in Chilean women, and involve the perspective of the father.