ABSTRACT
RESUMEN Introducción y objetivos: Aunque la criopreservación embrionaria es frecuentemente utilizada como parte de las técnicas de reproducción asistida, no existe información cuantitativa de cómo las parejas infértiles viven la experiencia de tener embriones criopreservados en Chile. El objetivo del estudio fue examinar las percepciones y creencias que tienen mujeres y hombres respecto de sus embriones criopreservados, sus perspectivas respecto de la donación reproductiva y destino de los embriones remanentes. Metodología: 153 mujeres y hombres con embriones criopreservados provenientes de un hospital público, Instituto de Investigaciones Materno Infantil y un centro privado, Clínica Las Condes, en Santiago, Chile, respondieron durante mayo 2015 a mayo 2016 un cuestionario en línea, anónimo, respecto de sus percepciones y creencias sobre criopreservación embrionaria. Resultados: Los encuestados reconocen a sus embriones criopreservados como un hijo (53.2%) o un proyecto de hijo (40.7%). Sólo 8% los considera un grupo organizado de células; sobre el 60% rechaza la opción de descartarlos o usarlos para investigación. Los participantes del hospital público tenían mayor disposición a donar sus embriones remanentes a otras parejas que aquellos del privado (61% vs 40%; P=0.016). Un 34% de las personas encuestadas estuvo de acuerdo con donar embriones a parejas de un mismo sexo. Conclusión: Este estudio muestra que las personas chilenas tienen un vínculo emocional con sus embriones criopreservados y no consideran descartarlos. Los resultados de este estudio pueden servir para dar adecuada consejería a las personas que se realizan técnicas de reproducción asistida, de tal modo de tomar decisiones informadas respecto de la criopreservación.
ABSTRACT Background and objetive: Although embryo cryopreservation is frequently used as part of assisted reproductive technology, quantitave information addressing how infertile couples live the experience of having cryopreserved embryos is lacking in Chile. The aim of this study is to examine men and women's perception and beliefs regarding their cryopreserved embryos, as well as their perspective on embryo donation and disposition. Methods: 153 women and men with frozen embryos from a public hospital, Instituto de Investigactiones Materno Infantil, and a private clinic, Clínica Las Condes, in Santiago, Chile, responded between May 2015 and May 2016 to an anonymous online survey addressing their perceptions and beliefs concerning their cryopreserved embryos. Results: Respondents considered their frozen embryos to be equivalent to a child (53.2%) or a potential child (40.7%). Only 8% regard them as an organized group of cells. Over 60% of respondents disagree with destroying surplus embryos or using them for research. Participants from the public hospital are more willing to donate their embryos to another couple than those from the private center (61% vs 40%; P=0.016); 34% of respondents agreed to donate surplus embryos to same sex couples. Conclusion: This study reveals that Chilean couples are emotionally bound to their frozen embryos, and that discarding them is not an option. The results from this survey will help strengthen counseling for couples to enable them to make informed decisions regarding their surplus embryos.
Subject(s)
Humans , Male , Female , Perception , Cryopreservation/statistics & numerical data , Reproductive Medicine/statistics & numerical data , Embryo Disposition/psychology , Surveys and Questionnaires , Decision Making , Observational StudyABSTRACT
Background: Assisted reproductive technologies still generate debate about ethical moral and religious issues. Aim: To analyze the opinions of the general public about the use of assisted reproduction technology (ART). Material and Methods: This analysis used the information gathered in a survey about human reproduction and modern reproduction technologies applied to a random sample of 1,500 volunteers aged 18 to 65 years, living in Santiago, Chile. Also, data from 25 structured interviews and six focal groups of eight participants each was used. To typify opinions concerning the use of assisted reproductive technologies (ART), a multiple correspondence analysis was undertaken. Results: People that support ART are non-religious young people of medium-high socioeconomic level. The arguments most commonly used by people to justify their positions about ART are the right to have children, the protection of kinship, that ART implies commercialization and manipulation of human life, the need to obey Gods will, and the autonomy of informed and educated adults. Conclusions: The study allows us to understand in more complex ways the positions about ART. Chile does not have a legislation that regulates the use of ART. Generating information on the public opinion about these techniques we hope to contribute to the debate about the access and regulation of new reproductive technologies in Chile.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Dissent and Disputes , Public Opinion , Reproductive Techniques, Assisted , Chile , Focus Groups , Socioeconomic FactorsABSTRACT
Background: Advances in reproductive medicine and the use of assisted reproductive technologies (ART) have a great impact in the lives of people and the conformation of their families. Aim: To report the results of an opinion survey applied to inhabitants of Santiago, Chile about the use of ART to conceive. Material and Methods: A survey was designed and applied to a random representative sample of 1.500 people between the ages of 18 and 65 in the 34 municipalities of Santiago. Results: Eighty eight percent of respondents support the use of medical assistance to conceive children. Wide approval exists for the use of in vitro fertilization (IVF) by heterosexual couples, even when not married (85.9%) and by single women (70.4%), by both mole and female participants of every socioeconomic level, age group and religious affiliation. Support decreases significantly when the use of IVF is considered for post-menopausal women (35.1 %) and by same-sex couples (26.6%). Conclusions: Results of this survey indicate that the majority of inhabitants in Santiago favor the use of ART, including IVF. This support decreases significantly for elderly women and homosexual couples.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Public Opinion , Reproductive Techniques, Assisted , Chile , Population Surveillance , Socioeconomic FactorsABSTRACT
El desafío de cualquier sociedad es construir acuerdos basados en consideraciones éticas y valóricas, que con dinamismo y pragmatismo se renueven según lo que aprendemos día a día a través de la ciencia, de la experiencia y de las realidades sociales. Acuerdos sociales así construidos generan deliberaciones tolerantes, pluralistas y respetuosas de la diversidad de pensamientos y creencias. Esta manera de relacionarse cívicamente ha demostrado ser difícil en el contexto latinoamericano. Este artículo intenta sentar las bases biológicas del desarrollo humano para ejercer un pensamiento ético separandolos mínimos morales, que deben aplicarse a todas las personas, de los máximos morales, que cada uno puede incorporar según sus propias creencias. En primer lugar, se describen los diferentes estadios del desarrollo embrionario previo a la implantación con objeto de reflexionar sobre el estatuto del embrión y luego se hace referencia a las técnicas de reproducción asistida y los desafíos éticos que éstas representan.
A major challenge for any society is to build agreements and regulations based on ethical considerations and value judgments which are dynamic and permanently reviewed and renewed according to what science, experience and social realities teach us every day. Social agreements, which respectthe different ways that people, think and believe, have proved to be a difficult task in Latin America. This article tries to set the biologic bases of early human development in order to separate ethical judgments based onminimal moralities which are applicable to all from maximal moralities which should not be obligatory and followed as personal beliefs. Firstly, the different stages of pre implantation development are described and the moral status of the embryo is examined. This is followed by comments on some challenges posed by modern reproductive Technologies.
Subject(s)
Humans , Infertility, Female/therapy , Reproductive Techniques, Assisted/ethicsABSTRACT
La Fecundación In Vitro (FIV) y la Transferencia de Gametos a la Trompa de Falopio (GIFT) han hecho posible el nacimiento de cientos de miles de niños. Estas tecnologías han puesto al hombre frente a frente a la posibilidad de intervenir en los inicios de su propia existencia. La pregunta es si aquello que es científica y técnicamente factible es bueno para el hombre. La respuesta requiere de una reflexión multidisciplinaria. La filosofia, la bioética y las distintas corrientes religiosas tienen un grano de arena que aportar a este gran desafio.
Subject(s)
Fertilization in Vitro , Reproductive HealthABSTRACT
Although there is very little doubt that when a child is born a new actual person can be identified, there is continuous debate as to the moment in embryological development when that same person begins its ixistence. Based on today's knowledge of human fertilization and the early stages of embryo development, this position paper examines three theses that deal with the establishment of personhood. The first thesis stipulates that a human individual exists prior to syngamy. Although the sperm has penetrated the plasmatic membrane of the oocyte, the genetic information contained in both gametes remain separated in the male and female pronucleus; thus, the oocyte contains the sum of two identities responsible for creating a new individual. This paper will argue that a human individual has not yet formed. The second thesis recognizes that with syngamy, a unicellular structure (zygote) is established, endowed with genetic individuality and with the potential to become a person maintaining that same genetic framework throughout its lifetime. The third thesis argues that although genetic individuality is established with syngamy, the ontological individuality is only reached once genetic expression and cellular specialization are achieved and twinning is on longer possible (15 days after fertilization)
Subject(s)
Humans , Organelle Biogenesis , Fertilization in Vitro/methods , Fertilization/physiology , Philosophy, Medical , Blastocyst/physiology , Genome, Human , Fetal Development/physiology , Fertility/physiology , Embryonic Structures , Legislation, MedicalABSTRACT
Se revisan retrospectivamente 407 ciclos de inseminación intrauterina con semen del marido con el objeto de determinar factores pronósticos del procedimiento y el número de ciclos a realizar. Se encontró una diferencia significativa al comparar edad y años de infertilidad entre ciclos concepcionales y no concepcionales. Hubo un 3 por ciento de embarazos por ciclos con recuentos < 1 millón de espermatozoides móviles inseminados (EMI). El 97,7 por ciento de los embarazos se lograron en los primeros 4 ciclos, con una tasa acumulativa de 0,387. Se concluye que la IIU tiene mejor pronóstico en pacientes menores de 35 años, con una infertilidad menor de 5 años. El procedimiento no se justifica con recuentos menores a 1 milllón de EMI, y se sugiere no realizar más de 4 ciclos de tratamiento
Subject(s)
Humans , Female , Adult , Pregnancy , Infertility, Female/therapy , Insemination, Artificial, Homologous/methods , Prognosis , Semen , Clomiphene/therapeutic use , Ovulation Induction/methods , Menotropins/therapeutic use , PrognosisSubject(s)
Humans , Female , Adolescent , Adult , Androgens , Anovulation/complications , Clomiphene/therapeutic use , Gonadotropins/metabolism , Infertility, Female/etiology , Ovarian Follicle/physiopathology , Polycystic Ovary Syndrome/physiopathology , Ovarian Function Tests/methods , Neurotransmitter Agents/physiologySubject(s)
Humans , Female , Fertilization in Vitro , Insemination, Artificial , Religion , Surrogate MothersABSTRACT
Se intenta caracterizar la concentración diaria de la hormona folículo estimulante, hormona luteinizante estradiol progesterona, correlacionando la concentración plasmática de estas hormonas con el perfil de crecimiento folecular en 12 mujeres normales durante su ciclo concepcional y en 15 nujeres normales en las cuales no ocurrió concepción. La duración media folecular fue de 15,7 días (rango de 13 a23) en los 12 ciclos concepcionales y de 14,3 días (rango de 11 a 20 en los 15 ciclos no concepcionales. La duración media de la fase lútea fue de 14,8 días (rango 14 a 16 en los ciclos no concepcionales. En la actualidad la mejor caracterización clínica del ciclo menstrual se puede lograr mediante una evaluación multianalítica que incluya al menos la visualización del desarroello folicular por ultrasonido, junto a mediciones hormonales seriadas. En mujeres con infertilidad de causa desconocida, se describen variadas formas de disfunción ovulatoria que pueden manifestarse parcialmente como insuficiencia lútea entre ellas: crecimiento folicular y atresia, luteinización de folículo no roto, ausencia de desarrollo folicular y folículo quéstico