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RESUMEN El artículo se interroga por los alcances y los límites del paradigma de la medicina de precisión y su relación con el enfoque de la salud colectiva. Para ello, se toma la evaluación genética preimplantatoria o PGT (preimplantation genetic testing) dado que constituye un ejemplo paradigmático de tecnologías que apuntan a la "individualización" de los procesos de salud. En esta dirección, se revisan las características y los fundamentos científico-normativos acerca de las tecnologías PGT en Argentina, y el camino que queda por recorrer para su análisis bioético. De manera más específica, se visibilizan algunas de las condiciones de posibilidad para su implementación desde la perspectiva norte-sur. Como síntesis del análisis, proponemos tres ejes o nudos problemáticos relacionados con los sesgos en la producción de conocimiento, los valores e intereses subyacentes a sus usos y los presupuestos epistemológicos que operan en la base de estas tecnologías. A lo largo de este trabajo, presentamos estos dilemas y sugerimos algunas recomendaciones para ser tenidas en cuenta en futuras investigaciones.
ABSTRACT This article examines the scope and limitations of the precision medicine paradigm and its relationship with the collective health approach. To that end, it takes preimplantation genetic testing (PGT) as a paradigmatic example of technologies aimed at the "individualization" of health processes. In this regard, we review the characteristics and scientific and regulatory foundations of PGT technologies in Argentina, and discuss the next steps for their bioethical analysis. More specifically, we shed light on some of the conditions for their implementation from a north-south perspective. We propose three themes or problematic aspects as a synthesis of our analysis, related to biases in the production of knowledge, the values and interests underlying its uses, and the underlying epistemological assumptions of these technologies. Throughout the article, we review these dilemmas and suggest some issues that should be taken into account in future research.
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La pandemia de SARS-CoV-2 es una emergencia sanitaria sin precedentes, que ha implicado un reordenamiento en la priorización de procedimientos médicos electivos, frente a un potencial colapso del sistema de salud a nivel mundial y riesgo de contagio del personal y pacientes. Al igual que en el resto del mundo, en Chile la mayoría de los centros de medicina reproductiva han debido suspender sus diferentes terapias de reproducción asistida (TRA). Sin embargo, a raiz de la disminución del número de contagios y mayor evidencia científica disponible, la Sociedad Europea de Reproducción Humana y Embriología (ESHRE) ha recomendado reiniciar los ciclos de medicina reproductiva de forma gradual, a través de sistemas de triage, priorizando pacientes por medio de la generación de distintos escenarios. Considerando esta recomendación, se realizó una revisión sobre la evidencia existente respecto a SARS-CoV-2 / COVID-19 en medicina reproductiva recopilando diferentes directrices de las principales sociedades internacionales, con el objetivo de generar una recomendación ajustada a la realidad nacional.
SARS-CoV-2 pandemic is an unprecedented health emergency, which involves a reorganization of elective procedures, facing a potential global health system collapse. In Chile, as in the rest of the world. most reproductive medicine centers have suspended their different assisted reproduction therapies (ART). However, due to the decrease in the number of infections and due to a greater collection of scientific evidence, the European Society for Human Reproduction and Embryology (ESHRE) have recommended restarting cycles gradually through triage systems, prioritizing patients through the generation of different scenarios. With this in mind, we carried out a review of the existing evidence so far regarding SARS-CoV-2 and reproductive medicine, and we tried to compile the different guidelines of the main international societies, to generate a recommendation adjusted to our local scenario.
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Humans , Female , Pneumonia, Viral/prevention & control , Coronavirus Infections/prevention & control , Reproductive Medicine/standards , Reproductive Techniques, Assisted/standards , Betacoronavirus , Ovulation Induction , Fertilization in Vitro , Triage , Practice Guidelines as Topic , Patient Selection , Embryo Transfer , Pandemics/prevention & controlABSTRACT
Resumen: ANTECEDENTES: La inmunología de la reproducción no es un área nueva: siempre ha estado relacionada con el aborto recurrente y con la falla repetida en la implantación, sobre todo en el contexto de una fertilización in vitro. Recientemente emergieron nuevos conceptos importantes que los ginecoobstetras deben considerar. OBJETIVO: Interrelacionar los conceptos básicos de inmunología, embriología y reproducción asistida para comprender mejor lo que la primera puede resolver y lo que no. METODOLOGÍA: Estudio retrospectivo efectuado con base en la búsqueda electrónica, llevada a cabo en febrero de 2020 en las bases de datos: PubMed y Google Scholar con los siguientes términos (MeSH): abortion, spontaneous/immunology; embryo implantation/immunology; HLA-c antigens/immunology; immune tolerance/immunology; immunity, maternally-acquired/immunology; uterus/immunology; killer cells, natural/immunology; placentation/immunology; receptors, kir/immunology; antigen presentation/genetics; antigen presentation/immunology; maternal-fetal exchange/genetics; maternal-fetal exchange/immunology. RESULTADOS: Se reunieron 289 artículos y se eliminaron 248 por no cumplir con los criterios de inclusión; solo se analizaron 41. Los artículos identificados sirvieron de base para actualizar la situación de la inmunología en el contexto de la medicina de la reproducción. Durante el proceso se revisaron otros artículos que sirvieran de soporte bibliográfico a los conceptos descritos en esta revisión. CONCLUSIONES: Debido al destacado interés en el estudio de la genética de los embriones, la medicina de la reproducción se enfocó más en ella y dejó de lado a la inmunología. Sin embargo, como la genética sigue sin poder explicar de manera adecuada las fallas en la implantación, la inmunología de la reproducción vuelve a cobrar impulso.
Abstract: BACKGROUND: Reproductive immunology is not a new area in reproductive medicine, it has always been related to recurrent miscarriage and repeated implantation failure, especially in the context of IVF. Recently, new concepts have emerged that are important for OBGYN specialists to keep in mind. OBJECTIVE: Interrelating the basic concepts of immunology, embryology and assisted reproduction to better understand what the former can and cannot solve. METHODOLOGY: Retrospective study based on the electronic search, carried out in February 2020, in the databases: PubMed and Google Scholar with the following terms (MeSH) The following MeSH terms were used: Abortion, Spontaneous/immunology; Embryo Implantation/immunology; HLA-C Antigens/immunology; Immune Tolerance/immunology; Immunity, Maternally-Acquired/immunology; Uterus/immunology; Killer Cells, Natural/immunology; Placentation/immunology; Receptors, KIR/immunology; Antigen Presentation/genetics; Antigen Presentation/immunology; Maternal-Fetal Exchange/genetics; Maternal-Fetal Exchange/immunology. RESULTS: 289 articles were collected, and 248 articles were deleted because they did not meet the inclusion criteria; only 41 were analyzed. The articles identified served as a basis for updating the status of immunology in the context of reproductive medicine. During the process, other articles were reviewed to serve as bibliographic support for the concepts described in this review. CONCLUSIONS: Due to the outstanding interest in the study of embryo genetics, reproductive medicine focused more on it and left immunology aside. However, since genetics still cannot adequately explain implantation failures, reproductive immunology is gaining momentum again.
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A 28-yr-old P2L2 lady, with history of two previous caesarean deliveries and tubal ligation, presented at 6weeks of amenorrhea with pain lower abdomen. The operative notes from her previous caesarean section stated that she had a unicornuate uterus without a rudimentary horn (ASRM Class II D Mullerian anomaly)5 and only right fallopian tube was visualised, which was ligated by Parkland’s method.On workup, she had a positive urine pregnancy test and ultrasound showed a left adnexal mass without any evidence of intraperitoneal collection, possibly an unruptured left ovarian ectopic pregnancy secondary to failed tubal ligation. Further investigation by MRI revealed an entirely new finding. The suspicious left adnexal mass was the left horn of bicornuate uterus which had an intrauterine gestational sac. Hence, her revised diagnosis was G3P2L2, post LSCS, bicornuate uterus (ASRM class IV B) with 6 weeks of intrauterine left horn pregnancy following failed tubal ligation.She underwent a medical followed by surgical evacuation of intrauterine pregnancy as patient was unwilling to continue the pregnancy.This case highlights the importance of a comprehensive evaluation, whenever a lady is diagnosed with a Mullerian anomaly, in order to correctly classify the patient and identify associated anomalies of urogenital tract which would avoid such erroneous diagnosis of site of pregnancy as illustrated in our case.
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The development of new genomic technologies has strengthened the influence of genetics in all medical specialties; reproductive medicine is no exception. The introduction of new genetic tests to daily clinical practice, together with the complexity of genetic information and its potential psychological burden, make specialized genetic counseling essential. Preimplantation genetic testing for aneuploidies (PGT-A) has become an almost routine procedure in assisted reproduction treatments. Nevertheless, in Peru, patients usually receive none or inadequate corresponding genetic counseling, which hinders informed decision-making.
El desarrollo de las nuevas tecnologías genómicas ha potenciado la influencia de la genética en todos los campos de la medicina, en donde la medicina reproductiva no es la excepción. La frecuente introducción de nuevas pruebas genéticas en la práctica clínica diaria, junto con la complejidad de la información genética y su potencial carga psicológica, hacen indispensable el asesoramiento genético especializado. En este contexto, el diagnóstico genético preimplantacional para aneuploidías (PGT-A) se ha convertido en un procedimiento casi de rutina en los tratamientos de reproducción asistida. Sin embargo, en el Perú, en la gran mayoría de casos los pacientes no reciben el asesoramiento genético correspondiente o este no es el adecuado, que no permite una toma de decisiones informada.
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Objective@#The aim of this study was to evaluate the value for CBL and LBL teaching method in the training of refresher doctors in reproductive medicine.@*Methods@#A questionnaire survey was conducted among 186 refresher doctors who had studied in the reproductive medicine center at Peking University Third Hospital from January 2016 and December 2017 one year after their graduation. We tested 33 refresher doctors in observe group and 33 refresher doctors in the CBL+LBL group who graduated at the same period.@*Results@#Ninety-two refresher doctors responded to the investigation. The questionnaire survey showed that 84.78% of the refresher doctors thought that CBL and LBL teaching method could improve their learning abilities, clinical problem analysis and solving skills, and surgical techniques, which was conducive to promoting their assisted reproductive technology. Besides, 63.04% of refresher doctors believed this method improved their research abilities. In CBL+LBL group, examination scores of theoretical knowledge were significantly higher than the observe group (P<0.05).@*Conclusion@#The combination of CBL and LBL is effective and feasible in the training of refresher doctors in reproductive medicine.
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Objective The aim of this study was to evaluate the value for CBL and LBL teaching method in the training of refresher doctors in reproductive medicine.Methods A questionnaire survey was conducted among 186 refresher doctors who had studied in the reproductive medicine center at Peking University Third Hospital from January 2016 and December 2017 one year after their graduation.We tested 33 refresher doctors in observe group and 33 refresher doctors in the CBL+LBL group who graduated at the same period.Results Ninety-two refresher doctors responded to the investigation.The questionnaire survey showed that 84.78％ of the refresher doctors thought that CBL and LBL teaching method could improve their learning abilities,clinical problem analysis and solving skills,and surgical techniques,which was conducive to promoting their assisted reproductive technology.Besides,63.04％ of refresher doctors believed this method improved their research abilities.In CBL+LBL group,examination scores of theoretical knowledge were significantly higher than the observe group (P＜0.05).Conclusion The combination of CBL and LBL is effective and feasible in the training of refresher doctors in reproductive medicine.
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We provide an overview of the detailed information on the application and fundings of the National Natural Science Foundation of China in reproductive system/perinatology/neonatology in 2018 to facilitate future applications for researchers and physicians in this area in 2019.In-depth analysis was performed from different aspects among all the applications;areas for improving in the format and compiling of the application form were pointed out together with practical suggestions;possible interesting topics in future application were also implicated.
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O biodireito é um ramo da ciência jurídica, e por essa lente podemos analisar os princípios e normas que influenciam e modificam as relações com o Estado e entre os próprios indivíduos, quando tratarem sobre a vida e dos direitos fundamentais dos indivíduos envolvidos. Os principais princípios analisados da bioética são: beneficência, autonomia, justiça, respeito pela pessoa e do consentimento informado. As pesquisas buscam trazer foco na legislação brasileira a respeito do assunto, a fim de propor uma maior abordagem para facilitar a compreensão das pessoas envolvidas no processo de Reprodução Assistida, tanto pacientes como profissionais. As normas analisadas foram a Constituição Federal, o Código Civil Brasileiro e as Resoluções do Conselho Federal de Medicina (CFM). O texto trata de assuntos polêmicos que envolvem pacientes, equipe multiprofissional e sociedade, pois ao analisar as técnicas de Reprodução Assistida há inúmeras indagações como por exemplo quais os direitos e deveres envolvidos, qual o limite do uso dessas técnicas para ter como resultado a gravidez e quais os direitos fundamentais que estão sendo preservados. Alguns pontos discutidos no trabalho são da cessão temporária do útero, doação de material genético, criopreservação e Reprodução Assistida post-mortem, entre outros. Assim, o desenvolvimento do tema exposto se dá em três momentos, sendo o primeiro o biodireito e os direitos humanos do ponto de vista da Reprodução Assistida, bem como as técnicas utilizadas, em seguida o estudo da legislação brasileira e por fim os aspectos polêmicos e discussões a respeito do tema. (AU)
Biolaw is a branch of legal science, through which it's possible to analyze the principles and regulations that influence and modify the relation with the State and among individuals themselves when it comes to the life and fundamental rights of the individuals involved. The main bioethics principles analyzed are: beneficence, autonomy, justice, respect for the person and the informed consent. Research aims to focus on the Brazilian legislation on the subject in order to propose a wider approach to promote the comprehension of people involved in the process of Assisted Reproduction, both patients and professionals. The regulations analyzed were the Brazilian Constitution, the Brazilian Civil Code and the Brazilian Federal Medical Council. The text brings up polemical subjects involving patients, a multiprofessional team and the society, as the Assisted Reproduction techniques are analyzed, numerous questions come up, as what are the rights and obligations involved, what is the limit of using these techniques to achieve pregnancy and what are the fundamental rights which are being preserved. Some of the topics discussed in this research are surrogacy, genetic material donation, cryopreservation and posthumous assisted reproduction. Therefore, the development of the exposed topic happens in three phases, the first one is Biolaw and Human Rights from the Assisted Reproduction point of view and the techniques that are used, then the study of the Brazilian legislation and finally the polemical aspects and discussions on the topic. (AU)
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Bioethics , Reproductive Medicine , Ethics, ProfessionalABSTRACT
Background It is widely known that infertility and its treatment have a negative impact on patients' well-being, yet not much is known about patients' satisfaction with the quality of reproductive care. Purpose To assess the quality of life (QoL) of patients receiving medical care under the Chilean public health system. Materials and Methods The FertiQoL international questionnaire was applied to 260 patients (both sexes) referred from rural and urban areas to undergo in vitro fertilization at a major university public hospital. FertiQol evaluates QoL as a product of psychosocial well-being and treatment experience. Demographic and reproductive data were collected. Results QoL due to treatment factors was significantly lower than psychosocial well-being. Couples from lower-density areas showed markedly worse medical satisfaction than patients treated in Chile's capital. No effects on QoL were observed as a function of age, education, or type of infertility. QoL was mostly affected by duration of infertility (inverse association) and geographical zone. Marital satisfaction was the component that most contributed to personal well-being. Conclusions QoL decreased more due to extrinsic factors, particularly lack of access to reproductive care, poor organization of medical services, and deficient clinical interaction, than due to psychosocial distress. These findings call for a revision of the delivery of public fertility care to satisfy patients' needs and improve their QoL.
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Humans , Male , Female , Quality of Life , Infertility/psychology , Socioeconomic Factors , Chile , Public Health , Cross-Sectional Studies , Surveys and Questionnaires , Public Sector , Infertility/complicationsABSTRACT
Background: Age plays a crucial role in women fertility and is related with a decreased oocyte quality and quantity. The evidence for this asseveration comes from data obtained in infertile women. However there is a paucity of studies in patients with proven fertility evaluating ovarian reserve and its decline with time. Aim: To measure antral follicle count (AFC) in probed fertile patients and to create a distribution chart based on variables that may affect its natural decline. Material and Methods: Observational prospective study. A transvaginal ultrasound was made between menstrual cycle days 3 and 5, evaluating AFC in 100 patients, followed during a year. Results: Median antral follicle count media was 14.5 (interval 3 to 26). There was a lineal decline of AFC with age. Women with hypertension and type 2 diabetes mellitus had significantly less follicles. However, a multiple regression analysis showed that only women's age was a significant predictor of AFC (R2 = 0.84). Conclusions: There was a lineal relationship between AFC and age in women with probed fertility.
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Humans , Female , Adolescent , Adult , Middle Aged , Young Adult , Aging/physiology , Fertility/physiology , Ovarian Reserve/physiology , Ovarian Follicle/diagnostic imaging , Echocardiography , Body Mass Index , Cell Count/statistics & numerical data , Predictive Value of Tests , Prospective Studies , Follow-Up Studies , Ultrasonography , Age FactorsABSTRACT
Reproductive medicine center in military researchhospital is a guarantee to implement the national population and family planning of eugenics policy, and can also meet the needs of the service support of the officers and soldiers under the new situation and enhance the strong support for the combat effectiveness. In recent years, our hospital has been deepening the connotation of military service, enhancing the talent training echelon, achieving the development of cutting-edge technology, promoting innovation in medical technology and improving the individual treatment model. In this review, we summarized and shared some experiences in the construction and exploration of reproductive medicine center in the military research hospital.
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At present, the evaluation of endometrial receptivity (ER) is a routine research direction in the diagnosis and treatment of infertility, and it has been an key problem that have to be settled urgently in clinical practice. The definition of ER is the ability that endometrium receives embryo implantation, thereby the concept of implantation time windows was proposed. Ultrasound was applied to evaluate ER has series advantages included of convenience, safety, non-invasive and repeatability. Therefore, gynecologists has pay more and more attention to it and it has been the most extensive imaging method in reproductive medicine for studying of ER. This paper through applied ultrasound indicators to review the research progress of evaluating ER from four aspects included morphological index, relative index of blood flow, uterine contraction and endometrial peristaltic wave and endometrial angiography.
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Los ductos Müllerianos son dos estructuras embrionarias que en su desarrollo pasan por tres procesos fundamentales: desarrollo, fusión ductal y reabsorción septal. Las anomalías de los ductos Müllerianos (ADM) incluyen un gran espectro de malformaciones que comprometen el útero, trompas de Falopio, cuello uterino y los dos tercios superiores de la vagina. La gravedad de las ADM y sus características morfológicas están dadas por el momento embriológico específico en el que aparece el trastorno. Las mujeres con estas anomalías consultan principalmente por amenorrea primaria, infertilidad y complicaciones obstétricas. La resonancia magnética (RM) se ha convertido en una herramienta muy útil para su adecuada evaluación por tratarse de una técnica no invasiva, que no utiliza radiación ionizante y permite una evaluación multiplanar con adecuada valoración del contorno uterino externo, lo que la constituye en una técnica necesaria para el diagnóstico preciso, así como para la planeación quirúrgica de las pacientes
The Müllerian ducts are two embryological structures that undergo three main processes during their formation: development, ductal fusion, and septal resorption. Müllerian duct anomalies (MDAs) include a large spectrum of malformations that involve the uterus, fallopian tubes, cervix, and the upper two-thirds of the vagina. The severity and morphological characteristics are given by the specific embryological moment in which the disorder occurs. Women with these anomalies present symptoms such as primary amenorrhea, infertility, and obstetric complications. Magnetic resonance imaging (MRI) has become a very useful tool for evaluation, given that it is a noninvasive technique that does not use ionizing radiation, while allowing multiplanar evaluation for a proper assessment of the external uterine contour, which makes this method a useful technique for accurate diagnosis and surgical planning
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Humans , Congenital Abnormalities , Magnetic Resonance Imaging , Reproductive MedicineABSTRACT
Over the years, a lot has developed in the field of infertility and artificial reproductive techniques worldwide, but the uterine factor infertility still remains an unresolved issue in reproductive medicine. Absolute uterine factor infertility is synonymous with congenital absence of uterus or a physiologically nonfunctioning uterus. Very few options including surrogacy and adoption are available for these patients. Both surrogacy and adoption are associated with legal, ethical, financial, religious, and psychological issues. For some of these patients, uterine transplant could be a viable option in future. However, the ability of uterus to carry the pregnancy to the period of viability and the effect of immunosuppressant on the fetus make the uterine transplant a more complex operation than any other transplants. From the earliest uterine transplant tried in 1931 in Germany to the first successful child birth following transplant in Sweden in 2014, uterine transplantation has come a long way. Among the countries that have tried this till now, Sweden has reported five cases of successful births posttransplant. Behind these successful cases, there is dedication and perseverance of few individuals who continued their efforts in spite of repeated failures. At the moment, the uterine transplant can be considered experimental at the best. However, considering the large number of hysterectomies done all over the world and uteruses available for transplantation, uterine transplant has potential to surpass, in numbers, the other transplant in near future.
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Objective To explore a variety of sustainable development under the network environment of doctor-patient communication service platform in the role of reproductive medicine nursing,to improve the reproductive efficiency of medical care services in the new environment,build new doctor-patient communication platform.Methods In reproductive medicine nursing practice,based on the internet to build diversification of doctor-patient communication information service platform,such as reproductive center website,QQ group of doctor-patient communication,Wechat public service platform.Through the questionnaire survey form,understand reproductive center patients through various network platform in the query,the information,make an appointment for reproductive assisted reproduction related information and interact with staff and other aspects of the usage and satisfaction.Results Recycling effective questionnaire was 517 papers.A total of the use of network platform for the overall coverage was more than 80％ of patients,among them the most widely Wechat public platform,utilization rate was 78.1％ (400/512);60.8％ (312/513) patients think Wechat platform using the most convenient.The overall satisfaction rate for center web services platform was 89.5％ (460/514).Conclusions Online platforms provide better nursing efficiency and quality,as well as improving doctor-patient communication based on the internet environment.It provides a new way for sustainable development for nursing system in the field of reproductive medicine.
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Through analyzing the ethical status quo in reproductive medicine treatment unit, this article dis-cussed the social ethical issues brought by ART technology development related to the reproductive medical treat-ment unit. Then it put forward the measures to solve those ethical problems: strengthening the ethical principles and ethical committee construction, sharing data information, fully informed consent, and suggestions to improving ethics education.
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Background: Endometriosis is one of the common gynaecological problems mostly affecting the women in reproductive age, associated with non menstrual pelvic pain and other symptoms and recurrence of endometriosis is common after medical or even surgical treatment. Objectives: This review is done to assess, whether conservative surgery and adjunctive hor- mone suppression therapy is more beneficiary than surgery alone in the treatment of sympto- matic endometriosis in term of pelvic pain and disease recurrence. Data sources and search method: Searched had been performed on Cochrane Central Register of Controlled trials, MEDLINE, PsycINFO. Journals and reference lists had been also searched. Review methods: Only Randomized controlled trials were included if they compared the effec- tiveness of hormone therapy following conservative surgery with surgery alone or surgery plus placebo in the treatment of symptomatic endometriosis. Outcome data had been analysed by using a Mantel-Haenzel Fixed-effect model to perform meta-analysis and results had been pre- sented as Risk ratio for binary data and Standardised Mean difference for continuous data with 95% confidence intervals. Results: Out of 8 trails pelvic pain was reported in 7 trials. No significant benefit was observed both in pelvic pain recurrence (RR= 0.75, 95% Cl- 0.54 to1.04) and disease recurrence (RR 0.89, 95% Cl 0.53 to 1.49) among 5 trials (481& 447 participants) in favour of surgery and adjunctive hormone therapy. On the other hand another 2 trials (280 participants) showed sig- nificant benefit in pelvic pain score (Std. Mean difference-0.80, 95%Cl -1.05 to -0.55) but con- siderable heterogeneity (I²= 96%) was observed. Conclusion: Women who received Post-surgical hormone therapy in the treatment of sympto- matic endometriosis had no advantages in respect of endometriosis and pelvic pain recurrence in compared with surgery alone.
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With the development of assisted reproductive technology , it brings the gospel to many infertility families , and it makes a new challenge to the moral and legal at the same time .Ministry of Health issued the notice on carrying out the special action to manage assisted reproductive technology .By thinking about the ethical and le-gal issues, this paper tried to explore a new response mode to advance the development of assisted reproductive technology and to ensure social harmony and stability .
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Introdução: Em Reprodução Assistida toda a equipe compartilha com o casal o árduo caminho composto pelas fases do tratamento, porém, o presente estudo deteve-se a experiência do médico. Objetivos: Investigar o Imaginário Coletivo de médicos que atuam em Reprodução Assistida sobre as situações de difícil manejo em sua prática profissional. Métodos: Foram feitas entrevistas únicas individuais, utilizando o Procedimento de Desenho-Estória com Tema como instrumento dialógico. A partir das entrevistas foi criada uma narrativa transferencial ficcional preservando elementos essenciais da dramática humana estudada. Os registros foram interpretados à luz do método psicanalítico buscando a criação/encontro de campos de sentido afetivo-emocional. Resultados: Foram encontrados os seguintes campos: "Não deu certo!?", que organiza-se ao redor da ideia de que não alcançar o objetivo pretendido seria o equivalente a fracassar, mesmo diante de situações incertas; "Engole o choro!", que organiza-se mediante a crença de que é preciso conter os sentimentos diante de determinadas situações, não deixar-se emocionar; "Fora do comum", que organiza-se por meio da crença de que quem está em posição de cuidador é e/ou precisa ser excepcional. Conclusões: Para a formação e à prática médica é preciso incluir, além da visão científica-tecnológica, a abordagem da subjetividade. É necessária a criação de enquadres diferenciados que auxiliem o médico a aproximar-se emocionalmente de seu trabalho, facilitem a superação de dissociações, promovam a saúde mental, contribuindo para que o exercício da profissão seja gratificante e dotado de um sentido genuíno...
In Assisted Reproduction the whole team shares with the couple the hard journey through the phases of the treatment, however, this study is about the doctor's experience. Objectives: To investigate the Collective Imaginary of doctors working in Assisted Reproduction on some difficult situations in their professional practice. Methods: Individual interviews were conducted using the Thematic Story-Drawing Procedure as dialogical instrument. From the interviews a fictional narrative transference were created preserving essential elements of the human drama studied. The records were interpreted in light of the psychoanalytic method seeking the creation / gathering of affective-emotional sense fields. Results: The following fields were found: "It did not work!?", which is organized around the idea that not reaching the target would be equivalent to failing, even due to uncertain situations; "Swallow your crying!", Which is organized by the belief that one must contain the feelings before certain situations, not allowing themselves to get emotional; "Out of the ordinary", which is organized by the belief that who is in the position caregiver is and / or needs to be exceptional. Conclusions: For the training and medical practice is necessary to include, beyond the scientific-technological view, the approach of subjectivity. It is necessary to create different framings that help the doctor to approach their work emotionally, facilitate the overcoming of dissociations, promote mental health, this way contributing to the exercise of the profession so it can be rewarding and endowed with a genuine sense...