Representações sociais sobre maternidade na reprodução humana assistida: discursos de mulheres inférteis / Social representations of motherhood in assisted human reproduction: discourses of infertile women / Representaciones sociales de la maternidad en la reproducción humana asistida: relatos de mujeres infértiles

Este trabalho tem o objetivo de analisar as concepções de maternidade para mulheres inférteis de diferentes níveis socioeconômicos que estão em tratamento de reprodução assistida. Trata-se de um estudo qualitativo, descritivo, que utilizou como instrumento uma entrevista semiestruturada e contemplou temas como o significado de família, desejo/expectativas sobre filho e gestação e expectativas sobre a maternidade. Participaram da pesquisa 48 mulheres inférteis acima de 35 anos que usam tecnologias de reprodução assistida de alta complexidade em instituições privada e pública. Os dados foram tratados pela análise de conteúdo em que emergiram os temas: representações sociais da família; representações sociais da maternidade; expectativas com a gestação e os modelos maternos; e o filho imaginado. As participantes representaram a família de forma positiva, como um sistema de suporte, de fundação e origem de amor, configurando-a como um laço social. Por outro lado, as concepções de família com base na consanguinidade também estiveram presentes, representando a família pela perpetuação da espécie e pela importância do laço biológico. A maternidade foi marcada por significativa idealização, sendo vista como um papel gratificante e de realização da feminilidade. O peso da cobrança social para procriar também foi sentido como um dever a cumprir e que, na impossibilidade de se realizar, gera sentimentos de inferioridade, menos-valia, impotência e inadequação perante a sociedade, o que reforça o estigma da infertilidade. Tais resultados apontam a importância de reflexões sobre o papel da mulher na nossa cultura, visto que a maternidade é ainda utilizada como medida para o sucesso ou fracasso feminino. Faz-se necessário também refletir sobre a possibilidade da maior inserção do trabalho psicológico na reprodução assistida, visto a carga emocional e social envolvidas nesse processo.(AU)

This study aimed to analyze the conceptions of motherhood for infertile women from different socioeconomic levels who are undergoing assisted reproduction treatment. This is a qualitative and descriptive study that used a semi-structured interview as an instrument and included topics such as the meaning of family and desires/expectations about the child, pregnancy, and motherhood. A total of 48 infertile women over 35 years of ages using high-complexity assisted reproductive technologies in private and public institutions participated in this research. The data were treated by content analysis in which the following themes emerged: family social representations; social representations of motherhood; expectations with pregnancy and maternal models; and the imagined son. Participants represented the family in a positive way as a support system and the foundation and origin of love, embracing the family as a social bond. On the other hand, the family concepts based on inbreeding were also present, representing the family by perpetuation of the species and the importance of biological bonds. Motherhood was marked by significant idealization, being seen as a gratifying role and the fulfillment of femininity. The weight of the social demand to procreate was also felt as a duty to be fulfilled that, in the impossibility of carrying it out, generates feelings of inferiority, worthlessness, impotence, and inadequacy toward society, which reinforce the stigma of infertility. Results point to the necessary reflections on the role of women and our culture since Motherhood is still used as a measure of female success or failure. They also point to a reflection on the possibility of greater inclusion of psychological work in assisted reproduction given the emotional and social burden involved in this process.(AU)

Este estudio tuvo como objetivo analizar las concepciones de maternidad de mujeres infértiles, de diferentes niveles socioeconómicos, que se encuentran en tratamiento de reproducción asistida. Se trata de un estudio cualitativo, descriptivo, que utilizó como instrumento una entrevista semiestructurada e incluyó temas como el sentido de la familia, deseos/expectativas sobre el hijo y el embarazo y expectativas sobre la maternidad. Participaron en la investigación un total de 48 mujeres infértiles, mayores de 35 años, usuarias de tecnologías de reproducción asistida de alta complejidad en instituciones públicas y privadas. Los datos se sometieron a análisis de contenido del cual surgieron los temas: representaciones sociales familiares; representaciones sociales de la maternidad; expectativas con el embarazo y modelos maternos; hijo imaginado. Las participantes representaron a la familia de manera positiva, como sistema de apoyo, fundamento y origen del amor, configurándola como vínculo social. Por otro lado, también estuvieron presentes las concepciones familiares basadas en la consanguinidad, representando a la familia para la perpetuación de la especie y la importancia del vínculo biológico. La maternidad estuvo marcada por una importante idealización, vista como un rol gratificante y de realización de la feminidad. También se sintió el peso de la demanda social de procrear como un deber que cumplir y que, ante la imposibilidad de realizarlo, genera sentimientos de inferioridad, desvalorización, impotencia e inadecuación en la sociedad, lo que refuerza el estigma de la infertilidad. Por tanto, son necesarias reflexiones sobre el papel de la mujer en nuestra cultura, ya que la maternidad se sigue utilizando como medida del éxito o fracaso femenino. También se reflexiona sobre la posibilidad de una mayor inclusión del trabajo psicológico en la reproducción asistida dada la carga emocional y social que implica este proceso.(AU)

La responsabilidad subjetiva en los derroteros del deseo de hijo / Subjective Responsibility in the Paths of the Desire for a Child

El presente escrito aborda la cuestión del proyecto monomarental, sus derroteros y periplos singulares. Al tiempo que en ellos se vislumbra un camino muchas veces compartido y repetido. La temática reviste una presencia estadística en aumento a nivel mundial que visibiliza cambios sociales, económicos y de derechos en la agenda femenina. El objetivo central del escrito radica en describir en primera persona las circunstancias que llevaron a Helen a recurrir a la ovodonación como método reproductivo y los duelos que dicho recorrido encierra. En síntesis, en la historia de Helen se vislumbra de modo paradigmático el encuentro con la imposibilidad del propio cuerpo reproductivo y la solución que ofrece la medicina; al tiempo que en otra cuerda, se trasluce la dimensión singular y clínica de las decisiones subjetivas por las que ella deberá responder

This paper addresses the question of the singleparent project, its paths and unique journeys. At the same time that in them a path many times shared and repeated is glimpsed. The issue has a growing statistical presence worldwide that makes visible social, economic and rights changes on the women's agenda. The central objective of the writing lies in describing in the first person the circumstances that led Helen to resort to egg donation as a reproductive method and the duels that this journey entails. In short, in Helen's story, the encounter with the impossibility of the reproductive body itself and the solution offered by medicine is glimpsed in a paradigmatic way; while on another string, the singular and clinical dimension of the subjective decisions for which she will have to answer shines through

La técnica de transferencia de huso meiótico desde la perspectiva legal en la República Argentina / THE MEIOTIC SPINDLE TRANSFER TECHNIQUE FROM THE LEGAL PERSPECTIVE IN THE ARGENTINE REPUBLIC

La transferencia de huso permite evitar enfermedades de herencia mitocondria. El art. 57 del Código Civil y Comercial, que utiliza una redacción amplia para no quedar obsoleto, apuntaría la prohibición a la manipulación de embriones en busca de mejoras determinadas, pero no a aquellas prácticas que tienen un fin terapéutico. Sin embargo, hay que repensar los límites de la prohibición y la razonabilidad de este tratamiento.

Spindle transfer makes it possible to avoid diseases of mitochondrial inheritance. The art. 57 of the Civil and Commercial Code, which uses a broad wording so as not to become obsolete, would point the prohibition to the manipulation of embryos in search of certain improvements, but not to those practices that have a therapeutic purpose. However, it is necessary to rethink the limits of the prohibition and the reasonableness of this treatment.

Anémie chez les donneurs de sang volontaires après vérification de l'hémoglobine pré-don au Centre de Transfusion Sanguine de Libreville / Anemia in voluntary blood donors after verification of pre-donation hemoglobin at the Libreville Blood Transfusion Center

Introduction : La nécessité de disposer de produits sanguins labiles (PSL) de qualité est un impératif de la transfusion sanguine. Le don de sang n'est pas sans risque pour le donneur. Ce qui soulève la question de la perte de fer par spoliation sanguine. Ce constat a conduit à la réalisation de cette étude dans le but de rechercher l'anémie chez le donneur de sang volontaire jugé apte après évaluation de l'hémoglobine pré-don et d'en déterminer la cause. Patients et méthodes : Il s'agissait d'une étude transversale prospective réalisée au Centre National de Transfusion Sanguine (CNTS) de Libreville. La population d'étude était constituée de donneurs de sang, nouveaux ou anciens, volontaires en bonne santé chez qui les examens suivant ont été réalisés pour le diagnostic de l'anémie et celui de la carence en fer tout en excluant d'autre étiologies: l'hémogramme, le dosage de la Protéine C Réactive (CRP), le fer sérique, la ferritine, l'hepcidine et le test de diagnostic du paludisme (TDR).Résultats : Sur l'ensemble des deux cent quinze volontaires inclus, trente - quatre (15,8%) présentaient une anémie parmi lesquels douze femmes et vingt- deux hommes d'un âge moyen de 32,8 ±8,0. Le nombre de dons effectués était corrélé à la survenue de l'anémie selon le genre et l'âge du donneur. Il en a été de même pour les valeurs de la ferritine, du fer sérique.Conclusion : Le nombre important d'anémie est lié à un seuil bas de l'hémoglobine pré-don. Le caractère microcytaire hypochrome de l'anémie laisse supposer une origine ferriprive.

Introduction: The need to have quality labile blood products (LBP) is an imperative of blood transfusion. Blood donation is not without risk for the donor. This raises the question of the loss of iron by blood spoliation. This finding led to the realization of this study with the aim of looking for anemia in voluntary blood donors deemed suitable after evaluation of the pre-donation hemoglobin and to determine the cause.Patients and methods: This was a prospective cross-sectional study carried out at the National Blood Transfusion Center (CNTS) in Libreville. The study population consisted of blood donors, new or old, healthy volunteers in whom the following examinations were carried out for the diagnosis of anemia and that of iron deficiency while excluding other etiologies: blood count, C-Reactive Protein (CRP), serum iron, ferritin, hepcidin and malaria diagnostic test (RDT). Results: Of the two hundred and fifteen volunteers included, thirty-four (15.8%) presented anemia, including twelve women and twenty-two men with an average age of 32.8 ±8.0. The number of donations made was correlated with the occurrence of anemia according to the sex and age of the donor. It was the same for the values of ferritin, serum iron. Conclusion: The large number of anemia is linked to a low threshold of pre-donation hemoglobin. The hypochromic microcytic character of the anemia suggests an iron deficiency origin.

Comunicación de orígenes en familias formadas por donación de gametos: del anonimato a la apertura como posibilidad / Comunicating origins in families formed by gamete donation: from anonymity to openness as a possibility

La reproducción asistida con donación ha venido a interrogar y a ampliar la noción de parentesco. La hegemonía del modelo biogenético dificulta que los padres de estas familias incorporen con tranquilidad la donación en su gestación. Desde los inicios de la técnica los padres han optado por no contar a su decendencia la historia de su concepción, muchas veces por miedo a que se deslegitimara su relación filial. Con el tiempo, se ha observado una apertura hacia la comunicación. Este cambio va de la mano con el desarrollo de la investigación en el área, que comenzó preguntándose por el bienestar psicológico de los nacidos por donación, por los aspectos relacionales de las familias concebidas de este modo e interrogando los beneficios de la comunicación de orígenes. Luego, investigando las percepciones en relación con su origen de las personas nacidas por donación. Finalmente, se ha publicado acerca la imposibilidad del anonimato en la era de los exámenes genéticos directos al consumidor. El modo de entender la reproducción con donante ha evolucionado, de un modelo médico en el que el foco es el lograr un embarazo saludable, a un modelo de formación de familia, en el que la motivación es contribuir a formar familias de buen funcionamiento. Esto tiene implicancias en la consejería a quienes participan del proceso, y también en los lineamientos que las sociedades científicas y comités de ética sugieren a los programas de reproducción con donante.

Gamete donation has come to question and broaden the notion of kinship. The hegemony of an biogenetic model has been an obstacle for parents of these families to incorporate donation into their history. From the beginning of the technique the parents chose not to tell their descent the history of their conception, often for fear that their filial relationship would be delegitimized. Over time, an openness to disclosure has been observed. This change goes hand in hand with the development of research in the area, which began by asking about the psychological well-being of those born by donation. Then investigating the relational aspects of families conceived in this way and questioning the benefits of disclosure. Subsequently, it was possible to study the perceptions regarding their origin of people born by donation. Finally, the impossibility of anonymity in the era of direct consumer genetic testing has been published. The way of understanding donor reproduction has evolved, from a medical model in focus is to achieve a healthy pregnancy, a family formation model, in which the motivation is to contribute to forming well-functioning families. This has implications in counseling to those who participate in the process, and in the guidelines that scientific societies and ethics committees affect donor reproduction programs.

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.

Male Inflammatory Parameters Are not Useful to Predict the Outcomes of Intracytoplasmic Sperm Injection: Results from a Cross-Sectional Study

PURPOSE: The relationship between male systemic inflammation and fertility seems intriguing, but no data about its impact on the assisted reproductive technology outcomes has been reported. Here, we aimed to evaluate the prognostic role of male systemic inflammatory parameters in intracytoplasmic sperm injection (ICSI) outcomes prediction, in couples undergoing an ovum donation program. MATERIALS AND METHODS: From January 2016 to December 2017, one hundred-ten couples were considered for this cross-sectional study. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-eosinophil ratio (MER), platelet-to-lymphocyte ratio (PLR), seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate (PR) were evaluated. Male patients were divided into Group A with FR ≤70%, Group B with FR >70%. RESULTS: Overall, FR was 74.5%, CR 90.9%, PR 41.8%. Group A included 43 patients, Group B 67 men. Group A showed a median NLR of 1.55, PLR of 106.09, MER of 2.33. Group B reported a median NLR of 1.64, PLR 109.0, MER 2.76. We found no statistically differences between two groups with respect to NLR, PLR, MER (p=0.90, p=0.70, p=0.96, respectively). The age-adjusted linear regression analysis demonstrated only a relationship between NLR and sperm motility count (r=−0.02; p<0.05). Using the univariate logistic regression analysis, we found no significant associations. CONCLUSIONS: We did not find any relationship between ICSI outcomes and male inflammation parameters.

Doação de gametas: questões sociais e éticas (não) respondidas em Portugal / Gamete donation: (un)answered social and ethical issues in Portugal / Donación de gametos: cuestiones sociales y éticas (no) respondidas en Portugal

Resumo: Conhecer a discussão em torno dos desafios sociais e éticos da doação de gametas é fundamental para a boa governança das técnicas de reprodução assistida. Neste artigo, analisam-se os tópicos que orientaram o debate nas organizações de ética portuguesas, discutindo as suas conexões com os temas abordados internacionalmente. Para tal, em março de 2018, pesquisamos sistematicamente os websites do Conselho Nacional de Procriação Medicamente Assistida e do Conselho Nacional de Ética para as Ciências da Vida. Procedemos à análise de conteúdo temática de 25 documentos. Os resultados indicam que o debate se centrou na acessibilidade, no anonimato e na compensação de doadores e, em menor extensão, nas responsabilidades profissionais. Observaram-se posicionamentos heterogêneos e tensões entre múltiplos direitos e princípios éticos associados a receptores, a pessoas nascidas com recurso à doação de gametas e a doadores. Esses têm em comum três alegações: a escassez de evidência científica; as experiências de outros países; e regulamentações oriundas de entidades internacionais. Na literatura abordam-se tópicos adicionais, nomeadamente: uma via dupla que conjugue anonimato/identificação de doadores; implementação de sistemas de registo reprodutivo para receptores e doadores; limites do rastreio genético a doadores; doação por familiares/conhecidos; e o papel dos doadores na decisão quanto ao destino de embriões criopreservados e na escolha das características dos receptores dos seus gametas. Há espaço para expandir o debate e promover a pesquisa em torno das implicações sociais e éticas da doação de gametas, considerando a participação de todos os cidadãos.

Abstract: Awareness of the discussion surrounding the social and ethical challenges regarding gamete donation is crucial for good governance of assisted reproduction techniques. In this article, we analyze the topics that guided the debate in the Portuguese ethics organizations, discussing their connections with themes addressed internationally. To that end, in March 2018, we systematically searched the websites of the National Council of Medically Assisted Procreation and of the National Ethics Council for Life Sciences. We carried out a thematic content analysis of 25 documents. Results indicate that the debate was focused on accessibility, anonymity and donors' compensation and, to a lesser extent, on professional responsibilities. We observed heterogeneous positions and tensions between multiple rights and ethical principles associated with recipients, donor-conceived individuals and donors. These invoke three similar arguments: the scarcity of scientific evidence; experiences from other countries; and regulations from in international entities. Literature addressed additional topics, namely: a double track that combines donor anonymity/identification; the implementation of reproduction registries for recipients and donors; limits to the genetic screening of donors; donations by family members/acquaintances; and donors' role in decisions regarding the fate of cryopreserved embryos and in choosing the characteristics of recipients of their gametes. There is room to expand the debate and to promote research on the social and ethical implications of gamete donation, considering the participation of all citizens.

Resumen: Conocer la discusión en torno a los desafíos sociales y éticos de la donación de gametos es fundamental para el buen gobierno de las técnicas de reproducción asistida. En este artículo se analizan los temas que orientaron el debate en las organizaciones de ética portuguesas, discutiendo sus conexiones con los temas abordados internacionalmente. Para este fin, en marzo de 2018, investigamos sistemáticamente las páginas webs del Conselho Nacional de Procriação Medicamente Assistida y del Conselho Nacional de Ética para as Ciências da Vida. Asimismo, procedimos al análisis de contenido temático de 25 documentos. Los resultados indican que el debate se centró en la accesibilidad, anonimato y compensación de donadores y, en menor extensión, en las responsabilidades profesionales. Se observaron posicionamientos heterogéneos y tensiones entre múltiples derechos y principios éticos, asociados a receptores, a personas nacidas gracias a la donación de gametos y a donadores. Estos tienen en común tres alegaciones: la escasez de evidencias científicas; las experiencias de otros países; y las regulaciones procedentes de entidades internacionales. En el literatura se abordan temas adicionales, en particular: una vía doble que conjugue anonimato/identificación de donadores; implementación de sistemas de registro reproductivo para receptores y donadores; límites del rastreo genético a donadores; donación por familiares/conocidos; y el papel de los donadores en la decisión respecto al destino de embriones criopreservados y en la elección de las características de los receptores de sus gametos. Existe espacio para abrir más el debate y promover la investigación en torno de las implicaciones sociales y éticas de la donación de gametos, considerando la participación de todos los ciudadanos.

Shared oocyte donation: ideas and expectations in a bioethical context based on a qualitative survey of brazilian women / Doação compartilhada de oócitos: ideias e expectativas em um contexto bioético com base em um levantamento qualitativo de mulheres brasileiras

Abstract Objective Assisted reproduction combines innovative technologies and new forms of procreation through gamete donation; however, it also leads to moral and ethical issues and to the wide application of referential bioethics. The objective of the present study was to understand the bioethical context of shared oocyte donation. Methods The present qualitative study used the Collective Subject Discourse methodology to interview donors and recipients in Brazil. Results Donors suffer from infertility, and in vitro fertilization opens the possibility of having a child; however, the cost is high, and helping the recipient is more important than the financial cost. The recipients regret delaying motherhood; adopting a child is their last option, and they desire to feel the physical stages of pregnancy. The recipients find the rules unfair regarding the lack of an oocyte bank and the fact that the treatment must be performed in shared cycles; however, oocyte donation makes it possible to realize the common dream of motherhood. Conclusion The obtained data showed that the patients are suffering and frustrated due to infertility, and they realize that in vitro fertilization may be the treatment they need. These women believe that children are essential in the constitution of the family, and scientific advances bring about innovative technologies and new forms of family constitution, with repercussions in the social, economic, political, and family contexts that lead to bioethical questions in Postmodernity.

Resumo Objetivo A reprodução assistida agrega tecnologias inovadoras e novas formas de procriação pormeio da doação de gametas; no entanto, também leva a questões éticas e morais e à ampla aplicação da bioética referencial. O objetivo deste estudo foi compreender o contexto bioético da doação compartilhada de oócitos. Métodos Este estudo qualitativo utilizou a metodologia do Discurso do Sujeito Coletivo para entrevistar doadoras e receptoras no Brasil. Resultados As doadoras sofrem de infertilidade, e a fertilização in vitro abre a possibilidade de ter um filho; no entanto, o custo é alto, e ajudar a receptora é mais importante do que o custo financeiro. As receptoras se arrependem de retardar a maternidade; adotar uma criança é sua última opção, e elas desejam sentir os estágios físicos da gravidez. As receptoras consideramas regras injustas emrelação à falta de um banco de oócitos e ao fato de que o tratamento deve ocorrer emciclos compartilhados; no entanto, a doação de oócitos possibilita a realização do sonho comum da maternidade. Conclusão Os dados obtidosmostraram que as pacientes estão sofrendo e frustradas devido à infertilidade, e percebem que a fertilização in vitro pode ser o tratamento de que necessitam. Essas mulheres acreditam que as crianças são essenciais na constituição da família, e os avanços científicos agregam tecnologias inovadoras e novas formas de constituição familiar com repercussões nos contextos sociais, econômicos, políticos e familiares que levam a questões bioéticas na Pós-modernidade.

Ovodonación y revelación del origen: representaciones sobre la importancia de comunicar el modo de concepción en psicólogos, médicos y legos / Egg donation and disclosure: social representations of the general public, psychologists and medical doctors concerning the importance of informing the mode of conception

¿Por qué cambia la disposición de los sujetos respecto de comunicar que han recurrido a un tratamiento de ovodonación luego de haber realizado dicho procedimiento? El presente trabajo forma parte de una investigación en curso del Proyecto UBACyT "(Bio)Ética y Derechos Humanos: cuestiones clínico-analíticas" donde se ha propuesto indagar las actitudes y representaciones de los sujetos en general (legos) y de los profesionales de la Salud en particular (psicólogos y médicos), acerca de la importancia de comunicar dicha información. En esta ocasión, se presenta un abordaje descriptivo longitudinal donde se consideran los argumentos y justificaciones que ofrecen los distintos agentes para examinar cuáles son los motivos que priman al momento de sostener la revelación o el ocultamiento del dato. Se considera que dicha circunstancia compromete una situación novedosa, que excede el campo de significaciones disponibles y supone acceder a una dimensión singular mediante un abordaje ético-clínico que contemple la complejidad situacional.

Why do oocyte donation users who were in favor of disclosure change their attitude once they have been through a successful treatment? This study, carried out within the UBACyT "(Bio)Ethics and Human Rights: clinical and analytical issues" research project, aims at examining the attitudes and representations of the general public and health practitioners (psychologists and medical doctors) concerning the importance of the disclosure of such information. The current descriptive longitudinal study analyzes the arguments put forward by the three groups when asked whether this information should be disclosed or remain a secret. We posit that the scenario we present to the subjects cannot be examined solely by drawing on the significations and representations linked to the matter that are already available in the social discourse. Rather, this task begs for an ethical and clinical approach that takes into account the complexity that stems from the situation and the singularity involved in each case.

What do Infertile Women Think about Oocyte Reception, Oocyte Donation, and Child Adoption? / O que as mulheres inférteis pensam em relação a ovo recepção, doação de oócitos e adoção de crianças?

Abstract Purpose The views of infertile couples regarding oocyte donation by third parties and adoption are unknown, as these may be interpreted as a final closure of the available options for conception. This study aimed to determine the acceptance of oocyte donation, oocyte reception, and child adoption of infertile women who submitted to assisted reproductive technology (ART) treatment Methods Sixty-nine women who were under treatment for infertility and submitted to ART procedures were included in this cross-sectional study. They were evaluated using semi-structured questionnaires administered during ovulation induction in a treatment cycle. Marital status, religion, years of schooling, occupation, type of infertility, age, duration of infertility, number of previous ART cycles, mean oocyte number per cycle, and mean number of embryos per cycle had no influence on a woman's acceptance of oocyte donation or oocyte reception. Results More than 90% of the patients thought that the subject of "adoption" should be brought up during their ART treatments, although they preferred to discuss this topic with psychologists, not doctors. Women with occupations were more willing to consider adoption. Conclusion The opinions of these patients on these issues seem to be based on personal concepts and ethical, religious, and moral values. Women preferred to discuss adoption with psychologists rather than doctors.

Resumo Objetivo Não se sabe ao certo o que os casais inférteis acham sobre doação de óvulos por terceiros e adoção, condições estas que podem ser interpretadas como um encerramento definitivo das opções disponíveis para concepção. Este estudo teve como objetivo determinar a aceitação da doação de oócitos, ovo recepção e adoção de crianças por mulheres inférteis submetidas a tratamento de reprodução assistida (RA). Métodos Sessenta e nove mulheres em tratamento para infertilidade e submetidas a procedimentos de RA foram incluídas neste estudo transversal. Elas foram avaliadas por meio de questionários semiestruturados administrados durante a indução da ovulação em um ciclo de tratamento. Resultados O estado civil, religião, escolaridade, ocupação, tipo de infertilidade, idade, duração da infertilidade, número de ciclos de RA anteriores, o número médio de oócitos por ciclo e de embriões por ciclo médio não tiveram influência sobre a aceitação da doação ou da recepção de oócitos. Mais de 90% das mulheres acha que o tema "adoção" deve ser discutido durante o tratamento de RA, porém preferem discutir este tema com psicólogos, e não com médicos. As mulheres com ocupações foram mais predispostas a considerar a adoção. Conclusão As opiniões destas pacientes sobre estas questões parecem ser baseadas em conceitos pessoais e valores éticos, religiosos e morais. As mulheres preferiam discutir a adopção com psicólogos, em vez de médicos.

Ovodonación y subjetividad: aportes clínicos a partir de un estudio teórico empírico / Egg donation and subjectivity: clinical contributions from a theoretical empirical study

Es deseable comunicarle a un niño concebido por ovodonación el procedimiento utilizado para su gestación? ¿Tiene el nacido por esta técnica derecho a conocer a quien ha aportado los gametos? ¿Qué efectos puede tener el modo de revelación de esta información en la estructuración psíquica del niño y en el contexto familiar y social? El nuevo Código Civil y Comercial de la Nación Argentina de entrada a estas cuestiones respecto de la paternidad y la maternidad, en los casos de TRHA con técnicas heterólogas. Este artículo propone una aproximación teórico-empírica al problema. En una primera instancia se analizan las respuestas de usuarios de la técnica de ovodonación, aportadas por una investigación realizada en un centro de reproducción humana asistida. En segundo lugar, se contrastan estos datos con las respuestas de profesionales y legos en materia de temas médicos y/o psicológicos, a quienes se les plantea la situación hipotética de transmitir la información al nacido. Finalmente, se extraen conclusiones, a partir de sistematizar cuatro variantes centrales: derecho a la identidad, edad del niño, fantasías inconscientes, relatos ficcionales. Se busca así suplementar la categoría jurídica de la "voluntad procreacional" a la luz de los aportes del campo de la subjetividad, contribuyendo a su mayor conocimiento y aplicación.

Is it advisable to communicate to a child, conceived by egg donation, the procedure used for its gestation? Does the child born by this technique have the right to know who has provided the gametes? What effects may the information disclosure have on the psychic structuring of the child, the family and the social context? The new Civil and Commercial Code of the Argentine Nation introduced these questions regarding paternity and maternity in cases of Human Reproductive Technology with heterologous techniques. This article proposes a theoretical-empirical approach to the problem. In the first place, the responses of the egg donation technique users, which were obtained through a research who was carried out in an Assisted Human Reproductive Technology Center, are analyzed. Secondly, these data are contrasted with the responses of professionals and laymen in matters of medic and/or psychological issues, to whom the hypothetical situation of communicating the information to the child is raised. Finally, conclusions are drawn systematized by four variants: right to identity, child's age, unconscious fantasies and fictional stories. It seeks to supplement the legal category of "procreational will" from the contributions of the subjectivity field, to promote its greater knowledge and practice.

Ethical issues of oocyte donation / 中华医学遗传学杂志

The birth and development of oocyte donation technology have brought hope for women with poor ovarian reserve and repeated failure for in vitro fertilization, as well as for those with chromosomal abnormalities, premature ovarian failure, or at perimenopausal or menopausal stages. It has not only preserved their reproductive right, but also stabilized their families and increased social harmony. However, this technology does not only involve infertile couples themselves, but also social and ethical issues concerning their families and the society. This paper has reviewed and discussed the hot issues concerning oocyte donation, e.g., source of eggs, compensation for donors, prerequisites for recipients and donors, privacy of donors, and made suggestions for further improvement for the administration of oocyte donation.

Cuerpos abstractos, riesgos concretos: dispositivos clínicos y la salud de las donantes de óvulos en la medicina reproductiva argentina / Abstract bodies, concrete risks: clinical devices and the health of ova donors in Argentine reproductive medicine

RESUMEN Desde una perspectiva metodológica inspirada por los estudios en ciencia y tecnología, este trabajo analiza dos dispositivos clínicos (estándares bioestadísticos y registros de donación) que se utilizan en la medicina reproductiva argentina con el objetivo de controlar el denominado "riesgo genético" que se originan en el uso de óvulos donados, así como los riesgos para la salud de las mujeres donantes. Al examinar cómo la implementación de criterios de control desatiende la especificidad de la donación de óvulos, el artículo propone que no es la ausencia de criterios y controles clínicos en fertilidad lo que produce el inadecuado control de esos riesgos, sino que es la forma concreta en la cual se implementan tales controles lo que resulta en un potencial perjuicio para la salud de las mujeres donantes.

ABSTRACT Using a methodological perspective grounded in science and technology studies, this article analyzes two sociotechnical devices used in Argentine reproductive medicine (biostatistical measures and donation registries) with the aim of controlling both the so-called "genetic risk" arising from the use of donated ova as well as the health risks to female donors. By examining how the deployment of monitoring criteria disregards the specificity of ova donation, the article suggests that it is not the absence of control measures and clinical criteria that produces an inadequate monitoring of such risks, but rather the concrete ways in which such measures are implemented that results in potential harms to the health of female donors.

Hospitalizations of children due to primary health care sensitive conditions in Pernambuco State, Northeast Brazil / Internações hospitalares de crianças por condições sensíveis à atenção primária à saúde em Pernambuco, Nordeste do Brasil / Hospitalizaciones de niños por condiciones sensibles a la atención primaria de salud en el Estado de Pernambuco, Nordeste de Brasil

Admissions due to primary health care sensitive conditions from 1999 to 2009 among children < 5 years old were analyzed for municipalities in Pernambuco State, Brazil. Using data from the Brazilian Unified National Health System's Hospital Information System, a negative binomial regression was applied to estimate rate ratio (RR) and 95%CI for the effect on primary health care sensitive condition rates (admissions/10,000 inhabitants) of the Family Health Program (FHP) coverage (%), some demographic variables and living conditions. Hospitalizations due to primary health care sensitive conditions represented 44.1% of 861,628 admissions and the rate declined from 557.6 to 318.9 (-42.8%), a reduction three times greater than the rate due to all other causes. Increased FHP coverage was protective against primary health care sensitive conditions (RR = 0.94; 95%CI: 0.89-0.99). A decline in hospitalizations due to primary health care sensitive conditions indicated improvements in health status and may be associated with the consolidation of primary health care. Studies on access and quality of primary health care in relation to child morbidity and hospitalizations are needed.

Analisaram-se as internações por condições sensíveis à atenção primária de 1999-2009 em crianças < 5 anos, em municípios de Pernambuco, Brasil. Com dados do SIH/SUS, aplicou-se regressão binomial negativa para estimar razão de taxas e IC95% do efeito sobre a taxa de internações por condições sensíveis à atenção primária (internações/10.000 habitantes) da cobertura (%) do Programa Saúde da Família (PSF), variáveis demográficas e de condições de vida. Do total de 861.628 internações, 44,1% foram por condições sensíveis à atenção primária. A taxa variou de 557,6 para 318,9 (-42,8%), redução 3 vezes maior que da taxa de internação por todas as outras causas. Maior cobertura do PSF teve efeito protetor contra internações por condições sensíveis à atenção primária (razão de taxa = 0,94; IC95%: 0,89-0,99). A diminuição de internações por condições sensíveis indicou melhoria na situação de saúde e pode estar associada à consolidação do PSF. Há necessidade de estudar acesso e qualidade da atenção primária à saúde em relação à morbidade e hospitalizações.

Se analizaron las hospitalizaciones por condiciones sensibles a la atención primaria entre 1999-2009 en niños < 5 años en municipios de Pernambuco, Brasil. Se aplicó una regresión binomial negativa a los datos del Sistema de Información Hospitalaria del SUS para estimar la razón de tasas (RT) y un IC95% de los efectos sobre la tasa de hospitalizaciones por condiciones sensibles (hospitalizaciones/10.000 habitantes) de la cobertura (%) del Programa de Salud de la Familia (PSF), variables demográficas y de condiciones de vida. Del total de 861.628 admisiones, un 44,1% eran hospitalizaciones por condiciones sensibles. La tasa varió de 557,6 a 318,9 (-42,8%), reducción tres veces mayor que la tasa por todas las otras causas. Una mayor cobertura del PSF fue protectora contra hospitalizaciones por condiciones sensibles (RT = 0,94; 95%IC: 0,89-0,99). La disminución de hospitalizaciones por condiciones sensibles indica una mejoría de condiciones de salud y puede estar asociada con el PSF. Se señala la necesidad de estudiar el acceso y la calidad de la atención primaria de salud, en relación con la morbilidad y hospitalizaciones.

A doação compartilhada de óvulos no Brasil sob enfoque do Direito e da Bioética / Egg sharing in Brazil from the legal and bioethical point of view

Este artigo analisa os aspectos jurídicos e bioéticos da prática médica da doação compartilhada de óvulos no contexto da Reprodução Assistida no Brasil. Trata-se de uma prática criada pela classe médica para auxiliar na obtenção de gametas femininos e beneficiar as pacientes que buscam alcançar a gravidez com assistência profissional (AU)

This paper examines the legal and bioethical aspects of medical practice of shared egg donation in the context of Assisted Reproduction in Brazil. This is a practice created by physicians to aid in obtaining female gametes and benefit patients seeking to achieve pregnancy with professional assistance (AU)

O que influencia doação de óvulos quando não há compensação financeira? / What influences oocyte donation when there is no financial compensation?

Aim: To evaluate the influence of factors such as age, education level and previous treatment for infertility in the decision to donate or receive eggs. Methods: Patients visting our service for the first time answered the question: “Would you donate or receive eggs?”. We assessed whether the inclination to donate or receive was related to age, level of education and the previous unsuccessful treatment for infertility.Results: 313 patients were included and most (56.9%) said they would donate eggs while only 34.5% would receive a donation. When giving and receiving were evaluated jointly we observed a positive correlation between them (Pearson correlation: r = 0.537, p < 0.01). Patients that underwent previous treatments for infertility were significantly more prone to egg donation (63.4% yes vs. 36.6% no, p < 0.05 vs no previous treatment group), but not toreceive (41.8% yes vs. 58, 2% no). In high and low levels of education most patients were in favor of donation (55.4% and 61.3%, respectively), but against the idea of receiving (33.9%and 37.5%, respectively). There was no significant differences between groups. The age of the patients (< 35 years old or > 35 years old) did not influence the will do donate (58.2% and56.4% respectively) or receive eggs (36.9% and 33.0%, respectively).Conclusions: Our results help understand the factors that may influence the decision to participate in an egg-sharing scheme. We could speculate that patients who have previously undergone unsuccessful treatments are more open to egg-sharing, despite their age or educational background. It would also be relevant to investigate the psychosocial reasons that make couples more willing to donate eggs than receiving.

Objetivo: Avaliar a influência da idade, grau de escolaridade e tratamento anterior na decisão de doar ou receber óvulos. Pacientes e métodos: Mulheres atendidas em nosso serviço responderam à pergunta: “Vocêdoaria ou receberia óvulos?”. Avaliou-se a concordância de aceitação de ovodoação ou ovorecepção com a idade, o grau de escolaridade e tratamento anterior para infertilidade. Resultados: Foram incluídas 313 pacientes e a maioria (56,9%) respondeu que doaria óvulos enquanto apenas 34,5% receberiam. Houve correlação positiva entre doação e recepção (r = 0,537, p < 0,01). Pacientes submetidas a tratamento anterior de infertilidade se mostraram significativamente mais propensas à doação (63,4% sim vs 36,6% não, p < 0.05 vs sem tratamento anterior), mas não a receber (41,8% sim vs 58,2% não). Em níveis altos e baixos de escolaridade a maioria dos pacientes se mostrou a favor da doação (55,4% e 61,3%, respectivamente), mas contra a ideia de receber (37,5% e 33,9%, respectivamente), não houvediferenças significativas entre os grupos. A maioria das pacientes com menos ou mais de 35 anos de idade doaria (58,2% e 56,4%, respectivamente), mas não receberia (36,9% e 33,0%, respectivamente).Conclusões: Nossos resultados são relevantes para entender os fatores que podem influenciar na decisão de participar em um esquema de partilha de óvulos. Poderíamos especular que pacientes previamente submetidas a tratamentos mal sucedidos são mais aberta à ovodoação, apesar de sua idade ou formação educacional.

Using fertile couples as embryo donors: an ethical dilemma

The use of donated embryos has offered hope for infertile couples who have no other means to have children. In Iran, fertility centers use fertile couples as embryo donors. In this paper, the advantages and disadvantages of this procedure will be discussed. We conclude that embryo-donation should be performed with frozen embryos thus preventing healthy donors from being harmed by fertility drugs. There must be guidelines for choosing the appropriate donor families. In countries where commercial egg donation is acceptable, fertile couples can be procured as embryo donors thus fulfilling the possible shortage of good quality embryos. Using frozen embryos seems to have less ethical, religious and legal problems when compared to the use of fertile embryo donors

Current status of assisted reproductive technology in Korea, 2009

Great advances have been made in the field of assisted reproductive technology (ART) since the first in vitro fertilization (IVF) baby was born in Korea in the year of 1985. However, it deserve to say that the invaluable data from fertility centers may serve as a useful source to find out which factors affect successful IVF outcome and to offer applicable information to infertile patients and fertility clinics. This article intended to report the status of ART in 2009 Korean Society of Obstetrics and Gynecology surveyed. The current survey was performed to assess the status and success rate of ART performed in Korea, between January 1 and December 31, 2009. Reporting forms had been sent out to IVF centers via e-mail, and collected by e-mail as well in 2012. With International Committee Monitoring Assisted Reproductive Technologies recommendation, intracytoplasmic sperm injection (ICSI) and non-ICSI cases have been categorized and also IVF-ET cases involving frozen embryo replacement have been surveyed separately. Seventy-four centers have reported the treatment cycles initiated in the year of 2009, and had performed a total of 27,947 cycles of ART treatments. Among a total of 27,947 treatment cycles, IVF and ICSI cases added up to 22,049 (78.9%), with 45.3% IVF without ICSI and 54.7% IVF with ICSI, respectively. Among the IVF and ICSI patients, patients confirmed to have achieved clinical pregnancy was 28.8% per cycle with oocyte retrieval, and 30.9% per cycle with embryo transfer. The most common number of embryos transferred in 2009 is three embryos (40.4%), followed by 2 embryos (28.4%) and a single embryo transferred (13.6%). Among IVF and ICSI cycles that resulted in multiple live births, twin pregnancy rate was 45.3% and triple pregnancy rate was 1.1%. A total of 191 cases of oocyte donation had been performed to result in 25.0% of live birth rate. Meanwhile, a total of 5,619 cases of frozen embryo replacement had been performed with 33.7% of clinical pregnancy rate per cycle with embryo transfer. When comparing with international registry data, clinical pregnancy rate per transfer from fresh IVF cycles including ICSI (34.1%,) was comparable to clinical pregnancy rate per transfer in European Society for Human Reproduction and Embryology report was 32.5% though lower than 45.0% for USA data. There was no remarkable difference in status of assisted reproductive technology in Korea between the current report and the data reported in 2008. The age of women trying to get pregnant was reconfirmed to be the most important factor that may have impact on success of ART treatment.