Reproducción asistida: Profesionales que ayudan a cumplir un sueño / No disponible

No disponible

Reproducción Asistida: ¿Debemos solo transferir un embrión? / Assisted Reproduction: Should be transferred only one embryo?

OBJETIVO: Comparar resultados obstétricos y perinatales de embarazos únicos espontáneos con los obtenidos por reproducción asistida, tanto únicos como gemelares. MATERIAL Y MÉTODO: Estudio descriptivo observacional retrospectivo. Se analizan un total de 1 096 embarazos de pacientes que acuden a control obstétrico en una clínica privada y se clasifican en tres grupos según el modo de concepción y número de fetos: Grupo 1, embarazo único espontáneo; Grupo 2, embarazo único por técnica de reproducción asistida (TRA) y, Grupo 3, embarazo gemelar por reproducción asistida. Se analizan los resultados obstétricos y perinatales entre los tres grupos. Se considera que hay diferencia estadística con un valor menor a <0.01 utilizando la prueba de chi cuadrado. RESULTADOS: La tasa de diabetes gestacional fue mayor en el grupo de embarazo único por TRA (23,78%) comparada a la de embarazo único espontáneo (6,66%) y gemelar por TRA (0%), presentando diferencia estadísticamente significativa. Hubo mayor presencia de anemia gestacional en el grupo de embarazo único espontáneo (76,66%) que en los grupos de TRA (19,51% y 31,25% para único y gemelar respectivamente) con diferencia estadística. Se presenta diferencia significativamente estadística a favor del grupo de embarazo gemelar por TRA en cuanto a un mayor número de casos de amenaza de parto pretérmino (25 %), una mayor ganancia de peso materno a final del embarazo (12,33 ± 3,2 Kg), un mayor número de nacimientos por cesárea (81,25%), menor edad en semanas de gestación al parto (35,28 ± 3,6), menor peso del recién nacido (2 388,69 ± 378 g) y un mayor número de casos que requieren ingreso a unidad de cuidados intensivos neonatales (18,75%). CONCLUSIONES: El embarazo gemelar tiene un peor pronóstico perinatal que el embarazo único sea espontáneo o por TRA

OBJETIVE: To determine the correlation between the semen parameters (concentration, motility, morphology and vitality) and sperm DNA integrity, using the test Halosperm. Material And METHODS: Prospective study conducted at the Laboratory of Andrology of Assisted Reproduction Laboratory FERTILAB, Lima - Peru, from August 2012 to March 2013. 282 patients were analyzed. We have established the DNA fragmentation index (IFA) from patients with semen sample normozoospermic and patients with semen sample altered in some parameters. We used two types of threshold (18% and 30%) and were correlated with semen parameters. In the total population was determined the Spearman correlation between sperm parameters and the IFA. RESULTS: It was determined that the value of the median the IFA of the patients with semen sample normozoospermic was significantly lower than that patients with semen sample altered in some parameters (12.8% vs 19.0, P=0.000). Using threshold of 18% was determined the there significant difference between the median of the two groups (Group 1: ≤ 18% y Group 2: > 18%) in age (37 years vs 40 years, P = .002), sperm concentration (82.30 X 106/ml vs 58.00 X 106/ml, P = 0.046), progressive motility (45.80% vs 27.40, P = 0.000), normal morphology (12.50% vs 9.00%, P = 0.000) and sperm vitality (89.0% vs 78.0%, P = 0.000). Using the threshold of 30 % was found significant difference between the median of the two groups (Group 1: ≤ 30% y Group 2:> 30%) in age (39 years vs 44 years, P=0.000), sperm concentration ( 78.00 X 106/ml vs. 36.75  X 106/ml, P = 0.015 ), motility progressive (40.85% vs 22.38 %, P=0.000 ), normal morphology (12.0 % vs 6.0 %, P=0.004) and sperm vitality (85.0 % vs 72.5%, P=0.000). Also identified an inverse correlation between the IFA and concentration (r=- 0.219 P=0.000), progressive motility (r=-0.452 P=0.000), normal morphology (r=-0.322 P=0.000) and vitality (r = -0.452 P = 0.000) in the total population. We determined a significant positive correlation between age and the IFA (r=0.267 P = 0.000). CONCLUSIONS: The results indicate that the level of DNA damage in sperm patients with semen sample altered in some parameters is significantly higher than in patients with semen sample normozoospermic. It has been shown that the semen parameters (concentration, motility, morphology and vitality) are highly negatively correlated with sperm DNA fragmentation index. It showed a positive correlation between age and the IFA

Perfil de puérperas submetidas a métodos de reprodução assistida / Profile of postpartum women submitted to assisted reproduction methods / Perfil de puérperas sometidas a métodos de reproducción asistida

Estudo cujo objetivo foi discutir o perfil de mulheres submetidas a métodos de reprodução assistida em hospital privado do Município de São Paulo, em 2009. Pesquisa quantitativa, descritiva, exploratória, transversal, de nível I. A amostra constituiu-se de 38 puérperas no segundo dia de internação, submetidas a método de reprodução assistida. Para a coleta de dados utilizou-se a entrevista estruturada baseada em formulário específico. As mulheres tinham entre 30 e 39 anos (77%), eram casadas (89%) e 68% eram profissionais da área das ciências humanas. Os métodos mais utilizados foram indução da ovulação (47%) e fecundação in vitro clássica (39%). Engravidaram na primeira tentativa 63% e o tempo entre as tentativas de fertilização e o sucesso variou de um mês e meio a dois anos. O grupo estudado corresponde a uma nova geração de mulheres que, independente da idade e da técnica utilizada, tiveram possibilidade de escolher e planejar uma gestação.

The study discussed the profile of women submitted to assisted reproduction methods in a private hospital in São Paulo, Brazil, in 2009. It was a Level I, exploratory, descriptive, quantitative, cross-sectional study. The sample was 38 mothers on the second day of hospitalization who had undergone assisted reproduction. Data collection was performed by structured interview based on a specific script. The women were from 30 to 39 years old (77%), married (89%), and professionals in the human sciences (68%). The methods used were ovulation induction (47%) and classical in vitro fertilization (39%); 63% becoming pregnant on the first try, and the interval between attempted and successful fertilization ranging from a month and a half to two years. The group studied represents a new generation of women who, regardless of age and the technique used, had the opportunity to choose and plan a pregnancy.

Estudio cuyo objetivo fue discutir el perfil de mujeres sometidas a métodos de reproducción asistida en hospital privado de São Paulo-Brasil, en 2009. Se trata de investigación cuantitativa, descriptiva, exploratoria, de corte transversal, de nivel I. La muestra estuvo conformada por 38 madres en el segundo día de hospitalización, sometidas a método de reproducción asistida. Para recopilar los datos se utilizó la entrevista estructurada basada en formulario específico. Las mujeres tenían edades entre 30 y 39 años (77%), eran casadas (89%) y 68% eran profesionales de las ciencias humanas. Los métodos utilizados fueron: inducción de la ovulación (47%) y la clásica fertilización in vitro (39%). 63% quedaran embarazadas en el primer intento y el tiempo entre los intentos y el éxito de la fertilización varió de un mes a dos años y medio. El grupo representa una nueva generación de mujeres que, independientemente de la técnica utilizada, pudieron escoger y planear un embarazo.

The practice gap in the care of women following successful infertility treatments: unasked research questions in midwifery and nursing.

The aim of this paper is to highlight the gap between existing research evidence and nursing and midwifery practices in caring for women following successful in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), and to suggest directions for research within these disciplines. We argue that although the number of couples in the UK experiencing fertility problems has risen, 1.4% of all births in the UK are as the result of infertility treatments (HFEA, 2005/2006); yet there is little research into the experiences of motherhood for women who successfully achieve pregnancy following IVF or GIFT. Consequently, there is negligible research evidence for nurses and midwives practicing in this area, and British healthcare staff appear to be unaware of the specific needs of infertile women during pregnancy, birth and early motherhood. In this paper we review the existing literature on this group of women, which falls into three areas: studies into the psychosocial development of the child conceived via IVF/GIFT/donor insemination; comparative studies into experiences of women following successful infertility treatment and women who conceive naturally; and studies into the experiences of women following successful IVF treatment. We review this literature to argue for research into the needs of infertile women following successful IVF/GIFT, to inform evidence for practice.

Transforming hope: the lived experience of infertile women who terminated treatment after in vitro fertilization failure.

Assisted reproductive treatments provide the hope of pregnancy for infertile women, but do not always turn this hope into reality. The purpose of this study was to explore the lived experience of infertile women who terminated treatment after in vitro fertilization (IVF) failure. Using a qualitative research design, 24 subjects were recruited who had experienced IVF failure and decided to terminate their treatment. Data were collected through interviews, and analyzed using interpretive research strategies of phenomenology. This study protocol was reviewed and approved by the University Review Board for Research. Informed consent was obtained from each subject. The theme of lived experience which emerged from the data was "transforming hope". This theme included three categories: (1) accepting the reality of infertility, (2) acknowledging the limitations of treatment involving high technology, and (3) re-identifying one's future. The results illustrated that counseling for these women should involve the provision of both positive and negative information, evaluation of the response to treatment, and assistance in defining their future.

Prevention of iatrogenic pelvic infection during in vitro fertilization--current practice in the UK.

Uterine instrumentation can provoke pelvic inflammatory disease in women infected with Chlamydia trachomatis. During an IVF treatment cycle, a fine plastic catheter is passed into the endometrial cavity to transfer the embryos. The objective of this survey was to find out what measures are being taken by IVF clinics to prevent ascending infection. Postal questionnaires were sent to 75 clinics in the UK, asking about their sexually transmitted infection screening policies and their protocols on antibiotic prophylaxis. Seventy clinics (93%) responded, of which 37 (53%) neither screen the female partner for C. trachomatis, nor give appropriate antibiotic prophylaxis. Approximately half of UK IVF clinics make no attempt to either detect or treat chlamydial infection prior to embryo transfer. More research is required to evaluate whether embryo transfer does pose a significant risk factor for pelvic inflammatory disease.

"I couldn't think that far": infertile women's decision making about multifetal reduction.

In this phenomenological study women's experiences regarding their decisions to undergo or forgo multifetal reduction of their higher-order multiple pregnancies were explored. Seven women who had conceived higher-order multiple pregnancies as the result of in vitro fertilization were interviewed. Four participants accepted reduction, whereas three participants declined. Three themes were discerned: (a) the presence of infertility as a barrier to contemplating hyperfertility; (b) multiple-birth pregnancy as yet another form of loss for infertile women; and (c) the lasting effects of having made the decision.

Effects of using a nursing crisis intervention program on psychosocial responses and coping strategies of infertile women during in vitro fertilization.

Infertility and its treatment may cause life crises in infertile women. The purpose of this study is to evaluate the effects of a crisis intervention program on improving psychosocial responses and enhancing coping strategies for infertile women attending different stages of an In-Vitro Fertilization V Embryo Transfer (IVF-ET) treatment program. Using an experimental study design, infertile women attending an IVF-ET treatment program were randomly assigned to experimental and control groups. In the experimental group, infertile women completed and answered a questionnaire and received nursing crisis intervention at the initial stage of treatment (day 3). This included (1). viewing a video explaining the therapeutic process of IVF-ET, (2). self-hypnosis and muscle relaxation training, and (3). provision of cognitive-behavioral counseling. The same questionnaire was used again for subjects at the stage of embryo transfer and before taking a pregnancy test. The women in the control group were only interviewed using the same questionnaire and at the same times as the experimental group. Analysis by repeated measurement ANOVA demonstrated that there was a reduction in psychosocial response in terms of interpersonal relationships, and there was an interaction between intervention effects and stage of treatment. However, there was no statistically significant difference in the level of psychosocial responses between the experimental and control groups although some meaningful findings were made. However, in terms of state of anxiety, confrontational problems, and isolated mind/body relaxation, there were significant differences between the two groups of infertile women at some stages of IVF-ET treatment. The women in the experimental group perceived a positive effect of the nursing intervention in relieving their psychosocial responses. The results of this nursing crisis intervention could be helpful in nursing practice when dealing with infertile women attending IVF treatment programs.

Is in-vitro fertilization for older women ethical? A personal perspective.

Fertility treatments raise a range of social and ethical issues regarding self-identity for family, sexual intimacy, and the interests and welfare of potential children. Eggs and sperm are combined to produce fertilized eggs. These eggs are then implanted as embryos and grow into viable fetuses, which are carried by the original mother or a surrogate mother. This artificial form of conception can challenge religious values and family structures. In-vitro fertilization (IVF) can be considered either as a medical miracle or playing with divinity. What obligation do medical professionals have to infertile women and to what extent? The bioethical dilemma of IVF use encompasses different moral issues for all involved in the process. Ethical issues address respect for personal autonomy, access and care, and the duty of the health care provider to be compassionate to persons whose actions and moral values may be different from their own. Health care providers need to impart empathy, understanding and sensitivity towards this unique type of patient population. The conflict for those treating patients who are trying to conceive by IVF includes respect for personal autonomy, nonmaleficence, justice, utility and the ethics of care. As a registered nurse in a postpartum hospital unit, I have seen antepartum and postpartum women involved with this new technology. I have worked with mothers and their partners as they experience different levels of anxiety and hope for the future. There is an underlying psychosocial connection with patients who undergo IVF treatments. The purpose of this article is to explore the ethical use of IVF on older women. Is this type of biotechnolgy being applied for the right reasons and for the best patient population?