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

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

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

New Diagnostic Criteria of Polycystic Ovarian Morphology for Adolescents: Impact on Prevalence and Hormonal Profile.

BACKGROUND: The ultrasonographic criteria used to identify polycystic ovarian morphology (PCOM) during adolescence have changed over time. Recently, a Worldwide Pediatric Consensus (PedC) defined PCOM using stricter criteria than the previous recommendations of the Rotterdam Consensus (RC) and Androgen Excess-Polycystic Ovarian Syndrome Society (AES/PCOS) criteria. The aim of this study was to determine the prevalence of PCOM in healthy adolescents according to the 3 reported diagnostic criteria and compare the hormonal profile in females with and without PCOM based on the PedC criteria. METHODS: Nonobese adolescents (n = 102) with regular menstrual cycles were studied. Transabdominal ultrasound and hormonal profiles were assessed during the follicular phase. PCOM was defined on the basis of the 3 published criteria. RESULTS: On the basis of the PedC, RC, and AES/PCOS criteria, PCOM was diagnosed in 13, 34, and 24% of adolescents, respectively. Adolescents with and without PCOM according to the PedC criteria had similar androgen levels. Serum anti-Müllerian hormone (AMH) levels were elevated in adolescents with PCOM, irrespective of the criteria used. CONCLUSIONS: Use of the new PedC diagnostic criteria for PCOM results in a lower prevalence of this ultrasonographic pattern in adolescents, but this condition is not associated with hyperandrogenism. Elevated AMH is associated with PCOM in adolescents regardless of the criteria used to determine the ultrasonographic pattern.

A dose-finding, cross-over study to evaluate the effect of a Nestorone®/Estradiol transdermal gel delivery on ovulation suppression in normal ovulating women.

OBJECTIVE: This study aims to determine the lowest effective of three Nestorone (NES)/estradiol (E2) transdermal gel doses to ensure ovulation suppression in 90-95% of cycles. METHODS: This was a randomized, open-label, three-treatment-period cross-over study to evaluate the effects of NES/E2 transdermal gel on ovulation inhibition, suppression of follicular growth and pharmacokinetic parameters. The doses were low (1.5 mg NES/0.5 mg E2), medium (3.0 mg NES/1.0 mg E2) and high (4.5 mg NES/1.5 mg E2). Participants applied gel daily to a fixed area on the abdomen for 21 consecutive days. They were interviewed regarding their experiences using the gel. RESULTS: Eighteen participants were randomized; 16 completed the study. Median NES C(max) values for low, medium and high dose groups at day 21 were 318.6 pmol/L, 783.0 pmol/L and 1063.8 pmol/L, respectively. Median maximum follicular diameter was higher with the lowest dose with 16.2 mm versus 10.0 and 10.4 mm with the medium and high doses, respectively. Among adherent participants, ovulation was inhibited in all dose groups, except for one participant in the medium dose (6.7%) that had luteal activity and an ultrasound image suggestive of a luteinized unruptured follicle. There were few reports of unscheduled bleeding, with more episodes reported for the lower dose. Adverse events were mild, and no skin irritation was reported from gel application. CONCLUSION: While all three doses blocked ovulation effectively and were evaluated as safe and acceptable, the medium dose was considered the lowest effective dose based on a more adequate suppression of follicular development. Further development of this novel contraceptive delivering NES and E2 is warranted and has potential for improved safety compared to ethinyl-estradiol-based methods.

Leukocyte adhesion deficiency syndrome: report on the first case in Chile and South America.

CONTEXT: Adhesion molecule deficiency type 1 is a rare disease that should be suspected in any patient whose umbilical cord presents delay in falling off, and who presents recurrent severe infections. Early diagnostic suspicion and early treatment improve the prognosis. CASE REPORT: The case of a four-month-old boy with recurrent hospitalizations because of severe bronchopneumonia and several episodes of acute otitis media with non-purulent drainage of mucus and positive bacterial cultures is presented. His medical history included neonatal sepsis and delayed umbilical cord detachment. Laboratory studies showed marked leukocytosis with predominance of neutrophils and decreased CD11b and CD18. These were all compatible with a diagnosis of leukocyte adhesion deficiency type I [LAD type 1].

Decreased anti-Müllerian hormone concentration in follicular fluid of female smokers undergoing artificial reproductive techniques.

BACKGROUND: Several reports indicate that women who smoke have an increased risk of failure to conceive compared with their non-smoker counterparts. Here, we assessed the effect of smoking during the Assisted Reproduction Therapy (ART) on a potential marker of ovarian reserve, anti-müllerian hormone (AMH) in the follicular fluid (FF). MATERIALS AND METHODS: This was a cohort prospective study to assess the association between cigarette smoking and AMH concentrations in FF in fifty-six women undergoing their first ART cycle. Self-reported smoking status over time was also collected through personal interview. The main outcome measured was the association between current smoking and AMH concentrations in FF. Smoking status was assessed by FF cotinine concentrations. Analysis of covariance was performed to test statistical interaction between the main outcome and confounders. RESULTS: The mean concentration of AMH in follicular fluid was significantly decreased among smokers (1.02±0.14 vs. 1.74±0.15, P<0.05). No statistical interaction was found between this difference in AMH concentrations and confounders like age and BMI. Thus, our data support the idea that AMH is decreased in active smokers across the fertile age. CONCLUSIONS: The hypothesis of decreased AMH concentration in follicular fluid in female smokers was confirmed. The mechanisms through which cigarette smoking induces this fall in AMH are unknown and additional research is needed to improve our comprehension of the negative impact of smoking on ART outcomes.

Leukocyte adhesion deficiency syndrome: report on the first case in Chile and South America / Síndrome de deficiencia de adhesión leucocitaria: informe del primer caso en Chile y América del Sur

CONTEXT: Adhesion molecule deficiency type 1 is a rare disease that should be suspected in any patient whose umbilical cord presents delay in falling off, and who presents recurrent severe infections. Early diagnostic suspicion and early treatment improve the prognosis. CASE REPORT: The case of a four-month-old boy with recurrent hospitalizations because of severe bronchopneumonia and several episodes of acute otitis media with non-purulent drainage of mucus and positive bacterial cultures is presented. His medical history included neonatal sepsis and delayed umbilical cord detachment. Laboratory studies showed marked leukocytosis with predominance of neutrophils and decreased CD11b and CD18. These were all compatible with a diagnosis of leukocyte adhesion deficiency type I [LAD type 1].

CONTEXTO: El deficit de moleculas de adhesión tipo 1 es una enfermedad rara que debe ser sospechada en todo paciente que presente un retardo en la caída del cordón unmbilical, además de infecciones graves a repetición. Un sospecha diagnóstica precoz y un tratamiento oportuno mejorarán el pronóstico. INFORMES DE CASO: Se presenta el caso de un niño de cuatro meses de edad, con hospitalizaciones recurrentes a causa de bronconeumonía severa y varios episodios de otitis media aguda con drenaje mucoso, no purulento, y cultivos bacterianos positivos. Su historial médico incluye la sepsis neonatal y el desprendimiento tardío del cordón umbilical. Los estudios de laboratorio mostraron leucocitosis marcada con predominio neutrofílico y disminución de CD11b y CD18, todos compatibles con el diagnóstico del tipo de deficiencia de adhesión leucocitaria 1 [tipo LAD 1].

Postergación de la maternidad en Chile: Una realidad oculta / Association between motherhood postponement and socioeconomic status

Background: Delayed motherhood is a common phenomenon in the developed world, where the age at frst delivery is around 30 years. In Chile the National Institute of Statistics established that this age has remained around 23 years for more than two decades. Motherhood postponement may be modulated by socioeconomic status. Aim: To determine whether the age at frst delivery is higher in a private clinic compared to a public hospital. Patients and Methods: Two cohorts of primiparous women delivering in 1998 and 2008 in the public hospital San Borja Arriarán (HSBA) and a private setting Clínica Las Condes (CLC), were analyzed. Results: The age of all delivering women was significantly lower in HSBA than in CLC in both study periods (26.3 ± 0.8 and 25.7 ± 0.9 compared to 31.6 ± 0.1 and 32.7 ± 0.1 years, respectively). Likewise, the frequency of adolescent pregnancy was significantly higher in HSBA than CLC in both study periods (38.8 and 42.2 percent compared to 1.7 and 1.6 percent respectively). The age at frst delivery was significantly lower in both periods in HSBA (21.8 and 21.3 years compared to 28.6 and 30.6 years, respectively). Excluding primiparous women of less than 20 years, the difference in age was smaller, but remained still significant (24.6 and 24.2 versus 29.9 and 31.0 years, respectively). Conclusions: In Santiago, the postponement of motherhood is more marked among women of high socioeconomic status.

Suppression of follicular rupture with meloxicam, a cyclooxygenase-2 inhibitor: potential for emergency contraception.

BACKGROUND: There is evidence that cyclooxygenase-2 (COX-2) inhibitors can prevent or delay follicular rupture. COX-2 inhibitors, such as meloxicam, may offer advantages over emergency contraception with levonorgestrel, such as extending the therapeutic window for up to 24 h. We assessed the effect of meloxicam administered in the late follicular phase upon ovulation in women. MATERIALS AND METHODS: This was a single center, double blind, crossover study designed to assess the effects in 27 eligible women (18-40 years old, surgically sterilized with regular menstrual cycles) of meloxicam, 15 or 30 mg/day, administered orally for five consecutive days during the late follicular phase, starting when the leading follicle reached 18 mm diameter. Volunteers underwent two treatment cycles separated by one resting cycle, with randomization to dose sequence. Main outcomes were follicular rupture; serum LH, progesterone and estradiol (E2) levels; and incidence of adverse events. RESULTS: Twenty-two volunteers completed the study. There were no differences between meloxicam doses in menstrual cycle length. Dysfunctional ovulation was observed in 11/22 (50%) cycles treated with 15 mg/day and 20/22 (90.9%) cycles with 30 mg/day (P = 0.0068). All women had normal luteal phase progesterone levels; mean maximal values +/- SEM were 42 +/- 4.1 and 46.8 +/- 2.6 nmol/l for 15 and 30 mg/day groups, respectively. There were no serious adverse events, and no changes in LH and E2 levels or in cycle length. CONCLUSIONS: Meloxicam 30 mg given for five consecutive days in the late follicular phase is safe, effective and may be an alternative form of emergency contraception.

[Association between motherhood postponement and socioeconomic status]. / Postergación de la maternidad en Chile: Una realidad oculta.

BACKGROUND: Delayed motherhood is a common phenomenon in the developed world, where the age at first delivery is around 30 years. In Chile the National Institute of Statistics established that this age has remained around 23 years for more than two decades. Motherhood postponement may be modulated by socioeconomic status. AIM: To determine whether the age at first delivery is higher in a private clinic compared to a public hospital. PATIENTS AND METHODS: Two cohorts of primiparous women delivering in 1998 and 2008 in the public hospital San Borja Arriarán (HSBA) and a private setting Clínica Las Condes (CLC), were analyzed. RESULTS: The age of all delivering women was significantly lower in HSBA than in CLC in both study periods (26.3 ± 0.8 and 25.7 ± 0.9 compared to 31.6 ± 0.1 and 32.7 ± 0.1 years, respectively). Likewise, the frequency of adolescent pregnancy was significantly higher in HSBA than CLC in both study periods (38.8 and 42.2% compared to 1.7 and 1.6% respectively). The age at first delivery was significantly lower in both periods in HSBA (21.8 and 21.3 years compared to 28.6 and 30.6 years, respectively). Excluding primiparous women of less than 20 years, the difference in age was smaller, but remained still significant (24.6 and 24.2 versus 29.9 and 31.0 years, respectively). CONCLUSIONS: In Santiago, the postponement of motherhood is more marked among women of high socioeconomic status.

Amniocentesis: técnica e indicaciones / Amniocentesis: techniques and indications

En obstetricia los procedimientos invasivos nacen de la necesidad de acoger al feto como paciente en su época prenatal, por esta razón, y de la mano del desarrollo tecnológico, han tenido un desarrollo vertiginoso en el curso de los últimos años. La amniocentesis es el procedimiento diagnóstico invasivo prenatal más usado en la actualidad. En países del primer mundo, es una práctica común de la rutina obstétrica, siendo su principal objetivo la búsqueda de algunas malformaciones genéticas. Sin embargo, en el curso de los últimos años, ha demostrado disminuir la mortalidad perinatal y las secuelas neurológicas en el síndrome de parto prematuro y en la rotura prematura de membranas. Además se ha utilizado en forma terapéutica en el síndrome de transfusión feto-fetal (amniodrenaje). En este trabajo se revisan algunas de las indicaciones, complicaciones y beneficios de la técnica.