Algunas reflexiones éticas en el uso de la tecnología reproductiva moderna para el tratamiento de la infertilidad

ResumenEl desafío de cualquier sociedad es construir acuerdos basados en consideraciones éticas y valóricas, que con dinamismo y pragmatismo se renueven según lo que aprendemos día a día a través de la ciencia, de la experiencia y de las realidades sociales. Acuerdos sociales así construidos generan deliberaciones tolerantes, pluralistas y respetuosas de la diversidad de pensamientos y creencias. Esta manera de relacionarse cívicamente ha demostrado ser difícil en el contexto latinoamericano.Este artículo intenta sentar las bases biológicas del desarrollo humano para ejercer un pensamiento ético separando los mínimos morales, que deben aplicarse a todas las personas, de los máximos morales, que cada uno puede incorporar según sus propias creencias.En primer lugar, se describen los diferentes estadios del desarrollo embrionario previo a la implantación con objeto de reflexionar sobre el estatuto del embrión y luego se hace referencia a las técnicas de reproducción asistida y los desafíos éticos que éstas representan.SummaryA major challenge for any society is to build agreements and regulations based on ethical considerations and value judgments which are dynamic and permanently reviewed and renewed according to what science, experience and social realities teach us every day. Social agreements, which respect the different ways that people, think and believe, have proved to be a difficult task in Latin America.This article tries to set the biologic bases of early human development in order to separate ethical judgments based on minimal moralities which are applicable to all from maximal moralities which should not be obligatory and followed as personal beliefs.Firstly, the different stages of pre implantation development are described and the moral status of the embryo is examined. This is followed by comments on some challenges posed by modern reproductive Technologies

Dilemas de la reproducción asistida

La Fecundación In Vitro (FIV) y la Transferencia de Gametos a la Trompa de Falopio (GIFT) han hecho posible el nacimiento de cientos de miles de niños. Estas tecnologías han puesto al hombre frente a frente a la posibilidad de intervenir en los inicios de su propia existencia. La pregunta es si aquello que es científica y técnicamente factible es bueno para el hombre. La respuesta requiere de una reflexión multidisciplinaria. La filosofía, la bioética y las distintas corrientes religiosas tienen un grano de arena que aportar a este gran desafío.Modern reproductive technologies, particularly in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), have made possible the establishment of new families through the birth of hundreds of thousands of children worldwide. Meanwhile, these technologies have compelled men to face the possibility of intervening at the very origins of their own biological existence, hence creating doubts and questions beyond the domain of medical science. Society is now asking itself whether all that is scientifically and technically possible is necessarily beneficial to mankind. The answer to this question is not to be found in biological science alone, but instead requires multidisciplinary reflection including all forms of knowledge: philosophical, bioethical, and religious, all contributing to the unavoidable adventure that we are endowed with in the search for a better life

Assisted reproductive technology in Europe, 2007: results generated from European registers by ESHRE

Peer reviewedPublisher PD

IoMT-Driven eHealth: A Technological Innovation Proposal Based on Smart Speakers

Internet of Medical Things (IoMT) is a technological concept applied in healthcare contexts to achieve the digital interconnection of everyday objects with the Internet in order to make life easier for people. IoMT can help monitor, inform and notify not only caregivers, but provide healthcare providers with actual data to identify issues before they become critical or to allow for earlier invention. In this sense, this paper is contextualized in Assisted Repro duction Treatment (ART) processes to reduce the number of hospital visits, reduce healthcare costs and improve patientcare, as well as the productivity of the healthcare professional. So, we present an IoMT-based technological pro posal to manage and control the prescription of pharmacological treatments to patients who are carried out ART processes. In this context, we propose the integration of iMEDEA (modular system specialized in the management of electronic clinical records for ART unit) and smart speaker devices (specifically, Amazon’s Alexa), as well as the validation of our proposal in the real envi ronment offered by Inebir clinicMinisterio de Economía y Competitividad TIN2016-76956-C3-2-R (POLOLAS)Junta de Andalucía AT17-5904-US

International Federation of Fertility Societies' Surveillance (IFFS) 2019: Global Trends in Reproductive Policy and Practice, 8th Edition

The triennial Surveillance project, initiated in 1998 by Drs. Howard Jones, Jr and Jean Cohen, continues to evolve, now with a new name, the International Federation of Fertility Societies’ Surveillance (IFFS) 2019: Global Trends in Reproductive Policy and Practice, 8th Edition. The new name more accurately reflects the scope and focus of the project, and makes the report more accessible to a global audience, particularly those seeking this information online. IFFS is a non-state actor (NSA) in official relations with the World Health Organization (WHO), and the publication of Surveillance serves as part of the IFFS’ WHO mandate. The 2019 version has several major changes. Some chapters have been expanded, and some topics have been combined to eliminate redundancies. The number of chapters has been reduced from 24 to 18, but all previous topics and questions have been retained. The 2018 online questionnaire was the sole source of data for IFFS Surveillance 2019: Global Trends in Reproductive Policy and Practice, 8th Edition. The online questionnaire was further refined, and was again administered by Medtech for Solutions®. The refined questionnaire consisted of 94 questions, in English, with translated versions available. On average, it took 90 minutes (cumulative on-site time) to complete. The survey was accessible online from February 1 through March 31, 2018. Although a few responses were accepted shortly after the deadline, they reflect the practices of assisted reproductive technology (ART) (also called assisted reproductive treatment) through that time. Respondents representing 97 countries (22 more than in 2015) registered online at the website, and all provided at least some responses to the 2018 questionnaire, enough to be included in the analysis

Improved pregnancy rate with administration of hCG after intrauterine insemination: a pilot study

<p>Abstract</p> <p>Background</p> <p>In natural cycles, women conceive when intercourse takes place during a six-day period ending on the day of ovulation. The current practice in intrauterine insemination (IUI) cycles is to perform the IUI 24-36 hours after the hCG administration, when the ovulation is already imminent. In this study hCG was administered after the IUI, which more closely resembles the fertilisation process in natural cycles.</p> <p>Methods</p> <p>All the IUIs performed since the beginning of 2007 were analysed retrospectively. Our standard protocol has been to perform the IUI 24-32 hours after hCG administration. From the end of 2008, we started to inject hCG after the IUI at random. The main outcome measure was the result of a urinary pregnancy test. Generalized Estimating Equations (GEE) was used to identify independent factors affecting the cycle outcome.</p> <p>Results</p> <p>The analysis included 228 cycles with hCG administered before and 104 cycles hCG administered after the IUI. The pregnancy rates were 10.9% and 19.6% (P = 0.040), respectively. Independent factors (OR, 95% CI) affecting the cycle outcome were sperm count (2.65, 1.20-5.81), number of follicles > 16 mm at IUI (2.01, 1.07-3.81) and the time of hCG administration (2.21, 1.16-4.19).</p> <p>Conclusion</p> <p>Improved pregnancy rate was observed with administration of hCG after IUI.</p

Familial twinning and fertility in Dutch mothers of twins.

We studied twinning and fertility indices in mothers with spontaneous monozygotic (MZ) and dizygotic (DZ) twins and in mothers who conceived their twins after the use of assisted reproduction techniques (ART). Participants in this study consisted of 8,222 and 5,505 women with spontaneous DZ and MZ offspring and 4,164 and 250 women with ART DZ and MZ twin pairs, respectively. Women were compared with respect to the number of sibs and offspring, the presence of other relatives with twins and the time it took to conceive the twins. We also compared familial twinning between a younger and an older age group. Women with spontaneous DZ twins more often reported female relatives with twins than those with spontaneous MZ twins. The proportion of DZ versus MZ twin offspring in relatives was also larger in women with spontaneous DZ offspring than in women with MZ offspring. The first group of women reported a shorter time to conceive. Women with ART twins had fewer sibs and offspring and less often reported relatives with twins. We did not observe that DZ twinning was more familial in women who had their twins before age 36 years compared to older women. Familial DZ twinning is clearly present in mothers of spontaneous DZ twins. The mechanisms underlying spontaneous and non-spontaneous DZ twinning are different and fertility treatment should be taken into account in any study of twinning. Twinning is not more familial in women who have their twins at a younger age

Repeated ovarian stimulation with corifollitropin alfa in patients in a GnRH antagonist protocol: no concern for immunogenicity

BACKGROUND One injection of corifollitropin alfa replaces the first seven daily FSH injections in controlled ovarian stimulation (COS) cycles. Repeated treatment with therapeutic proteins may cause immune responses or hypersensitivity reactions. We assessed the immunogenicity and safety of corifollitropin alfa treatment in up to three COS cycles. METHODS In this multicentre, phase III uncontrolled trial, patients (>60 kg) started treatment with one injection of 150 µg corifollitropin alfa on cycle Day 2 or 3 of menses and 0.25 mg ganielix on stimulation Day 5 or 6. Primary outcome measures were antibody formation against corifollitropin alfa (using highly sensitive radioimmunoprecipitation assay), hypersensitivity reactions, local tolerance and adverse events (AEs). RESULTS First, second and third COS cycles were started by 682, 375 and 198 patients, respectively. No clinically relevant immunogenicity or drug-related hypersensitivity was observed. For 192 patients undergoing their third cycle a post-treatment blood sample was negative in the anti-corifollitropin antibody assay, resulting in an upper limit of the one-sided 95% confidence interval (CI) of 1.5%. Most frequent AEs were procedural pain (17.7%, 95% CI: 14.9–20.8%), headache (9.1%, 95% CI: 7.0–11.5%) and pelvic pain (7.6%, 95% CI: 5.7–9.9%). Cumulative ongoing pregnancy rate after three cycles, including frozen-thawed embryo transfer cycles and spontaneous pregnancies, was 61% (95% CI: 56–65%) after censoring for patients who discontinued. CONCLUSIONS Treatment with corifollitropin alfa can safely and effectively initiate and sustain ovarian stimulation during the first 7 days of COS in normal responder patients undergoing up to three treatment cycles, without concerns of immunogenicity.Robert J. Norman, Fernando Zegers-Hochschild, Bruno S. Salle, Jolanda Elbers, Esther Heijnen, Maya Marintcheva-Petrova, and Bernadette Mannaerts for the Trust Investigator

International Federation of Fertility Societies’ Surveillance (IFFS) 2019: Global Trends in Reproductive Policy and Practice, 8th Edition

The triennial Surveillance project, initiated in 1998 by Drs. Howard Jones, Jr and Jean Cohen, continues to evolve, now with a new name, the International Federation of Fertility Societies’ Surveillance (IFFS) 2019: Global Trends in Reproductive Policy and Practice, 8th Edition. The new name more accurately reflects the scope and focus of the project, and makes the report more accessible to a global audience, particularly those seeking this information online. IFFS is a non-state actor (NSA) in official relations with the World Health Organization (WHO), and the publication of Surveillance serves as part of the IFFS’ WHO mandate

Serum estradiol/progesterone ratio on day of embryo transfer may predict reproductive outcome following controlled ovarian hyperstimulation and in vitro fertilization

BACKGROUND: To determine whether estradiol-to-progesterone (E(2)/P) ratios at the time of embryo transfer (ET) have an effect on implantation and pregnancy in IVF cycles. METHODS: 239 women consecutively treated by IVF or ICSI were retrospectively analyzed and early luteal serum E(2 )and P were measured on the day of ET. Transfer occurred after a variable in vitro culture period ranging from 4–7 days after ovulation induction (OI). Following ET, serum E(2)/P ratios were calculated for clinical pregnancies, preclinical abortions and non-coneption cycles. RESULTS: Receiver-operator curve analysis demonstrated that the E(2)/P ratio could differentiate between clinical pregnancies and non-pregnant cycles (area under the curve on OI +4 days = 0.70; 95% CI = 0.60–0.80; p = 0.003, on OI +5 days = 0.76; 95% CI = 0.64–0.88; p = 0.001, OI +7 days = 0.85; 95% CI = 0.75–0.96; p < 0.0001). CONCLUSION: These retrospective data may hold prognostic value regarding endometrial receptivity as reflected by E(2)/P measurements and may help improve IVF treatment outcome. Further prospective studies should be undertaken to confirm these obersveration