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

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

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

Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature

BACKGROUND: Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature. OBJECTIVE AND RATIONALE: The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies. SEARCH METHODS: A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached. OUTCOMES: Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society. WIDER IMPLICATIONS: Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain

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