Assisted Human Reproduction Techniques Research Articles

Access to assisted human reproduction techniques in Colombia: Disparity between the recognition of reproductive rights and their effective implementation.

Public funding of assisted reproduction technologies (ARTs) is a controversial issue. Some health systems have proposed public funding of ARTs. In recent years, there has been evidence of a change in the line of jurisprudence and legislation in Colombia about this topic. This article analyzes the tension between the recognition of individual sexual and reproductive rights and the common good, in terms of the sustainability of the health system and the reasonable use of limited resources to meet the health needs of the population. This article concludes that, despite regulatory progress, there has been a lack of corresponding progress in their effective implementation and the recognition of reproductive rights.

Importanţa endometritei cronice şi a disbiozei în eşecul de implantare în ciclurile de FIV

Recurrent implantation failures have multiple causes. Microorganisms frequently invade the uterine cavity, and consecutive endometrial infection or inflammation can play a role in implantation failure during assisted human reproduction techniques. Pathological microorganisms and inflammatory mediators in the host can cause a cascade of events, leading to the implantation failure or expulsion of the embryo. This review addresses an important factor related to implantation failure, dysbiosis and chronic endometritis. Prolonged menstrual bleeding, previous abortions, uterine curettage, tubal pathology or a history of vaginal bacterial infections are common risk factors for endometritis. Chronic endometritis is often asymptomatic, but it plays an important role in implantation failures. The embryo implantation rates were significantly higher in patients receiving combined antibiotic therapy for chronic endometritis. It is therefore important that, in the case of infertile couples, this potential cause be sought and treated, because, if left untreated, it has the potential to determine recurrent implant failure. Oral antibiotic therapy, associated with oral and vaginal probiotics, plays an important role in regulating endometrial microbiome.  

Inteligenţa artificială în tehnicile de reproducere asistată

Artificial intelligence (AI) represents a continuously expanding technique, recording real progress in multiple medical specialties. The improvement of calculation algorithms, the appearance of more and more powerful computers, the training of doctors to use this equipment, and data processing techniques have contributed to the increased performance of assisted reproduction technology. Currently, implementing AI algorithms in the clinical activity of assisted reproductive technology (ART) represents a challenge. There are a series of limitations of the deep learning and decision tree processes due to the risks regarding the validation of the results, the ethical aspects, the responsibility for the correctness of the information, the doctors’ reluctance to use AI, and the lack of empathy for patients. However, the continuous research on the AI algorithms is essential in clinical embryology and in assisted human reproduction techniques. The early diagnosis of infertility, the personalization of treatment schemes, and the prediction of ART success are just a few directions for promoting AI applications in reproductive medicine, without being able to replace the current clinical model. The possibility of making predictions regarding the quality of embryo transfer procedures and the normal pregnancy rate are factors that show the future direction of the development of in vitro fertilization techniques.

Endometrial scratching technique

Problems of female subfertility are a current challenge. Implant failure of the embryo after an assisted human reproduction technique is undesirable and unpleasant, and strategies to improve this implant rate are welcome. One of these techniques is endometrial scratching. We performed a literature review by searching in the PubMed and Cochrane databases for relevant information regarding the technique of endometrial scratching. The technique of endometrial scratching is not complex, but choosing an optimal period in the menstrual cycle seems to produce the desired effects for the successful implantation of the embryo. Pregnancy rates obtained through assisted human reproduction techniques have been improved due to endometrial scratching techniques.

Bilateral absence of vas deferens (BAVD) a case report

Mutations in transmembrane conductance of cystic fibrosis (CFTR) are found in men in couples followed for infertility and for which azoospermia associated with congenital bilateral absence of the deferential canal (CBAVD) were found in men. There is a frequent association between CFTR and CBAVD abnormalities. CBAVD exists in almost all men with cystic fibrosis and causes an obstructive azoospermia that cannot be treated surgically; this poses a diagnostic and therapeutic problem because its management remains complex. However, with the use of assisted reproductive techniques (ART), in particular the aspiration of testicular or epididymic sperm, the injection of intracytoplasmic sperm and in vitro fertilization, it is possible that men with CBAVD can produce offspring. We report the case of a 32-year-old patient who consulted for primary infertility evolving over the past 5 years (genetic advice was provided). The aim of this article is to show the diagnostic and therapeutic difficulties related to this particular form of male primary infertility. Recent assisted human reproduction techniques like Intracytoplasmic Sperm Injection (ICSI) or In Vitro Fertilization (FIV) offer very good results for couple consulting for infertility of man with CBAVD.

Reflexión crítica sobre el principio de anonimidad en los datos del donante en procedimientos de técnicas de reproducción humana asistida heteróloga

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Derecho a la identidad de origen y técnicas de reproducción humana asistida

El derecho a la identidad es un derecho humano fundamental oponible erga omnes, del cual debe gozar todo individuo sin discriminación y el Estado debe garantizar, a través de todos los medios de los que disponga para hacerlo efectivo. El presente artículo aborda la problemática que generan las técnicas de reproducción humana asistida (en adelante TRHA) en relación con el derecho a conocer la identidad de origen. El enfoque inédito que se presenta, sustenta que la regulación del Código Civil y Comercial de la Nación (en adelante CCC) con relación al derecho a conocer la identidad origen de las personas nacidas mediante TRHA heterólogas, es inconstitucional en tanto no supera el examen de proporcionalidad.
  

Abstracts of the 24th Annual Congress of the SBRA, 2020 (Virtual Meeting).

Objective:Osteogenesis Imperfecta (OI) is a disease characterized by fragile bones and a decrease in bone mass. There are approximately nineteen types of OI differing from each other by morbidity, mortality and causative mutation. The OI Type IV occurs in most cases of deleterious variant in heterozygosis (autosomal dominant) in the COL1A1 or COL1A2 genes. Those genes are responsible for the production of procollagen chains that are part of type I collagen molecule. Patients with OI type IV have a high risk (50%) of transmitting the pathogenic variant to their offspring being recommendable genetic counseling to discuss family planning alternatives. The use of assisted human reproduction techniques followed by analysis of Pre-implantation Genetic Test for Monogenic Diseases (PGT-M) in embryos has proven to be an effective alternative to reduce the risk of recurrence. Objective: Family planning with In Vitro Fertilization (IVF) cycles and cumulation of frozen embryos followed by PGT-M as an alternative to reduce the risk of transmission of the pathogenic variant that causes OI Type IV.Methods:The case reported a couple in which the male patient has a diagnosis of OI Type IV caused by a deleterious variant in COL1A2. Informative study was conducted with the carrier and his wife before the IVF cycle and the PGT-M. The previous test was designed to find the informative polymorphic Short Tandem Repeats (STR) markers linked to mutations or genomic regions. For the IVF treatment three cycles were made with the same stimulation protocol. It was used clomiphene citrate, gonadotropin, antagonist GnRh and trigger with agonist GnRh. In the first cycle, six embryos were produced and frozen on the third day of development (D3). In the following cycle three embryos had vitrified in the same development day. In the third cycle six embryos were developed and after they reached cleavage state (D3), all other embryos, from the previous cycles, were thawed, survived the technique and developed until the blastocyst stage. From the total fifteen embryos in the cleavage stage, nine evolved to the blastocyst stage. The PGT-M was performed at all blastocysts followed by embryo cryopreservation. Regarding the genetic analysis of embryo cells, for those samples that the deleterious variant in COL1A2 was not found, the research advanced with Pre-implantation Genetic Test for Aneuploidy (PGT-A). The antagonist protocol used for the endometrial preparation in the embryo thaw cycle, from the third day of menstrual flow progressive doses of estradiol were used until the appropriate thickness and pattern was reached. It was administered 10.000 UI of urinary HCG subcutaneous. After 48 hours, 75 mg of intramuscular progesterone was started. On the sixth day of administration, the euploid embryo without the mutation searched was thawed and transferred to the uterine cavity.Results:In this cohort of nine embryos, there were five embryos with COL1A2 mutation present. From the four embryos without the mutation, three of them were aneuploids. One embryo did not present the haplotype with the mutation in COL1A2 and was euploid. This embryo was thawed and followed by transfer and resulted in an unaffected live birth. Conclusion:This article evidences an IVF cycle with a multidisciplinary approach with genetic counseling, serial ovarian stimulation, cumulative IVF cycles with embryo freezing, PGT-M, PGT-A and cycle of thawing can be a viable treatment to reduce recurrence risk of autosomal-dominant disease (50%).

Utilização da reprodução humana assistida e seus efeitos no Direito de Família e Direito Sucessório sob a ótica do princípio da dignidade da pessoa humana

A presente pesquisa tem por objetivo discutir sobre a reprodução humana assistida e suas consequências jurídicas frente ao Direito de Família e Sucessões, sob a ótica do princípio da dignidade da pessoa humana, principalmente no que tange às relações de parentesco e aos direitos sucessórios do filho, o que faz com que o conceito de filiação e de alguns institutos do direito sucessório sejam repensados. A respeito da temática, destaca-se que a Constituição Federal de 1988 possui como fundamento da democracia e pressuposto de respeito entre os indivíduos a dignidade da pessoa humana. Além disso, o ordenamento brasileiro consagra, além da filiação biológica e jurídica, a filiação civil ou a socioafetiva. E é justamente sob este prisma que o caráter biológico da filiação abre espaço também à afetividade, estendendo o direito de igualdade no âmbito dos direitos sucessórios à filiação adotiva, inclusive àqueles advindos fora da constância do casamento e aos gerados por meio de técnicas de reprodução humana assistida. Por isso, há proibição de qualquer tipo de discriminação ou diferenciação entre os filhos. Nesta perspectiva, é necessário que o Direito de Família e Sucessões seja aplicado de forma que atenda não só aos anseios daqueles que querem ter realizado o seu projeto parental, mas também e, principalmente, que assegure o melhor interesse da criança gerada através das técnicas de reprodução assistida.

The Principle of "Damage Exclusion" as a Benchmark in Catholic Discussions of Homologous Artificial Insemination.

The Catholic perspective rejects assisted human reproduction techniques, but the morality of artificial insemination (AI) is open for discussion. This article aims to analyze the morality of AI from a new angle, namely whether these interventions exclude all possibility of damaging the human embryo and the offspring's health. The scientific evidence about the children's health who are born through AI allows us to affirm that the procedures do not comply with the principle of damage exclusion: AI does not exclude all possibility of damaging the embryo and impacting the health and exposure to disease of the offspring born through these techniques.

¿Autonomía de la voluntad en el derecho de las familias? Opiniones sociojurídicas sobre filiación de usuarios de técnicas de reproducción humana asistida con donación de gametos y/o gestación por sustitución

The objective of the article is to describe and analyse how the autonomy of the will was manifested in users of assisted human reproduction techniques where the donation of gametes –ovules and / or spermatozoids– or gestational surrogacy were used to form nuclear families as well as single-parent, homo-parental or co-maternal families in Argentina. The users highlighted the importance of issues related to ?liation by referring to the individual, sociocultural and legal context in which reproductive decisions were made.

Debates en torno a los efectos de la fertilización in vitro heteróloga en la filiación

Los avances logrados en la Biotecnología, especialmente en el ámbito de las técnicas de reproducción humana asistida, han provocado transformaciones en la forma en que actualmente se conciben algunas instituciones jurídicas. La fertilización in vitro heteróloga de modo particular, a razón de la intervención de donantes de material genético, trastoca los fundamentos en los cuales se ha sostenido la filiación como categoría del Derecho de Familia, dando lugar a que se contemple la posibilidad de existencia de una tercera tipicidad filiatoria. Las polémicas teóricas y doctrinales que genera su implementación para los usuarios en relación a las presunciones filiatorias y la dimensión del consentimiento informado trascienden a los ordenamientos foráneos en soluciones diversas que son reflejadas de modo igualmente variado en el plano a jurisprudencial. Aún existen ordenamientos ajenos a estos cambios, generando una desprotección a los derechos de los sujetos involucrados en su utilización, cuestión que amerita una construcción normativa que atempere los basamentos teóricos de la filiación a la realidad social y la ciencia en evolución.

Conflictos contemporáneos en Técnicas de Reproducción Asistida: la experiencia en el derecho argentino

The Argentine legal system has been the protagonist of a large number of substantial legal modifications that have had a direct impact on the techniques of assisted human reproduction (TRHA). Recognize this medical practice as a third filiatory type sharing the stage of filial right together with filiation by nature and adoptive, means granting them a place of privilege with what that means. Now, it is questionable whether the current regulation is capable of covering all the legal problems that arise in social reality, in a field marked by dynamism and constant movement; what would be the legal spaces that were not yet covered by the law and which would remain pending and what doctrinal and jurisprudential positions have been put forward in this regard; what would be the bases or principles to build legal solutions to this silence. All questions must be answered, taking as a starting point the obligatory perspective of human rights as an obligatory view in order to achieve a practice that is in tune with the rights and interests at stake. For this purpose, inquiring about the contributions and implications of key notions such as procreational will and informed consent constitute key analysis tools, what happens with the revocation in special cases such as death and the rupture of the union, as when dissociation will procreational gestation by substitution, even until, when the procreational will is lent by more than two people. All these complex debates have starred the scenario of the right of families in contemporary Argentine law in which the plural has been sponsored, precisely, by the techniques of assisted reproduction.

Discussão bioética sobre reprodução humana assistida no Brasil: revisão sistemática da literatura.


 
 
 
 No Brasil as discussões sobre as técnicas de reprodução humana assistida iniciaram em 1984. Após décadas com projetos de lei tramitando no Congresso Nacional ainda é necessário regulamentar as técnicas de reprodução humana assistida (TRHA), visto que é importante definir possibilidades de tratamentos e modalidades de aplicação, bem como assegurar o bem-estar de todas as pessoas envolvidas no processo, impondo limites quanto ao avanço científico. O presente trabalho apresenta uma revisão sistemática com o objetivo de mostrar uma visão interdisciplinar sobre a reprodução humana assistida no Brasil. Constatou-se a escassez de estudos publicados em nível nacional que discutem questões bioéticas envolvendo as TRHA no Brasil; entretanto, os estudos encontrados confirmam a necessidade de legislação e normatização das TRHA.
 
 
 

O dilema da “produção independente” de parentalidade: é legítimo escolher ter um filho sozinho?

Resumo A família monoparental é uma entidade familiar constitucionalmente protegida no artigo 226, § 4°, da Constituição Federal de 1988. No entanto, pairam ainda, sobretudo na doutrina, algumas dúvidas quanto à possibilidade de uma pessoa intencionalmente constituir uma família monoparental, fazendo uso das técnicas de reprodução humana assistida, a chamada “produção independente”. A partir de tal perspectiva, pergunta-se: seria legítimo escolher desempenhar individualmente uma paternidade ou maternidade? Com a finalidade de responder tal indagação, o presente trabalho objetivou analisar a legitimidade de uma pessoa solteira em empreender um projeto particular de parentalidade, recorrendo-se ao auxílio das modernas técnicas de procriação medicamente assistida. Para tanto, utilizou-se do método analítico-dedutivo, mediante o uso de revisão bibliográfica, com o intuito de buscar as formulações doutrinárias acerca da temática, analisando-as em conformidade com uma metodologia bioética-civil-constitucional. Assim, observou-se que, sob a ótica do planejamento familiar e de suas limitações legais, não há como se obstar legalmente à concretização de tais projetos de paternidade ou maternidade. Afinal, o ideal de família previsto pelo ordenamento brasileiro preserva a afetividade e o cuidado nas relações familiares, acima de qualquer padrão de constituição familiar predeterminado.

Protection of the rights of persons interested in assisted human reproduction techniques. A perspective of comparative law

A nivel internacional, las legislaciones en materia de técnicas de reproducción humana asistida (TRHA) difieren en temas como el acceso a las mismas, la fecundación post-mortem y la donación de gametos. Si las legislaciones se fundamentan en tres principios comunes ¿Cómo explicar entonces disposiciones tan distintas, muchas de las cuales podrían considerarse violatorias de los derechos fundamentales de las personas interesadas? El objetivo de este artículo es explicar dichas diferencias a partir de una jerarquización distinta de los principios comunes. Mediante una metodología cualitativa con un enfoque hermenéutico y crítico social, el diseño de la investigación, de carácter documental, implicó una revisión de la normativa y la jurisprudencia de siete países, así como de la literatura científica sobre la materia. El análisis de los resultados permitió identificar que si bien, los derechos de las personas interesadas son protegidos, dicha protección se realiza de manera distinta en cada país.

Http://contraceptivestudies.imedpub.com/commented-madness-project-works-about-the-academical-vision-of-conceptsin-psychiatry-and-mental-health.php?aid=23386

Introduction: The serologies for HIV screening, hepatitis B and C and Zika virus are routine in infertility research. Objectives: To establish the seroprevalence of these viral infections in couples submitted to assisted reproduction and compare the seroprevalence of these infections in the group of patients who underwent intrauterine insemination or in-vitro fertilization. Methods: An retrospective analytical study with a survey of the cases of couples submitted to assisted human reproduction techniques carried out in a public institution (Human Reproduction Laboratory of the Clinical Hospital of the Federal University of Goias-LabRep (HC/UFG) and in a private clinic (Fertile), with serologies for the Zika virus, HIV, hepatitis B virus and hepatitis C, from July 2016 to July 2017. Results: 871 patients were evaluated, of which 186 were from LabRep-HC/UFG and 685 from Fertile Clinic. From the total number of patients analysed: 636 underwent IVF/ICSI treatment and 235 underwent IUI. Conclusion: There was no difference between the prevalence of the diseases analysed considering the sex and the type of clinic the patients belonged. The overall prevalence of hepatitis B, hepatitis C, HIV and Zika was 0.57%, 0.57%, 0.46% and 0.23%, respectively. Considering the techniques of assisted reproduction, all cases of hepatitis B and C were from patients who underwent in-vitro fertilization/ intracytoplasmic injection in-vitro, with a statistically significant difference compared to couples who underwent intrauterine insemination. Comparing the two clinics where the couples performed the assisted reproduction treatments, there wasn’t significant difference between the prevalence of the infections analysed. There was also no significant difference between the prevalence of the diseases surveyed when compared to the two clinics, for each treatment performed, whether high or low complexity.

The infra-value of human rights in the context of assisted regulation in México.

Infertility represents a problem in the context of reproductive health; to treat it were developed the techniques of assisted human reproduction, despite medical advances, the practice of techniques is subject to medical, legal and ethical dysfunctions. In Mexico, since the late 1980s assisted reproduction clinics were set up in public and private sector hospitals; however, they do not yet have a legal framework to regulate them in a specific way, which causes human rights violations that could be avoided with adequate regulation. This article advances the need to provide Mexico with such regulation as a means of guaranteeing both human rights and the rights of physicians and other health workers involved in these techniques.

El novedoso concepto de familia influenciado por las técnicas de reproduccion asistida (T.R.A) en Colombia:

A partir de la expedición de la Carta Política Colombiana de 1991, se establece la posibilidad de existencia de hijos con asistencia científica, por lo que a través de una investigación de enfoque cualitativa, tipo dogmático, y con técnicas de recolección de información documental, se plantea una novedosa forma de configuración familiar a través de la utilización de las técnicas de reproducción humana asistida, enfatizando en la configuración familiar homoparental, y en el tránsito de la “familia homoparental” al “matrimonio igualitario en Colombia”, por lo que se abordan los desafíos jurídicos que enfrentan las familias biparentales y homoparentales para acceder a las técnicas de reproducción humana asistida, distinguiendoentre parejas homosexuales femeninas y masculinas, para finalmente plantear conclusiones.

La maternidad de alquiler frente a la summa divisio iuris entre las personas y las cosas

Legalizing gestational surrogacy is on the political agenda of many European countries. It may seem difficult not to admit this procedure into the law as it relies on the techniques of assisted human reproduction that, in most countries, have been recognized and regulated. This paper aims to identify the specific problems raised by surrogate motherhood. From a primarily legal approach, this practice is questioned both in regard to the surrogate mother and for the child to be born. It is found that, upsetting the summa divisio iuris between persons and things, gestational surrogacy leads to the instrumentalization of women and to the unborn child reification.