Publications by authors named "Fernando Zegers-Hochschild"

46 Publications

International Committee for Monitoring Assisted Reproductive Technologies (ICMART): world report on assisted reproductive technologies, 2013.

Fertil Steril 2021 Apr 26. Epub 2021 Apr 26.

Equal3 Fertility, Cupertino; Stanford University School of Medicine, Palo Alto; and University of California School of Medicine, San Francisco, California.

Objective: To report the utilization, effectiveness, and safety of practices in assisted reproductive technology (ART) globally in 2013 and assess global trends over time.

Design: Retrospective, cross-sectional survey on the utilization, effectiveness, and safety of ART procedures performed globally during 2013.

Setting: Seventy-five countries and 2,639 ART clinics.

Patient(s): Women and men undergoing ART procedures.

Intervention(s): All ART.

Main Outcome Measure(s): The ART cycles and outcomes on country-by-country, regional, and global levels. Aggregate country data were processed and analyzed based on methods developed by the International Committee for Monitoring Assisted Reproductive Technology (ICMART).

Result(s): A total of 1,858,500 ART cycles were conducted for the treatment year 2013 across 2,639 clinics in 75 participating countries with a global participation rate of 73.6%. Reported and estimated data suggest 1,160,474 embryo transfers (ETs) were performed resulting in >344,317 babies. From 2012 to 2013, the number of reported aspiration and frozen ET cycles increased by 3% and 16.4%, respectively. The proportion of women aged >40 years undergoing nondonor ART increased from 25.2% in 2012 to 26.3% in 2013. As a percentage of nondonor aspiration cycles, intracytoplasmic sperm injection (ICSI) was similar to results for 2012. The in vitro fertilization (IVF)/ICSI combined delivery rates per fresh aspiration and frozen ET cycles were 24.2% and 22.8%, respectively. In fresh nondonor cycles, single ET increased from 33.7% in 2012 to 36.5% in 2013, whereas the average number of transferred embryos was 1.81-again with wide country variation. The rate of twin deliveries after fresh nondonor transfers was 17.9%; the triplet rate was 0.7%. In frozen ET cycles performed in 2013, single ET was used in 57.6%, with an average of 1.49 embryos transferred and twin and triplet rates of 10.8% and 0.4%, respectively. The cumulative delivery rate per aspiration was 30.4%, similar to that in 2012. Perinatal mortality rate per 1,000 births was 22.2% after fresh IVF/ICSI and 16.8% after frozen ET. The data presented depended on the quality and completeness of the data submitted by individual countries. This report covers approximately two-thirds of world ART activity. Continued efforts to improve the quality and consistency of reporting ART data by registries are still needed.

Conclusion(s): Reported ART cycles, effectiveness, and safety increased between 2012 and 2013 with adoption of a better method for estimating unreported cycles.
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http://dx.doi.org/10.1016/j.fertnstert.2021.03.039DOI Listing
April 2021

Identifying suitable indicators of access to infertility care - a discussion.

Reprod Biomed Online 2020 12 17;41(6):1158. Epub 2020 Sep 17.

Clinica las Condes and Program of Ethics and Public Policies in Human Reproduction, University Diego Portales, Santiago, Chile.

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http://dx.doi.org/10.1016/j.rbmo.2020.09.009DOI Listing
December 2020

International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2012†.

Hum Reprod 2020 08;35(8):1900-1913

Equal3 Fertility, Cupertino, CA, USA.

Study Question: What was the utilization, effectiveness and safety of practices in ART globally in 2012 and what global trends could be observed?

Summary Answer: The total number of ART cycles increased by almost 20% since 2011 and the main trends were an increase in frozen embryo transfers (FET), oocyte donation, preimplantation genetic testing and single embryo transfers (SET), whereas pregnancy and delivery rates (PR, DR) remained stable, and multiple deliveries decreased.

What Is Known Already: ART is widely practiced throughout the world, but continues to be characterized by significant disparities in utilization, availability, practice, effectiveness and safety. The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) annual world report provides a major tool for tracking trends in ART treatment for over 25 years and gives important data to ART professionals, public health authorities, patients and the general public.

Study Design, Size, Duration: A retrospective, cross-sectional survey on the utilization, effectiveness and safety of ART procedures performed globally during 2012 was carried out.

Participants/materials, Setting, Methods: Sixty-nine countries and 2600 ART clinics submitted data on ART cycles performed during the year 2012, and their pregnancy outcome, through national and regional ART registries. ART cycles and outcomes are described at country, regional and global levels. Aggregate country data were processed and analyzed based on methods developed by ICMART.

Main Results And Role Of Chance: A total of 1 149 817 ART cycles were reported for the treatment year 2012. After imputing data for missing values and non-reporting clinics in reporting countries, 1 948 898 cycles (an increase of 18.6% from 2011) resulted in >465 286 babies (+17.9%) in reporting countries. China did not report and is not included in this estimate. The best estimate of global utilization including China is ∼2.8 million cycles and 0.9 million babies. From 2011 to 2012, the number of reported aspirations and FET cycles increased by 6.9% and 16.0%, respectively. The proportion of women aged 40 years or older undergoing non-donor ART increased from 24.0% in 2011 to 25.2% in 2012. ICSI, as a percentage of non-donor aspiration cycles, increased from 66.5% in 2011 to 68.9% in 2012. The IVF/ICSI combined delivery rates per fresh aspiration and FET cycles were 19.8% and 22.1%, respectively. In fresh non-donor cycles, SET increased from 31.4% in 2011 to 33.7% in 2012, while the average number of transferred embryos decreased from 1.91 to 1.88, respectively-but with wide country variation. The rates of twin deliveries following fresh non-donor transfers decreased from 19.6% in 2011 to 18.0% in 2012, and the triplet rate decreased from 0.9% to 0.8%. In FET non-donor cycles, SET was 54.8%, with an average of 1.54 embryos transferred and twin and triplet rates of 11.1% and 0.4%, respectively. The cumulative DR per aspiration increased from 28.0% in 2011 to 28.9% in 2012. The overall perinatal mortality rate per 1000 births was 21.4 following fresh IVF/ICSI and 15.9 per 1000 following FET.

Limitations, Reasons For Caution: The data presented depend on the quality and completeness of data submitted by individual countries to ICMART directly or through regional registries. This report covers approximately two-thirds of` world ART activity, with a major missing country, China. Continued efforts to improve the quality and consistency of reporting ART data by registries are still needed, including the use of internationally agreed standard definitions (International Glossary of Infertility and Fertility Care).

Wider Implications Of The Findings: The ICMART world reports provide the most comprehensive global statistical census and review of ART utilization, effectiveness, safety and quality. While ART treatment continues to increase globally, the wide disparities in access to treatment, procedures performed and embryo transfer practices warrant attention by clinicians and policy makers. With the increasing practice of SET and of freeze all and resulting increased proportion of FET cycles, it is clear that PR and DR per aspiration in fresh cycles do not give an overall accurate estimation of ART efficiency. It is time to use cumulative live birth rate per aspiration, combining the outcomes of FET cycles with the associated fresh cycle from which the embryos were obtained, and to obtain global consensus on this approach.

Study Funding/competing Interest(s): The authors declare no conflict of interest and no specific support from any organizations in relation to this manuscript. ICMART gratefully acknowledges financial support from the following organizations: American Society for Reproductive Medicine; European Society for Human Reproduction and Embryology; Fertility Society of Australia; Japan Society for Reproductive Medicine; Japan Society of Fertilization and Implantation; Red Latinoamericana de Reproduccion Asistida; Society for Assisted Reproductive Technology; Ferring Pharmaceuticals and Abbott (both providing ICMART unrestricted grants unrelated to world reports).

Trial Registration Number: NA.
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http://dx.doi.org/10.1093/humrep/deaa090DOI Listing
August 2020

Assisted reproductive techniques in Latin America: The Latin American Registry, 2017.

JBRA Assist Reprod 2020 Jul 14;24(3):362-378. Epub 2020 Jul 14.

Latin American Network of Assisted Reproduction (REDLARA), Montevideo, Uruguay.

Research Question: What was the utilization, effectiveness and safety of assisted reproductive techniques performed in Latin America during 2017.

Design: Retrospective collection of multinational data on ART performed in 188 institutions from 15 Latin American countries.

Results: We are reporting 93,600 initiated cycles, 16,976 deliveries and the birth of 20,404 babies. ART utilization was 221 cycles/million inhabitants (15 to 535). Despite women aged ≥40 represented 30.5% of fresh IVF/ICSI, after removing freeze-all cycles, delivery rate per oocyte retrieval was 19.9% for ICSI and 20.2% for IVF. Overall, single embryo transfer (SET) represented 26.9% of fresh transfers, with 18.2% delivery rate per transfer; increasing to 32.3% in elective SET. Delivery rate in double embryo transfers (DET) was 28.3% increasing to 37.3% with elective DET. This 5% increment in births in eDET over eSET resulted in10-fold increase in twin births, almost 3 weeks' shorter gestations and 3-fold increase in perinatal mortality. Delivery rate in frozen/thawed SET, reached 25.5% increasing to 30.8% with DET; the majority being blastocysts transfers. Of all births, 67% were singletons, 31.4% twins, and 1.6% triplets and higher. Overall, preterm deliveries reached 9.5% in singletons, 64.3% in twins and 97.9% in triplets; and perinatal mortality was 9.4‰ in singletons, 25.3‰ in twins, and 63.3‰ in high-order multiples.

Conclusions: The number of initiated cycles slowly increases. Frozen embryo transfers, blastocyst transfers and SET are also increasing. Our data shows that especially in young women and oocyte recipients, when there is more than one blastocyst for transfer, elective SET should be the rule.
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http://dx.doi.org/10.5935/1518-0557.20200029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365541PMC
July 2020

ART utilization: an indicator of access to infertility care.

Reprod Biomed Online 2020 07 14;41(1):6-9. Epub 2020 Mar 14.

Clinica las Condes and Program of Ethics and Public Policies in Human Reproduction, University Diego Portales, Santiago, Chile.

This commentary outlines the importance of utilizing assisted reproductive technology (ART) as an indicator of access to infertility care and provides a standard way of reporting utilization to facilitate international comparisons. Factors that influence ART utilization as well as underlying inequalities and inequities in access to care are discussed. The relevance of a marker that can inform and evaluate policy initiatives, monitor progress and document change is emphasized.
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http://dx.doi.org/10.1016/j.rbmo.2020.03.007DOI Listing
July 2020

Assisted reproductive technology in Latin America: the Latin American Registry, 2017.

Reprod Biomed Online 2020 Jul 20;41(1):44-54. Epub 2020 Feb 20.

Latin American Network of Assisted Reproduction (REDLARA), Plaza Independencia 811 Montevideo, Uruguay.

Research Question: What was the utilization, effectiveness and safety of assisted reproductive technologies (ART) carried out in Latin America during 2017.

Design: Retrospective collection of multinational data on ART carried out in 188 institutions from 15 Latin American countries.

Results: In this study, 93,600 initiated cycles, 16,976 deliveries and 20,404 births reported. Utilization of ART was 221 cycles per million inhabitants (15 to 535). Women aged 40 years and above represented 30.5% of fresh IVF and intracytoplasmic sperm injection (ICSI); however, after removing freeze-all cycles, delivery rate per oocyte retrieval was 19.9% for ICSI and 20.2% for IVF. Overall, single embryo transfer (SET) represented 26.9% of fresh transfers, with 18.2% delivery rate per transfer, increasing to 32.3% in elective SET. Delivery rate in double embryo transfers (DET) was 28.3% increasing to 37.3% with elective DET. This 5% increment in births in elective DET over elective SET resulted in a tenfold increase in twin births, gestational periods almost 3 weeks' shorter and a threefold increase in perinatal mortality. Delivery rate in frozen-thawed SET reached 25.5% increasing to 30.8% with DET, most being blastocyst transfers. Of all births, 66.9% were singletons, 31.4% twins and 1.6% triplets and higher. Overall, preterm deliveries reached 9.5% in singletons, 64.3% in twins and 97.9% in triplets; perinatal mortality was 9.4‰ in singletons, 25.3‰ in twins and 63.3‰ in high-order multiples.

Conclusions: The number of initiated cycles has slowly increased. Frozen embryo transfers, blastocyst transfers and SET are also increasing. Our data show that, especially in young women and oocyte recipients, when there is more than one blastocyst for transfer, elective SET should be the rule.
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http://dx.doi.org/10.1016/j.rbmo.2020.02.004DOI Listing
July 2020

Assisted reproductive techniques in Latin America: The Latin American registry, 2016.

JBRA Assist Reprod 2019 08 22;23(3):255-267. Epub 2019 Aug 22.

Latin American Network of Assisted Reproduction (REDLARA), Montevideo, Uruguay.

Research Question: What was the utilization, effectiveness and perinatal outcome of assisted reproductive technologies (ART) performed in Latin America during 2016.

Design: Retrospective collection of multinational data on ART performed in 178 institutions from 15 Latin American countries.

Results: We are reporting 85,474 initiated cycles, 15,070 deliveries and 18,182 babies born in this period. Of all fresh autologous IVF/ICSI cycles, 40.9% were performed in women aged 35-39 years, and 31.1% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 20.31% for ICSI and 21.85% for IVF. Fresh single embryo transfer including all age categories represented 22.96%, with a 15.35% delivery rate per transfer. Double embryo transfer represented 61.58% of transfers, with a 27.62% delivery rate per transfer. Multiple births included 18.12% twins and 0.55% triplets and higher. In oocyte donation, delivery rate per transfer was 32.89%, with a twin and triplet rate of 23.48% and 0.73%, respectively. Overall, preterm deliveries reached 17.11% in singletons, 65.69% in twins and 95.51% in triplets. Perinatal mortality was 8.0 ‰ in singletons, 19.0 ‰ in twins, and 62.3 ‰ in high-order multiples.

Conclusions: The number of initiated cycles continues to increase. Compared with previous years, the number of embryos transferred decreased while the proportion of single embryo transfers increased with a drop in multiple births. It is mandatory to stimulate health care providers and consumers to continue in this trend.
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http://dx.doi.org/10.5935/1518-0557.20190037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724392PMC
August 2019

Assisted reproductive techniques in Latin America: the Latin American Registry 2016.

Reprod Biomed Online 2019 Sep 7;39(3):452-460. Epub 2019 May 7.

Latin American Network of Assisted Reproduction (REDLARA), Plaza Independencia 811, Montevideo, Uruguay; Unifertes, Avenue San Juan Bosco, Caracas, Venezuela.

Research Question: What was the utilization, effectiveness and perinatal outcome of assisted reproductive technologies (ART) performed in Latin America during 2016?

Design: Retrospective collection of multinational data on ART performed in 178 institutions from 15 Latin American countries.

Results: This paper reports on 85,474 initiated cycles, 15,070 deliveries and 18,182 babies born in this period. Of all fresh autologous IVF/intracytoplasmic sperm injection (ICSI) cycles, 40.9% were performed in women aged 35-39 years, and 31.1% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 20.31% for ICSI and 21.85% for IVF. Fresh single embryo transfer including all age categories represented 22.96%, with a 15.35% delivery rate per transfer. Double embryo transfer represented 61.58% of transfers, with a 27.62% delivery rate per transfer. Multiple births included 18.12% twins and 0.55% triplets and higher. In oocyte donation, delivery rate per transfer was 32.89%, with a twin and triplet rate of 23.48% and 0.73%, respectively. Overall, preterm deliveries reached 17.11% in singletons, 65.69% in twins and 95.51% in triplets. Perinatal mortality was 8.0‰ in singletons, 19.0‰ in twins, and 62.3‰ in high-order multiples.

Conclusions: The number of initiated cycles continues to increase. Compared with previous years, the number of embryos transferred decreased while the proportion of single embryo transfers increased with a drop in multiple births. It is vital to motivate health care providers and consumers to continue this trend.
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http://dx.doi.org/10.1016/j.rbmo.2019.04.129DOI Listing
September 2019

Assisted Reproductive Techniques in Latin America: The Latin American Registry, 2015.

JBRA Assist Reprod 2019 04 30;23(2):143-153. Epub 2019 Apr 30.

Latin American Network of Assisted Reproduction (REDLARA), Montevideo, Uruguay.

Research Question: What was the utilization, effectiveness and safety of assisted reproductive technologies (ART) performed in Latin American countries during 2015, and what were the regional trends?

Design: Retrospective collection of multinational data on assisted reproduction techniques (IVF and intracytoplasmic sperm injection [ICSI], frozen embryo transfer, oocyte donation, preimplantation genetic testing and fertility preservation), from 175 institutions in 15 Latin American countries.

Results: In total, 41.25% of IVF/ICSI cycles were performed in women aged 35-39 years, and 28.35% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 21.39% for ICSI and 24.29% for IVF. Multiple births included 19.58% twins and 0.95% triplets and higher. In oocyte donation, delivery rate per transfer was 36.77%, with a twin and triplet rate of 27.65% and 1.06%, respectively. Overall, preterm deliveries reached 17.38% in singletons, 64.94% in twins and 98.41% in triplets. Perinatal mortality in 14,936 births and 18,391 babies born was 10.5 per 1000 in singletons, 17.9 per 1000 in twins, and 57.1 per 1000 in high-order multiples. Elective single embryo transfer represented 3.11% of fresh transfers, with a 31.78% delivery rate per transfer. Elective double embryo transfer represented 23.3% of transfers, with a 37.79% delivery rate per transfer. Out of 18,391 babies born, 63.22% were singletons, 34.4% twins, and 2.38% triplets and higher.

Conclusions: Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred remains mandatory.
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http://dx.doi.org/10.5935/1518-0557.20190021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501753PMC
April 2019

International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.

Fertil Steril 2018 11;110(6):1067-1080

Department of Obstetrics & Gynaecology Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Objective: To report the utilization, effectiveness, and safety of practices in assisted reproductive technology (ART) globally in 2011 and assess global trends over time.

Design: Retrospective, cross-sectional survey on the utilization, effectiveness, and safety of ART procedures performed globally during 2011.

Setting: Sixty-five countries and 2,560 ART clinics.

Patient(s): Women and men undergoing ART procedures.

Intervention(s): All ART.

Main Outcome Measure(s): The ART cycles and outcomes on country-by-country, regional, and global levels. Aggregate country data were processed and analyzed based on methods developed by the International Committee for Monitoring Assisted Reproductive Technology (ICMART).

Result(s): A total of 1,115,272 ART cycles were reported for the treatment year 2011. Imputing data for nonreporting clinics, 1,643,912 cycles resulted in >394,662 babies, excluding People's Republic of China. The best estimate of global utilization including People's Republic of China is approximately 2.0 million cycles and 0.5 million babies. From 2010 to 2011, the number of reported aspiration and frozen ET cycles increased 13.1% and 13.8%, respectively. The proportion of women aged ≥40 years undergoing nondonor ART increased from 23.2% in 2010 to 24.0% in 2011. As a percentage of nondonor aspiration cycles, intracytoplasmic sperm injection (ICSI) decreased slightly from 67.4% in 2010 to 66.5% in 2011. The IVF/ICSI combined delivery rates per fresh aspiration and frozen ET cycles were 19.8% and 21.4%, respectively. In fresh nondonor cycles, single ET increased from 30.0% in 2010 to 31.4% in 2011, whereas the average number of transferred embryos decreased from 1.95 in 2010 to 1.91 in 2011-again with wide country variation. The rates of twin deliveries after fresh nondonor transfers decreased from 20.4% in 2010 to 19.6% in 2011; the triplet rate decreased from 1.1%-0.9%. In frozen ET cycles performed in 2011, single ET was 51.6%, with an average of 1.59 embryos transferred and twin and triplet rates were 11.1% and 0.4%, respectively. The cumulative delivery rate per aspiration increased from 27.1% in 2010 to 28.0% in 2011. Fresh IVF/ICSI carried a perinatal mortality rate per 1,000 births of 21.0 in 2010 and 16.3 in 2011. This compared with a perinatal mortality rate after frozen ET of 14.6 per 1,000 births in 2010 and 8.6 in 2011. The data presented depend on the quality and completeness of data submitted by individual countries. This report covers approximately two-thirds of'world ART activity.

Conclusion(s): Global ART utilization, effectiveness, and safety increased between 2010 and 2011.
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http://dx.doi.org/10.1016/j.fertnstert.2018.06.039DOI Listing
November 2018

Assisted reproductive techniques in Latin America: the Latin American Registry, 2015.

Reprod Biomed Online 2018 Dec 6;37(6):685-692. Epub 2018 Oct 6.

Latin American Network of Assisted Reproduction (REDLARA), Plaza Independencia 811 Montevideo, Uruguay; Unifertes, Av. San Juan Bosco, Caracas, Venezuela.

Research Question: What was the utilization, effectiveness and safety of assisted reproductive technologies (ART) performed in Latin American countries during 2015, and what were the regional trends?

Design: Retrospective collection of multinational data on assisted reproduction techniques (IVF and intracytoplasmic sperm injection [ICSI], frozen embryo transfer, oocyte donation, preimplantation genetic testing and fertility preservation), from 175 institutions in 15 Latin American countries.

Results: In total, 41.25% of IVF/ICSI cycles were performed in women aged 35-39 years, and 28.35% in women aged ≥40 years. After removing freeze-all cycles, delivery rate per oocyte retrieval was 21.39% for ICSI and 24.29% for IVF. Multiple births included 19.58% twins and 0.95% triplets and higher. In oocyte donation, delivery rate per transfer was 36.77%, with a twin and triplet rate of 27.65% and 1.06%, respectively. Overall, preterm deliveries reached 17.38% in singletons, 64.94% in twins and 98.41% in triplets. Perinatal mortality in 14,936 births and 18,391 babies born was 10.5 per 1000 in singletons, 17.9 per 1000 in twins, and 57.1 per 1000 in high-order multiples. Elective single embryo transfer represented 3.11% of fresh transfers, with a 31.78% delivery rate per transfer. Elective double embryo transfer represented 23.3% of transfers, with a 37.79% delivery rate per transfer. Out of 18,391 babies born, 63.22% were singletons, 34.4% twins, and 2.38% triplets and higher.

Conclusions: Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred remains mandatory.
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http://dx.doi.org/10.1016/j.rbmo.2018.08.026DOI Listing
December 2018

Endometriosis does not affect live birth rates of patients submitted to assisted reproduction techniques: analysis of the Latin American Network Registry database from 1995 to 2011.

J Assist Reprod Genet 2018 Aug 27;35(8):1395-1399. Epub 2018 Jun 27.

ORIGEN, Center for Reproductive Medicine, Belo Horizonte, Brazil.

Purpose: The purpose of this study is to compare the results of ART treatment in patients with and without endometriosis in a large cohort of patients from different centers over an extented period of time.

Methods: This retrospective study is using data from patients undergoing 27,294 cycles of IVF/ICSI treatment between 1995 and 2011 that were registered in the database of the Latin American Registry maintained by the Latin America Network of Assisted Reproduction.

Results: The mean number of retrieved oocytes was higher in the control group, but the mean number of metaphase II oocytes was similar. Fertilization rate and transfer rate were higher in the control group. We observed higher pregnancy rates, per cycle initiated and per embryo transfer and higher live birth rate in the endometriosis group. In the group of patients with 25-35 years old, the number of oocytes, fertilization rate, and number of transferred embryos were significantly higher in the control group. However, pregnancy rate and live birth rate were higher in the endometriosis group. In the group of patients with 36-40 years old, the number of transferred embryos was higher in the control group, but the pregnancy rate and live birth rate were higher in the endometriosis group. In the group of patients with 41 to 42 years old, the number of transferred embryos and the transfer rate were higher in the control group, but the pregnancy rate was higher in the endometriosis group.

Conclusion: Our results demonstrate that endometriosis does not affect the outcome of patients subjected to IVF/ICSI and although patients with endometriosis present lower number of oocytes and higher cancelation rate, these shortcomings do not reduce pregnancy and live birth rates.
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http://dx.doi.org/10.1007/s10815-018-1214-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086800PMC
August 2018

Percepciones y creencias sobre criopreservación embrionaria en mujeres y hombres que se realizan técnicas de reproducción asistida en Santiago, Chile.

Rev Chil Obstet Ginecol 2018 Feb;83(1):27-44

Programa de Ética y Políticas Públicas en Reproducción Humana, Universidad Diego Portales.

Background And Objetive: Although embryo cryopreservation is frequently used as part of assisted reproductive technology, quantitave information addressing how infertile couples live the experience of having cryopreserved embryos is lacking in Chile. The aim of this study is to examine men and women's perception and beliefs regarding their cryopreserved embryos, as well as their perspective on embryo donation and disposition. Methods: 153 women and men with frozen embryos from a public hospital, Instituto de Investigactiones Materno Infantil, and a private clinic, Clínica Las Condes, in Santiago, Chile, responded between May 2015 and May 2016 to an anonymous online survey addressing their perceptions and beliefs concerning their cryopreserved embryos.

Results: Respondents considered their frozen embryos to be equivalent to a child (53.2%) or a potential child (40.7%). Only 8% regard them as an organized group of cells. Over 60% of respondents disagree with destroying surplus embryos or using them for research. Participants from the public hospital are more willing to donate their embryos to another couple than those from the private center (61% vs 40%; P=0.016); 34% of respondents agreed to donate surplus embryos to same sex couples.

Conclusion: This study reveals that Chilean couples are emotionally bound to their frozen embryos, and that discarding them is not an option. The results from this survey will help strengthen counseling for couples to enable them to make informed decisions regarding their surplus embryos.
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http://dx.doi.org/10.4067/s0717-75262018000100027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188406PMC
February 2018

The International Glossary on Infertility and Fertility Care, 2017.

Hum Reprod 2017 09;32(9):1786-1801

The Population Council, The Rockefeller University, New York, NY 10065, USA.

Study Question: Can a consensus and evidence-driven set of terms and definitions be generated to be used globally in order to ensure consistency when reporting on infertility issues and fertility care interventions, as well as to harmonize communication among the medical and scientific communities, policy-makers, and lay public including individuals and couples experiencing fertility problems?

Summary Answer: A set of 283 consensus-based and evidence-driven terminologies used in infertility and fertility care has been generated through an inclusive consensus-based process with multiple stakeholders.

What Is Known Already: In 2006 the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) published a first glossary of 53 terms and definitions. In 2009 ICMART together with WHO published a revised version expanded to 87 terms, which defined infertility as a disease of the reproductive system, and increased standardization of fertility treatment terminology. Since 2009, limitations were identified in several areas and enhancements were suggested for the glossary, especially concerning male factor, demography, epidemiology and public health issues.

Study Design, Size, Duration: Twenty-five professionals, from all parts of the world and representing their expertise in a variety of sub-specialties, were organized into five working groups: clinical definitions; outcome measurements; embryology laboratory; clinical and laboratory andrology; and epidemiology and public health. Assessment for revisions, as well as expansion on topics not covered by the previous glossary, were undertaken. A larger group of independent experts and representatives from collaborating organizations further discussed and assisted in refining all terms and definitions.

Participants/materials, Setting, Methods: Members of the working groups and glossary co-ordinators interacted through electronic mail and face-to-face in international/regional conferences. Two formal meetings were held in Geneva, Switzerland, with a final consensus meeting including independent experts as well as observers and representatives of international/regional scientific and patient organizations.

Main Results And The Role Of Chance: A consensus-based and evidence-driven set of 283 terminologies used in infertility and fertility care was generated to harmonize communication among health professionals and scientists as well as the lay public, patients and policy makers. Definitions such as 'fertility care' and 'fertility awareness' together with terminologies used in embryology and andrology have been introduced in the glossary for the first time. Furthermore, the definition of 'infertility' has been expanded in order to cover a wider spectrum of conditions affecting the capacity of individuals and couples to reproduce. The definition of infertility remains as a disease characterized by the failure to establish a clinical pregnancy; however, it also acknowledges that the failure to become pregnant does not always result from a disease, and therefore introduces the concept of an impairment of function which can lead to a disability. Additionally, subfertility is now redundant, being replaced by the term infertility so as to standardize the definition and avoid confusion.

Limitations, Reasons For Caution: All stakeholders agreed to the vast majority of terminologies included in this glossary. In cases where disagreements were not resolved, the final decision was reached after a vote, defined before the meeting as consensus if passed with 75%. Over the following months, an external expert group, which included representatives from non-governmental organizations, reviewed and provided final feedback on the glossary.

Wider Implications Of The Findings: Some terminologies have different definitions, depending on the area of medicine, for example demographic or clinical as well as geographic differences. These differences were taken into account and this glossary represents a multinational effort to harmonize terminologies that should be used worldwide.

Study Funding/competing Interests: None.

Trial Registration Number: N/A.
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http://dx.doi.org/10.1093/humrep/dex234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850297PMC
September 2017

Assisted reproductive techniques in Latin America: The Latin American Registry, 2014.

JBRA Assist Reprod 2017 09 1;21(3):164-175. Epub 2017 Sep 1.

Latin American Network of Assisted Reproduction (REDLARA), Uruguay.

Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159 institutions in 15 countries in Latin America. Treatments included IVF/ ICSI, FET, OD, PGD and fertility preservation (FP). 41.34% of IVF/ICSI cycles were performed in women aged 35 to 39 years and 23.35% in women aged 40 and older. After removing cases with total freezing, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92 % triplets and over. In OD, twins reached 28.93% and triplets 1.07 %. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer (eSET) represented only 2.63 % of fresh transfers, with a delivery rate of 32.15% per transfer. Elective double embryo transfer (eDET) represented 23.74% of transfers, with a delivery rate of 41.03% per transfer. Among babies born during this period 11,373 (62.6%) were singletons; 6,398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory.
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http://dx.doi.org/10.5935/1518-0557.20170034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574636PMC
September 2017

The International Glossary on Infertility and Fertility Care, 2017.

Fertil Steril 2017 09 29;108(3):393-406. Epub 2017 Jul 29.

The Population Council, The Rockefeller University, New York, NY 10065, USA.

Study Question: Can a consensus and evidence-driven set of terms and definitions be generated to be used globally in order to ensure consistency when reporting on infertility issues and fertility care interventions, as well as to harmonize communication among the medical and scientific communities, policy-makers, and lay public including individuals and couples experiencing fertility problems?

Summary Answer: A set of 283 consensus-based and evidence-driven terminologies used in infertility and fertility care has been generated through an inclusive consensus-based process with multiple stakeholders.

What Is Known Already: In 2006 the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) published a first glossary of 53 terms and definitions. In 2009 ICMART together with WHO published a revised version expanded to 87 terms, which defined infertility as a disease of the reproductive system, and increased standardization of fertility treatment terminology. Since 2009, limitations were identified in several areas and enhancements were suggested for the glossary, especially concerning male factor, demography, epidemiology and public health issues.

Study Design, Size, Duration: Twenty-five professionals, from all parts of the world and representing their expertise in a variety of sub-specialties, were organized into five working groups: clinical definitions; outcome measurements; embryology laboratory; clinical and laboratory andrology; and epidemiology and public health. Assessment for revisions, as well as expansion on topics not covered by the previous glossary, were undertaken. A larger group of independent experts and representatives from collaborating organizations further discussed and assisted in refining all terms and definitions.

Participants/materials, Setting, Methods: Members of the working groups and glossary co-ordinators interacted through electronic mail and face-to-face in international/regional conferences. Two formal meetings were held in Geneva, Switzerland, with a final consensus meeting including independent experts as well as observers and representatives of international/regional scientific and patient organizations.

Main Results And The Role Of Chance: A consensus-based and evidence-driven set of 283 terminologies used in infertility and fertility care was generated to harmonize communication among health professionals and scientists as well as the lay public, patients and policy makers. Definitions such as 'fertility care' and 'fertility awareness' together with terminologies used in embryology and andrology have been introduced in the glossary for the first time. Furthermore, the definition of 'infertility' has been expanded in order to cover a wider spectrum of conditions affecting the capacity of individuals and couples to reproduce. The definition of infertility remains as a disease characterized by the failure to establish a clinical pregnancy; however, it also acknowledges that the failure to become pregnant does not always result from a disease, and therefore introduces the concept of an impairment of function which can lead to a disability. Additionally, subfertility is now redundant, being replaced by the term infertility so as to standardize the definition and avoid confusion.

Limitations, Reasons For Caution: All stakeholders agreed to the vast majority of terminologies included in this glossary. In cases where disagreements were not resolved, the final decision was reached after a vote, defined before the meeting as consensus if passed with 75%. Over the following months, an external expert group, which included representatives from non-governmental organizations, reviewed and provided final feedback on the glossary.

Wider Implications Of The Findings: Some terminologies have different definitions, depending on the area of medicine, for example demographic or clinical as well as geographic differences. These differences were taken into account and this glossary represents a multinational effort to harmonize terminologies that should be used worldwide.

Study Funding/competing Interests: None.

Trial Registration Number: N/A.
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http://dx.doi.org/10.1016/j.fertnstert.2017.06.005DOI Listing
September 2017

Assisted reproduction techniques in Latin America: the Latin American Registry, 2014.

Reprod Biomed Online 2017 Sep 21;35(3):287-295. Epub 2017 Jun 21.

Latin American Network of Assisted Reproduction (REDLARA), Plaza Independencia 811, Montevideo, Uruguay; Unifertes, Av. San Juan Bosco, Caracas, Venezuela.

Multinational data on assisted reproduction techniques (IVF and intractytoplasmic sperm injection [ICSI], frozen embryo transfer, oocyte donation, preimplantation genetic diagnosis and fertility preservation) were collected from 159 institutions in 15 Latin American countries. A total of 41.34% of IVF-ICSI cycles were conducted in women aged 35-39 years and 23.35% in women aged 40 years and older. After removing freeze-all cases, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92% triplets and over. In oocyte donation, twins reached 28.93% and triplets 1.07%. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer represented 2.63% of fresh transfers, with a 32.15% delivery rate per transfer. Elective double embryo transfer represented 23.74% of transfers, with a 41.03% delivery rate per transfer; 11,373 babies (62.6%) were singletons; 6398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory.
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http://dx.doi.org/10.1016/j.rbmo.2017.05.021DOI Listing
September 2017

Measuring the distribution of adolescent births among 15-19-year-olds in Chile: an ecological study.

J Fam Plann Reprod Health Care 2017 Oct 21;43(4):302-308. Epub 2017 Jun 21.

Program of Ethics and Public Policy in Human Reproduction (PREPRE), University Diego Portales, Santiago, Chile.

Background: Although within Latin America Chile has one of the lowest birth rates among adolescents, it has a high rate in comparison to other developed nations.

Aim: To explore trends in birth rates among adolescents by selected demographics in Chile.

Methods: The national trend in birth rates was examined for women aged 15-19 years between 1992 and 2012. The birth rates for regions and communes were calculated using birth and census data and were analysed to determine its relationship to the regional or communal poverty rate, which were obtained from the Casen Survey. Differences in educational attainment were explored among adolescents with first-order and second-order or higher births using the Chi-square test.

Results: The birth rate among adolescents has experienced a 25% decline in the past 20 years. Cross-regional variance in birth rates could not be explained by poverty rates. Within the Metropolitan Region, there is a positive correlation between poverty and adolescent birth rates. Among adolescents giving birth, 67% had completed 10-12 years of school at birth, but there is a significant difference in educational attainment between girls with a first-order and those with a higher-order birth.

Conclusions: In Chile, the adolescent birth rate varies greatly among regions and communes. This study found that urban and wealthy areas had lower birth rates than poor and rural ones, and that girls with a first-order birth had completed more years of school than girls with higher-order births.
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http://dx.doi.org/10.1136/jfprhc-2015-101230DOI Listing
October 2017

Outcome of assisted reproductive technology in overweight and obese women.

JBRA Assist Reprod 2017 06 1;21(2):79-83. Epub 2017 Jun 1.

Latin American Network of Assisted Reproduction.

Objective: The main objective of this study was to assess the prevalence of overweight and obesity among patients undergoing assisted reproductive technology (ART) in Latin America and its consequences on treatment outcomes.

Methods: We used the Latin American Registry of ART to obtain women's age and body mass index (BMI), cancellation rate, number of oocytes retrieved and embryos transferred, clinical pregnancy, live birth and miscarriage rates from 107.313 patients undergoing autologous IVF and ICSI during four years; a multivariable analysis was performed to determine the effect of BMI on cancellation, oocytes retrieved, pregnancy, live birth and miscarriage, adjusting for age, number of embryos transferred and embryo developmental stage upon embryo transfer, when appropriate.

Results: The prevalence of overweight and obesity was 16.1% and 42.4%, respectively; correcting for age of female partner, overweight and obesity were associated to an increase in the odds of cancellation and to a lower mean number of oocytes retrieved; after adjusting for age, number of embryos transferred and stage of embryo development at transfer, we found that the BMI category was not associated to a change in the likelihoods of pregnancy, live birth and miscarriage.

Conclusions: The prevalence of obesity among women seeking ART in Latin America is surprisingly high; however, BMI does not influence the outcome of ART performed in these women.
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http://dx.doi.org/10.5935/1518-0557.20170020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473698PMC
June 2017

The impact of endometriosis on the outcome of Assisted Reproductive Technology.

Reprod Biol Endocrinol 2017 Jan 24;15(1). Epub 2017 Jan 24.

Obstetrics and Gynecology, Hospital del Mar, Parc de Salut Mar de Barcelona, Barcelona, Spain.

Background: Endometriosis has been described to impair fertility through various mechanisms. However, studies evaluating the reproductive outcomes of women undergoing assisted reproductive technologies show controversial results. The aim of this study is to assess whether the reproductive outcome is impaired among women with endometriosis-associated infertility undergoing IVF.

Methods: A retrospective cohort study was performed, including women undergoing IVF reported by the Red Latinoamericana de Reproduccion Asistida (Redlara) registry, between January 2010 and December 2012. The study group included women with endometriosis-associated infertility, and the control group women with tubal factor, endocrine disorders or unexplained infertility. Women above 40 years, severe male factor and premature ovarian failure were excluded. The reproductive outcomes of between both groups were compared. The primary outcome was live birth. Secondary outcomes included clinical pregnancy, miscarriage, number of oocytes retrieved and number of fertilized oocytes. Outcomes were assessed after the first fresh IVF cycle, and were adjusted for age and number of embryos transferred.

Results: A total of 22.416 women were included (3.583 with endometriosis and 18.833 in the control group). Mean age of patients in the endometriosis group and control group was 34.86 (3.47) and 34.61 (3.91) respectively, p = 0.000. The mean number of oocytes retrieved were 8.89 (6.23) and 9.86 (7.02) respectively, p = 0.000. No significant differences were observed between groups in terms of live birth (odds ratio (OR) 1.032, p = 0.556), clinical pregnancy (OR 1.044, p = 0.428) and miscarriage rates (OR 1.049, p = 0.623). Women with endometriosis had significantly lower number of oocytes retrieved (incidence risk ratio (IRR) 0.917, 95% CI 0.895-0.940), however, the number of fertilized oocytes did not differ among the two groups when adjusting for the number of oocytes retrieved (IRR 1.003, p = 0.794). An age-stratified analysis was performed, and no differences were observed in the reproductive outcomes between groups for women aged under 35 and 35 to 40.

Conclusions: Reproductive outcomes among women undergoing IVF and diagnosed with endometriosis-associated infertility do not differ significantly from women without the disease. Although women with endometriosis generate fewer oocytes, fertilization rate is not impaired and the likelihood of achieving a live birth is also not affected.
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http://dx.doi.org/10.1186/s12958-016-0217-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260022PMC
January 2017

Addition of neither recombinant nor urinary luteinizing hormone was associated with an improvement in the outcome of autologous in vitro fertilization/intracytoplasmatic sperm injection cycles under regular clinical settings: a multicenter observational analysis.

Fertil Steril 2016 Dec 24;106(7):1714-1717.e1. Epub 2016 Sep 24.

Reproductive Medicine Unit, Clinica Las Condes, Las Condes, Chile; Program of Ethics and Public Policies in Human Reproduction, University Diego Portales, Santiago, Chile.

Objective: To determine whether the addition of either urinary or recombinant LH in patients undergoing routine clinical care improved the outcome in terms of the number of oocytes recovered for insemination or the delivery rate per initiated cycle.

Design: Cohort analysis.

Patient(s): Couples undergoing IVF/ICSI in 158 institutions in 15 countries in Latin America.

Setting: In vitro fertilization clinics.

Intervention(s): We compared the outcome of three different protocols of COH, including rFSH only, rFSH plus rLH, and rFSH plus hMG.

Main Outcome Measure(s): The number of mature oocytes recovered and inseminated; proportion of ETs at the blastocyst stage; clinical pregnancy, miscarriage, and delivery rates; proportion of cycles with embryo cryopreservation; and mean number of embryos cryopreserved.

Result(s): After correcting for the age of the female partner, body mass index, number of embryos transferred, and stage of embryo development at transfer, we found that LH addition was not associated with an increase in the mean number of metaphase II oocytes inseminated or with an increase in the delivery rate or changes in the miscarriage rate.

Conclusion(s): Our study strongly suggests that in routine clinical practice, the type of controlled ovarian stimulation-FSH alone or in combination with LH-has little impact on the outcome of assisted reproductive technology; therefore a more friendly and accessible alternative should be favored.
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http://dx.doi.org/10.1016/j.fertnstert.2016.09.003DOI Listing
December 2016

Assisted reproductive techniques in Latin America: The Latin American Registry, 2013.

JBRA Assist Reprod 2016 May 1;20(2):49-58. Epub 2016 May 1.

Unifertes, Venezuela.

Multinational data on assisted reproduction techniques undertaken in 2013 were collected from 158 institutions in 15 Latin American countries. Individualized cycle-based data included 57,456 initiated cycles. Treatments included autologous IVF and intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations. In autologous reproduction, 29.22% of women were younger than 35 years, 40.1% were 35-39 years and 30.6% were 40 years or older. Overall delivery rate per oocyte retrieval was 20.6% for ICSI and 25.4% for IVF. Multiple births included 20.7% for twins and 1.1% for triplets and over. In oocyte donations, twins reached 30% and triplets 1.4%. In singletons, pre-term births were 7.5%: 36.58% in twins and 65.52% in triplets. The relative risk for prematurity was 4.9 (95% CI 4.5 to 5.3) in twins and 8.7 (95% CI 7.6 to 10.0) in triplets and above. Perinatal mortality was 29.4 per 1000 in singletons, 39.9 per 1000 in twins and 71.6 per 1000 in high order multiples. Elective single embryo transfer represented only 2% of cycles, with delivery rate of 39.1% in women aged 34 years or less. Given the effect of multiple births and prematurity, it is mandatory to reduce the number of embryos transferred in the region.
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http://dx.doi.org/10.5935/1518-0557.20160013DOI Listing
May 2016

Assisted reproductive techniques in Latin America: the Latin American Registry, 2013.

Reprod Biomed Online 2016 Jun 8;32(6):614-25. Epub 2016 Mar 8.

Latin American Network of Assisted Reproduction (REDLARA), Uruguay; Unifertes, Venezuela.

Multinational data on assisted reproduction techniques undertaken in 2013 were collected from 158 institutions in 15 Latin American countries. Individualized cycle-based data included 57,456 initiated cycles. Treatments included autologous IVF and intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations. In autologous reproduction, 29.22% of women were younger than 35 years, 40.1% were 35-39 years and 30.6% were 40 years or older. Overall delivery rate per oocyte retrieval was 20.6% for ICSI and 25.4% for IVF. Multiple births included 20.7% for twins and 1.1% for triplets and over. In oocyte donations, twins reached 30% and triplets 1.4%. In singletons, pre-term births were 7.5%: 36.58% in twins and 65.52% in triplets. The relative risk for prematurity was 4.9 (95% CI 4.5 to 5.3) in twins and 8.7 (95% CI 7.6 to 10.0) in triplets and above. Perinatal mortality was 29.4 per 1000 in singletons, 39.9 per 1000 in twins and 71.6 per 1000 in high order multiples. Elective single embryo transfer represented only 2% of cycles, with delivery rate of 39.1% in women aged 34 years or less. Given the effect of multiple births and prematurity, it is mandatory to reduce the number of embryos transferred in the region.
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http://dx.doi.org/10.1016/j.rbmo.2016.02.012DOI Listing
June 2016

[Typologies and arguments about the use of assisted reproductive technologies among people living in Santiago, Chile].

Rev Med Chil 2015 Dec;143(12):1527-32

Background: Assisted reproductive technologies still generate debate about ethical moral and religious issues.

Aim: To analyze the opinions of the general public about the use of assisted reproduction technology (ART).

Material And Methods: This analysis used the information gathered in a survey about human reproduction and modern reproduction technologies applied to a random sample of 1,500 volunteers aged 18 to 65 years, living in Santiago, Chile. Also, data from 25 structured interviews and six focal groups of eight participants each was used. To typify opinions concerning the use of assisted reproductive technologies (ART), a multiple correspondence analysis was undertaken.

Results: People that support ART are non-religious young people of medium-high socioeconomic level. The arguments most commonly used by people to justify their positions about ART are the right to have children, the protection of kinship, that ART implies commercialization and manipulation of human life, the need to obey God's will, and the autonomy of informed and educated adults.

Conclusions: The study allows us to understand in more complex ways the positions about ART. Chile does not have a legislation that regulates the use of ART. Generating information on the public opinion about these techniques we hope to contribute to the debate about the access and regulation of new reproductive technologies in Chile.
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http://dx.doi.org/10.4067/S0034-98872015001200004DOI Listing
December 2015

Effect of embryo freezing on perinatal outcome after assisted reproduction techniques: lessons from the Latin American Registry of Assisted Reproduction.

Reprod Biomed Online 2015 Jul 27;31(1):39-43. Epub 2015 Mar 27.

Unit of Reproductive Medicina Unit, Clinica Las Condes, Chile; Program of Ethics and Public Policies in Human Reproduction, University Diego Portales, Chile.

Embryo cryopreservation is an integral part of assisted reproduction techniques; it allows the sequential transfer of all embryos, thus diminishing the risk of multiple pregnancies and associated perinatal complications. To address concerns about the safety of this procedure, neonatal outcome after 43,070 fresh embryo transfers was compared with 12,068 frozen-thawed embryo transfers (FET). After adjusting for maternal age, gestational age, embryo development at time of transfer, number of babies born and gestational order, FET was not found to be associated with an increase in perinatal mortality (odds ratio [OR] 1.72, 95% confidence interval [CI] 0.81 to 3.62); preterm birth (OR 1.05, 95% CI 0.93 to 1.18); or extreme preterm birth (OR 0.82, 95% CI 0.64 to 1.06). Furthermore, after correcting for known confounding factors, FET was found to be associated with an increase in neonatal weight of 39.7 g (95% CI 1.54 to 64.10; P < 0.0001). Embryo cryopreservation was, therefore, not associated with an increase in the risk of poor perinatal outcome.
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http://dx.doi.org/10.1016/j.rbmo.2015.03.006DOI Listing
July 2015

International committee for monitoring assisted reproductive technologies: world report on assisted reproductive technologies, 2007.

Fertil Steril 2015 Feb 13;103(2):402-13.e11. Epub 2014 Dec 13.

Egyptian In Vitro Fertilization-Embryo Transfer Center, Cairo, Egypt.

Objective: To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years.

Design: Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during 2007.

Setting: Not applicable.

Patient(s): Infertile women and men undergoing ART globally.

Intervention(s): Collection and analysis of international ART data.

Main Outcome Measure(s): Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality.

Result(s): Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh in vitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged ≥40 years increased to 19.8% from 15.5% in 2006.

Conclusion(s): The international trend toward <3 transferred embryos continued, as did the wider uptake of FET. This was achieved without compromising delivery rates. The application of ART for women aged >40 years was a major component of ART services in some regions and countries.
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http://dx.doi.org/10.1016/j.fertnstert.2014.11.004DOI Listing
February 2015

Assisted reproductive technologies in Latin America: the Latin American Registry, 2012.

Reprod Biomed Online 2015 Jan 22;30(1):43-51. Epub 2014 Oct 22.

Fertipraxis- Centro de Reprodução Humana, Av. das Américas, 4.666 grupos 312/313, Rio de Janeiro, Brasil.

Multinational data on assisted reproduction technologies were collected from 155 institutions in 14 Latin American countries during 2012. Case-by-case data included 47,326 assisted reproduction technology cycles covering over 80% of cycles carried out in Latin America. Treatments included IVF, intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations and fertility preservation. Embryo transfer and IVF-ICSI was carried out in 39% of women aged 35-39 years and 31% of women aged 40 years or over. Delivery rate per oocyte retrieval was 20.9% for ICSI and 26.5% for IVF. Multiple births comprised 20.6% twins and 1.2% triplets and over. In oocyte donations, twins reached 27.8% and triplets and over 2.4%. Pre-term births in singletons were 14%. The relative risk of prematurity increased by 4.30 (95% CI 4.1 to 4.6) in twins and 43.8 (95% CI 28.5 to 67.4) in triplets and higher. Perinatal mortality increased from 25.2 per thousand in singletons to 44.4 in twins and 80.7 in triplets and over. Elective single embryo transfer was carried out in only 1.4%, of cycles, with a delivery rate of 30% in women 34 years or younger, and should be considered the way forward provided access is facilitated with public funding.
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http://dx.doi.org/10.1016/j.rbmo.2014.10.003DOI Listing
January 2015

[Medical and ethical basis for embryo cryopreservation].

Rev Med Chil 2014 Jul;142(7):896-902

As part of Assisted Reproductive Technologies (ART), the advent of embryo freezing lowered the number of embryos transferred, decreasing multiple births without jeopardizing pregnancy rates. Using vitrification technology, 90% of embryos survive after thawing, producing clinical pregnancy rates similar to those of fresh embryos (41.6%y 44.3% respectively). Furthermore, cumulative pregnancy rates, obtained after transferring fresh plus frozen/thawed embryos, can reach 70%. Frozen embryo transfers (FET) are reported by six of seven institutions, which are part of the Chilean ART registry, and altogether constitute 22.8% of all ART procedures. Increasing use of cryopreservation lowered overall multiple gestations from 33% in 1995 to 23% in 2011, reducing pre term births and perinatal mortality. For many people, embryo freezing generates ethical dilemmas, due to the potential risks to which embryos are exposed, and the uncontrolled accumulation and disposal of human embryos. Scientific evidence today shows that frozen/thawed embryos are not exposed to disproportionate risks, and by hindering its use, both women and their children are exposed to the risks of multiple gestation, repeated cycles of ovarian hormonal stimulation or the impossibility to afford repeated ART cycles. In this article, we provide biomedical, as well as ethical, arguments to sustain that embryo cryopreservation is not only justified but fundamental when offering infertility treatment with ART.
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http://dx.doi.org/10.4067/S0034-98872014000700010DOI Listing
July 2014

International Committee for Monitoring Assisted Reproductive Technologies world report: Assisted Reproductive Technology 2006.

Hum Reprod 2014 Jul 2;29(7):1536-51. Epub 2014 May 2.

Study Question: What are the access, effectiveness and safety of assisted reproductive technology (ART) worldwide in 2006?

Summary Answer: ART access, effectiveness and safety vary markedly among countries. Overall, there was an increase in the use of ICSI, single embryo transfer (SET) and frozen embryo transfer (FET). There was a decline in the multiple delivery rate (DR) and preterm birth rate.

What Is Known Already: ART is widely practiced worldwide and there is a need for its continuous monitoring to improve the comprehensiveness and quality of ART data and services.

Study Design, Size, Duration: This is a retrospective, cross-sectional survey of ART cycles undertaken worldwide in 2006.

Participants, Setting, Methods: A total of 2352 clinics in 56 countries provided data. Data were analyzed at a country and regional level. The forms for data collection were developed by the International Committee Monitoring Assisted Reproductive Technologies (ICMART) and sent to each country or regional ART register.

Main Results And The Role Of Chance: A total of >1,050,300 initiated cycles resulted in an estimated >256,668 babies. The overall pregnancy rates (PRs) and DRs per aspiration for IVF were 30.7 and 22.8%, respectively, and for ICSI 29.7 and 20.0%, respectively. The PRs and DRs for FETs were 26.4 and 17.8%, respectively. Multiple DR per PR were 22.2% for twins and 1.5% for triplets following fresh IVF/ICSI and 16.4% for twins and 0.8% for triplets for FETs. Ovarian hyperstimulation syndrome complicated >4585 cycles (0.6%). Access to ART varied from 11 to 3988 cycles per million population. ICSI comprised 66.0% of all initiated cycles, FET 27.4% and SET 20.7%. Perinatal mortality rate was 25.2 per 1000 births for fresh IVF/ICSI and 17.5 per 1000 for FETs.

Limitations, Reasons For Caution: 44.6% of the countries provided incomplete data. Quality of data varies among individual countries and is dependant on the policy of the local regulatory authority for monitoring ART clinics. Continuous efforts are needed to improve comprehensiveness and quality of data collected.

Wider Implications Of The Findings: Adopting the policy of SET, FET and the cessation of transferring more than two embryos should be widely applied. ICMART will continue helping countries and regions to establish their own ART registries.

Study Funding/competing Interest(s): ICMART receives financial support from medical societies: European Society for Human Reproduction and Embryology (ESHRE), American Society for Reproduction Medicine (ASRM), Fertility Society of Australia (FSA), Japan Society for Reproductive Medicine (JSRM), Latin American Network for Reproductive Medicine (REDLARA) and Middle East Fertility Society (MEFS) and Society for Assisted Reproductive Technology (SART). All authors have no conflict of interest in relation to this work. We declare no support or financial relationship with any organizations or any activities that could appear to have influenced the submitted work.
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http://dx.doi.org/10.1093/humrep/deu084DOI Listing
July 2014

[Opinion survey on the use of assisted reproductive technologies applied to inhabitants of Santiago, Chile].

Rev Med Chil 2013 Jul;141(7):853-60

Programa de Ética y Políticas Públicas en Reproducción Humana, Universidad Diego Portales, Santiago, Chile.

Background: Advances in reproductive medicine and the use of assisted reproductive technologies (ART) have a great impact in the lives of people and the conformation of their families.

Aim: To report the results of an opinion survey applied to inhabitants of Santiago, Chile about the use of ART to conceive.

Material And Methods: A survey was designed and applied to a random representative sample of 1.500 people between the ages of 18 and 65 in the 34 municipalities of Santiago.

Results: Eighty eight percent of respondents support the use of medical assistance to conceive children. Wide approval exists for the use of in vitro fertilization (IVF) by heterosexual couples, even when not married (85.9%) and by single women (70.4%), by both mole and female participants of every socioeconomic level, age group and religious affiliation. Support decreases significantly when the use of IVF is considered for post-menopausal women (35.1 %) and by same-sex couples (26.6%).

Conclusions: Results of this survey indicate that the majority of inhabitants in Santiago favor the use of ART, including IVF. This support decreases significantly for elderly women and homosexual couples.
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http://dx.doi.org/10.4067/S0034-98872013000700004DOI Listing
July 2013