Assisted reproductive technologies in Latin America: the Latin American Registry, 2019

Zegers‐Hochschild, Fernando; Crosby, Javier; Musri, Carolina; Souza, María do Carmo Borges de; Martinez, A Gustavo; Silva, Adelino Amaral; Mojarra, José María; Masoli, Diego; Posada, Natalia; Reproduction, Latin American Network Of Assisted

doi:10.5935/1518-0557.20220034

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…Second, it could be argued that the study population may not have adequately represented the ART group, since those who had uncomplicated pregnancy after ART may have chosen to deliver elsewhere. However, the observed proportion of ART pregnancies attended in our institution was above the expected according to national rates of ART deliveries [67]. Third, we are aware that formulas for EFW have never been validated before 24 weeks.…”

Section: Discussionmentioning

confidence: 87%

Fetal Growth Velocity according to the Mode of Assisted Conception

Bull¹,

Ávila²,

Vargas³

et al. 2023

Fetal Diagn Ther

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Introduction: Pregnancies conceived through assisted reproductive techniques (ARTs) are on the rise worldwide and have been associated with a higher risk of placental-related disease in the third trimester. Methods: A cohort was created of singleton pregnancies after assisted reproduction, admitted at our institution for delivery, between January 2020 and August 2022. Fetal growth velocity from the second trimester to delivery was compared against a gestational-age-matched group of pregnancies spontaneously conceived according to the origin of the selected oocyte (i.e., autologous vs. donated). Results: 125 singleton pregnancies conceived through ART were compared to 315 singleton spontaneous conceptions. Overall, after adjusting for possible confounders, multivariate analysis demonstrated that ART pregnancies had a significantly lower estimated fetal weight (EFW) z-velocity from the second trimester to delivery (adjusted mean difference = −0.002; p = 0.035) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 2.32 [95% CI, 1.15–4.68]). Also, when ART pregnancies were compared according to the type of oocyte, those conceived with donated oocytes showed a significantly lower EFW z-velocity from the second trimester to delivery (adjusted mean difference = −0.008; p = 0.001) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 5.33 [95% CI, 1.34–21.5]). Conclusions: Pregnancies achieved through ART exhibit a pattern of lower growth velocity across the third trimester, especially those conceived with donated oocytes. The former represents a sub-group at the highest risk of placental dysfunction that may warrant closer follow-up.

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Section: Discussionmentioning

confidence: 87%

Fetal Growth Velocity according to the Mode of Assisted Conception

Bull¹,

Ávila²,

Vargas³

et al. 2023

Fetal Diagn Ther

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“…Of all fresh transfers, SET continued to increase, from 36.2% as reported in 2019 (Zegers-Hochschild et al, 2022), to 38.3% in 2020, and 90.6% of all fresh transfers included a maximum of two embryos (Figure 4). The effect of the number of embryos transferred on the CPR, delivery rate and multiple births can be seen in Figure 4.…”

Section: Outcome Of Autologous Fresh Ivf and Icsi Cycles According To...mentioning

confidence: 92%

ART in Latin America: the Latin American Registry, 2020

Zegers-Hochschild,

A Crosby,

Musri

et al. 2023

JBRA

Self Cite

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Research question What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2020? Design Retrospective collection of multinational data on ART performed by 188 institutions in 16 countries. Results Overall, 87,732 initiated cycles resulted in 12,778 deliveries and 14,582 births. The major contributors were Brazil (46.0%), Mexico (17.0%) and Argentina (16.8%). However, the highest utilization (cycles/million inhabitants) was Uruguay with 558, followed by Argentina with 490 and Panama with 425 cycles/million. Globally, women aged ≥40 years increased to 34% while women ≤34 dropped to 24.7%. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 14.8% for intracytoplasmic sperm injection and 15.6% for IVF. Single-embryo transfer (SET) represented 38.3% of all fresh transfers, with delivery rate per transfer of 20.0%; this increased to 32.4% for elective SET (eSET) and 34.2% for blastocyst eSET, compared with blastocyst elective double embryo transfer (eDET) of 37.9%. However, multiple births increased from 1% in eSET to 30.5% in eDET. Perinatal mortality increased from 7.7‰ in singletons to 24.4‰ in twins and 64.0‰ in triplets. Frozen embryo transfer (FET) represented 66.6% of all transfers, with a delivery rate/transfer of 29.0%, significantly higher than 23.9% after fresh transfers at all ages ( p <0.0001). Preimplantation genetic testing, reported in 8920 cycles, significantly improved delivery rate and decreased miscarriage rates at all ages ( p ≤0.041), including oocyte donation ( p =0.002). Endometriosis was diagnosed in 28.3% of cases. The delivery rate in 5779 women after removal of peritoneal endometriosis was significantly better than tubal and endocrine factors in women aged 35-39 ( p =0.0004) and women aged ≥40 ( p =0.0353). Conclusions Systematic collection and analysis of big data in a south-south cooperation model allow regional growth by implementing evidence-based reproductive decisions.

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“…Como hemos intentado argumentar a lo largo de este trabajo, encontramos tres grandes formas de problematizar la adopción de tecnologías reproductivas como el PGT en el contexto latinoamericano. Una de ellas, que puede tal vez considerarse la más tradicional, cuestiona los sesgos de producción de conocimiento que en este caso se hacen evidentes, por un lado, en la subrepresentación de las comunidades latinoamericanas en las bases de datos utilizadas para el cálculo de riesgos genéticos y, por otro, en las dificultades para generar datos fiables sobre la aplicación de las tecnologías en los países de la región, dado que los únicos reportes existentes son voluntarios (10,54) . Como hemos mencionado, la escasa evidencia disponible es, en gran medida, construida por el sector privado-empresarial y depende también de la voluntad de los centros Una tercera forma de problematizar estas tecnologías requiere la operación de reflexionar sobre las tecnologías mismas y sus presupuestos en el contexto latinoamericano; dicha reflexión, menos habitual en la literatura sobre estas temáticas, es un ejercicio que puede plantearse desde la salud colectiva y la bioética latinoamericana a través del análisis crítico de las iniciativas de salud en su contexto social (55) .…”

Section: Conclusionesunclassified

De la salud colectiva a la medicina “personalizada”: desafíos bioéticos de la evaluación genética preimplantatoria desde la perspectiva norte-sur

Lima,

Petino Zappala,

Delvitto

et al. 2023

SCOL

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El artículo se interroga por los alcances y los límites del paradigma de la medicina de precisión y su relación con el enfoque de la salud colectiva. Para ello, se toma la evaluación genética preimplantatoria o PGT (preimplantation genetic testing) dado que constituye un ejemplo paradigmático de tecnologías que apuntan a la “individualización” de los procesos de salud. En esta dirección, se revisan las características y los fundamentos científico-normativos acerca de las tecnologías PGT en Argentina, y el camino que queda por recorrer para su análisis bioético. De manera más específica, se visibilizan algunas de las condiciones de posibilidad para su implementación desde la perspectiva norte-sur. Como síntesis del análisis, proponemos tres ejes o nudos problemáticos relacionados con los sesgos en la producción de conocimiento, los valores e intereses subyacentes a sus usos y los presupuestos epistemológicos que operan en la base de estas tecnologías. A lo largo de este trabajo, presentamos estos dilemas y sugerimos algunas recomendaciones para ser tenidas en cuenta en futuras investigaciones.

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Assisted reproductive technologies in Latin America: the Latin American Registry, 2019

Cited by 7 publications

References 6 publications

Fetal Growth Velocity according to the Mode of Assisted Conception

Fetal Growth Velocity according to the Mode of Assisted Conception

ART in Latin America: the Latin American Registry, 2020

De la salud colectiva a la medicina “personalizada”: desafíos bioéticos de la evaluación genética preimplantatoria desde la perspectiva norte-sur

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