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      Deseados pero abandonados: el incierto destino de los embriones criopreservados Translated title: Desitjats però abandonats: la incerta destinació dels embrions criopreservats Translated title: Desired but abandoned: the uncertain fate of cryopreserved embryos

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          Abstract

          Resumen La reproducción asistida, de la mano de ciencias afines como la genómica y la criobiología, ha transformado de modo vertiginoso el abordaje de la fertilidad, no solamente por los avances científico-técnicos, sino por la coyuntura social contemporánea. Como es conocido, en la actualidad se ha elevado el porcentaje de mujeres y parejas que deben recurrir a estas técnicas biomédicas y, con ellas, se han diversificado las etiologías de la infertilidad. El continuo avance por superar los obstáculos biológicos y ofrecer nuevas opciones con las que solventar la infertilidad, lleva también asociados interrogantes y dilemas éticos y normativos. Entre esos dilemas nos encontramos los usos y destinos de los embriones criopreservados sobrantes de las técnicas de reproducción asistida (TRA). Tras más de cuatro décadas de fecundación in vitro (FIV), la problemática surgida a raíz de la criopreservación embrionaria y la incesante acumulación de embriones parece no haber alcanzado su fin. Así, las diferentes opciones contempladas por la normativa vigente no acaban de satisfacer a los pacientes y profesionales para poder responder a la situación existente de almacenamiento de un número importante de embriones criopreservados en los biobancos de los centros de reproducción asistida, sin destino definido.

          Translated abstract

          Resum La reproducció assistida, de la mà de ciències afins com la genòmica i la criobiologia, ha transformat de manera vertiginosa l'abordatge de la fertilitat, no solament pels avanços cientificotècnics, sinó per la conjuntura social contemporània. Com és conegut, en l'actualitat s'ha elevat el percentatge de dones i parelles que han de recórrer a aquestes tècniques biomèdiques i, amb elles, s'han diversificat les etiologies de la infertilitat. El continu avanç per superar els obstacles biològics i oferir noves opcions amb les quals solucionar la infertilitat, porta també associats interrogants i dilemes ètics i normatius. Entre aquests dilemes ens trobem els usos i destinacions dels embrions criopreservats sobrants de les tècniques de reproducció assistida (TRA). Després de més de quatre dècades de fecundació in vitro (FIV), la problemàtica sorgida arran de la criopreservació embrionària i la incessant acumulació d'embrions sembla no haver aconseguit la seva fi. Així, les diferents opcions contemplades per la normativa vigent no acaben de satisfer als pacients i professionals per a poder respondre a la situació existent d'emmagatzematge d'un nombre important d'embrions criopreservats en els biobancs dels centres de reproducció assistida, sense destinació definida.

          Translated abstract

          Abstract Assisted reproduction, hand in hand with related sciences such as genomics and cryobiology, has vertiginously transformed the approach to fertility, not only because of scientific and technical advances, but also because of the contemporary social context. As is well known, a high percentage of women and couples who have to resort to this biotechnology and, with them, the aetiologies of infertility have diversified. The continuous progress in overcoming biological barriers and provide new therapeutic options to address infertility also raises ethical and regulatory questions and dilemmas. Among these dilemmas are the uses and purpose of cryopreserved embryos left over from assisted reproduction techniques. After more than four decades of in vitro fertilization (IVF), the concern arising from embryo cryopreservation and the incessant accumulation of embryos do not seem to have reached an end. Thus, the different options contemplated by the current regulations do not satisfy users and professionals to be able to respond to the existing situation of storage of a significant number of cryopreserved embryos in the biobanks of assisted reproduction clinics, with no defined destination.

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          Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method.

          To evaluate the outcome of oocyte vitrification using the Cryotop method, observed in an egg donation program by simultaneously evaluating embryos derived from vitrified and fresh oocytes coming from the same stimulated cycle. Cohort prospective randomized study. Instituto Valenciano de Infertilidad (IVI) Valencia, Spain. Thirty oocyte donors and 30 recipients with informed consents. Vitrification by the Cryotop method. Warming 1 hour after vitrification. Microinjection of surviving MII and fresh oocytes, evaluation of fertilization, embryo development, and clinical results. Survival, fertilization, and cleavage rate. Embryo quality, pregnancy rate (PR), and implantation rate. Survival rate observed was 96.7%. There was no difference in fertilization rates (76.3% and 82.2%), day 2 cleavage (94.2% and 97.8%), day 3 cleavage (80.8% and 80.5%), and blastocyst formation (48.7% and 47.5%) for vitrified and fresh oocytes, respectively. Embryo quality on day 3 and on day 5-6 were similar for vitrification and fresh oocyte group (80.8% vs. 80.5% and 81.1% vs. 70%, respectively). A total of 23 embryo transfers were carried out in the vitrification group. Pregnancy rates, implantation rates, miscarriage rates, and ongoing PR were 65.2%, 40.8%, 20%, and 47.8%, respectively. The Cryotop method preserves the potential of vitrified oocytes to fertilize and further develop, which is similar, when evaluated simultaneously, to fresh counterparts. Excellent clinical outcome indicates the possible use of this technology for egg donation programs, as well as a high potential for establishing oocyte banking.
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            Human pregnancy following cryopreservation, thawing and transfer of an eight-cell embryo

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              A 14-day limit for bioethics: the debate over human embryo research

              Background This article explores the reasons in favour of revising and extending the current 14-day statutory limit to maintaining human embryos in culture. This limit is enshrined in law in over a dozen countries, including the United Kingdom. In two recently published studies (2016), scientists have shown that embryos can be sustained in vitro for about 13 days after fertilisation. Positive reactions to these results have gone hand in hand with calls for revising the 14-day rule, which only allows embryo research until the 14th day after fertilisation. Main text The article explores the most prominent arguments in favour of and against the extension of the 14-day limit for conducting research on human embryos. It situates these arguments within the history of the 14-day limit. I start by discussing the history of the 14-day limit in the United Kingdom and the reasons behind the decision to opt for a compromise between competing moral views. I then analyse the arguments that those who are generally in favour of embryo research put forward in support of extending the 14-day rule, namely (a) the argument of the beneficence of research and (b) the argument of technical feasibility (further explained in the article). I then show how these two arguments played a role in the recent approval of two novel techniques for the replacement of faulty mitochondrial DNA in the United Kingdom. Despite the popularity and widespread use of these arguments, I argue that they are ultimately problematic and should not be straightforwardly accepted (i.e. accepted without further scrutiny). I end by making a case for respecting value pluralism in the context of embryo research, and I present two reasons in favour of respecting value pluralism: the argument of public trust and the argument of democracy. Conclusion I argue that 14-day limit for embryo research is not a valuable tool despite being a solution of compromise, but rather because of it. The importance of respecting value pluralism (and of respecting different views on embryo research) needs to be considered in any evaluation concerning a potential change to the 14-day rule.
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                Author and article information

                Journal
                bioetica
                Revista de Bioética y Derecho
                Rev. Bioética y Derecho
                Observatori de Bioètica i Dret - Cátedra UNESCO de Bioética (Barcelona, Barcelona, Spain )
                1886-5887
                2021
                : 53
                : 139-157
                Affiliations
                [1] orgnameHospital Universitario Marqués de Valdecilla orgdiv1Unidad de Reproducción Asistida orgdiv2Comité Ética Asistencial España
                [2] orgnameIDIVAL-Universidad de Cantabria orgdiv1Grupo de Investigación en Derecho Sanitario y Bioética España
                Article
                S1886-58872021000300139 S1886-5887(21)00005300139
                10.1344/rbd2021.53.36977
                10ef209a-82b9-4b28-8d6f-ca2fb54ef2b1

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 27 March 2021
                : 09 June 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 19
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                SciELO Spain

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                embriones,destinos,ética,reproducció assistida,criopreservació,embrions,destinacions,ètica,assisted reproduction,cryopreservation,embryos,destination,vitrification,ethics,reproducción asistida,criopreservación

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