ABSTRACT 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.

RESUMEN Introducción y objetivos: Aunque la criopreservación embrionaria es frecuentemente utilizada como parte de las técnicas de reproducción asistida, no existe información cuantitativa de cómo las parejas infértiles viven la experiencia de tener embriones criopreservados en Chile. El objetivo del estudio fue examinar las percepciones y creencias que tienen mujeres y hombres respecto de sus embriones criopreservados, sus perspectivas respecto de la donación reproductiva y destino de los embriones remanentes. Metodología: 153 mujeres y hombres con embriones criopreservados provenientes de un hospital público, Instituto de Investigaciones Materno Infantil y un centro privado, Clínica Las Condes, en Santiago, Chile, respondieron durante mayo 2015 a mayo 2016 un cuestionario en línea, anónimo, respecto de sus percepciones y creencias sobre criopreservación embrionaria. Resultados: Los encuestados reconocen a sus embriones criopreservados como un hijo (53.2%) o un proyecto de hijo (40.7%). Sólo 8% los considera un grupo organizado de células; sobre el 60% rechaza la opción de descartarlos o usarlos para investigación. Los participantes del hospital público tenían mayor disposición a donar sus embriones remanentes a otras parejas que aquellos del privado (61% vs 40%; P=0.016). Un 34% de las personas encuestadas estuvo de acuerdo con donar embriones a parejas de un mismo sexo. Conclusión: Este estudio muestra que las personas chilenas tienen un vínculo emocional con sus embriones criopreservados y no consideran descartarlos. Los resultados de este estudio pueden servir para dar adecuada consejería a las personas que se realizan técnicas de reproducción asistida, de tal modo de tomar decisiones informadas respecto de la criopreservación.

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.

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.

The Inter-American Court of Human Rights has ruled that the Supreme Court of Costa Rica's 2000 judgment prohibiting in vitro fertilization (IVF) violated the human right to private and family life, the human right to found and raise a family, and the human right to non-discrimination on grounds of disability, financial means, or gender. The Court's conclusions of violations contrary to the American Convention on Human Rights followed from its ruling that, under the Convention, in vitro embryos are not "persons," and do not possess a right to life. Accordingly, the prohibition of IVF to protect embryos constituted a disproportionate and unjustifiable denial of infertile individuals' human rights. The Court distinguished fertilization from conception, since conception, unlike fertilization, depends on an embryo's implantation in a woman's body. Under human rights law, legal protection of an embryo "from conception" is inapplicable between its creation by fertilization and completion of its implantation in utero.

La Corte Interamericana de Derechos Humanos dictaminó que la sentencia de la Corte Suprema de Justicia de Costa Rica del año 2000, que prohibió la fecundación in vitro (FIV), infringe el derecho humano a la vida privada y la vida familiar, el derecho humano a fundar y criar una familia, y el derecho humano a la no discriminación en base a discapacidad, situación económica, o género. Las conclusiones de la Corte Interamericana respecto de las violaciones a la Convención Americana de Derechos Humanos, se traducen en que de acuerdo con la Convención los embriones in vitro no son "personas," y no tienen derecho a la vida. Consecuentemente, la prohibición de la FIV con el objeto de proteger a dichos embriones constituye una denegación desproporcionada e injustificable de los derechos humanos de las personas infértiles. La Corte distingue entre fecundación y concepción, donde la concepción, a diferencia de la fecundación, depende de la implantación del embrión en el cuerpo de la mujer. De acuerdo con el derecho de los derechos humanos, la protección jurídica de un embrión "desde la concepción" es inaplicable en el período que se comprende entre su creación mediante la fecundación y la implantación intrauterina. Conclusión: La Corte Interamericana de Derechos Humanos dictaminó que la FIV cumple un servicio en favor de los derechos humanos, los embriones in vitro no son "personas", y no tienen derecho jurídico a la vida.

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.

Modern reproductive technologies, particularly in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), have made possible the establishment of new families through the birth of hundreds of thousands of children worldwide. Meanwhile, these technologies have compelled men to face the possibility of intervening at the very origins of their own biological existence, hence creating doubts and questions beyond the domain of medical science. Society is now asking itself whether all that is scientifically and technically possible is necessarily beneficial to mankind. The answer to this question is not to be found in biological science alone, but instead requires multidisciplinary reflection including all forms of knowledge: philosophical, bioethical, and religious, all contributing to the unavoidable adventure that we are endowed with in the search for a better life.

La Fecundación In Vitro (FIV) y la Transferencia de Gametos a la Trompa de Falopio (GIFT) han hecho posible el nacimiento de cientos de miles de niños. Estas tecnologías han puesto al hombre frente a frente a la posibilidad de intervenir en los inicios de su propia existencia. La pregunta es si aquello que es científica y técnicamente factible es bueno para el hombre. La respuesta requiere de una reflexión multidisciplinaria. La filosofía, la bioética y las distintas corrientes religiosas tienen un grano de arena que aportar a este gran desafío.

Modern reproductive technologies, particularly in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), have made possible the establishment of new families through the birth of hundreds of thousands of children worldwide. Meanwhile, these technologies have compelled men to face the possibility of intervening at the very origins of their own biological existence, hence creating doubts and questions beyond the domain of medical science. Society is now asking itself whether all that is scientifically and technically possible is necessarily beneficial to mankind. The answer to this question is not to be found in biological science alone, but instead requires multidisciplinary reflection including all forms of knowledge: philosophical, bioethical, and religious, all contributing to the unavoidable adventure that we are endowed with in the search for a better life.

La Fecundación In Vitro (FIV) y la Transferencia de Gametos a la Trompa de Falopio (GIFT) han hecho posible el nacimiento de cientos de miles de niños. Estas tecnologías han puesto al hombre frente a frente a la posibilidad de intervenir en los inicios de su propia existencia. La pregunta es si aquello que es científica y técnicamente factible es bueno para el hombre. La respuesta requiere de una reflexión multidisciplinaria. La filosofía, la bioética y las distintas corrientes religiosas tienen un grano de arena que aportar a este gran desafío.