Ansiedad en medicina reproductiva

Los aspectos emocionales y psicológicos, en general han sido poco estudiados en la población de las parejas que tienen problemas de fertilidad. Suele aceptarse que los problemas reproductivos causan repercusiones en la esfera psicológica, pero aún se discute que el factor psicológico pueda ser causa de problemas de fertilidad. Al iniciar este tipo de estudios, se sugirió que las mujeres con un rol femenino tradicional se muestran más ansiosas que los varones. Sin embargo, en buena medida lo anterior dependerá de las concepciones que se establezcan en torno a la relación entre masculinidad y paternidad, feminidad y maternidad.

Perspectiva de género

La perspectiva de género hace referencia a la concepción académica, ilustrada y científica que sintetiza la teoría, la filosofía y la política liberadoras, creadas por las mujeres en la cultura feminista.

El análisis de género feminista es detractor del orden patriarcal, contiene de manera específica una crítica a los aspectos nocivos, destructivos, opresivos y enajenantes que se producen por la organización genérica originada en la desigualdad, la injusticia, y la jerarquía política de las personas basadas en el género. La categoría de cautiverio para el género femenino y la de dominio para el masculino no pueden escapar al ámbito de la medicina reproductiva y a la posibilidad teórica, cada vez más real, de utilizar embriones humanos con fines de investigación.

La ansiedad de culpa

La ansiedad de culpa se puede asociar con la visión de desaprobación que tiene el cristianismo en occidente respecto de la medicina reproductiva en general y de la donación de embriones en particular, independientemente de si el fin es reproductivo o no. Se podría situar un primer momento del dominio patriarcal a través de la Iglesia y el control ejercido en la sexualidad y la reproductividad en la Familia, y un segundo momento de dominio patriarcal cuando, al no ser suficiente lo anterior, utiliza la medicina reproductiva como agente de dominio sobre el cautiverio femenino: el cautiverio de madresposa.

Ansiedad de separación

Para la ansiedad de separación se puede considerar lo que despierta la serie de procedimientos que intervienen en la tan tecnificada medicina reproductiva: la sensación de soledad que puede experimentar un cuerpo humano al auto percibirse como un cuerpo biológico, como un objeto más de la tecno ciencia al servicio de la reproducción humana. Soledad, aislamiento, pérdida de lo que se ha ganado o aislamiento de lo que está por ganarse a través de la técnica. Si se considera al embrión como un ente de igual valor ontológico que un individuo adulto, existirá mayor ansiedad de separación al donar embriones.

Consideraciones finales

Por diferentes mecanismos, la religiosidad de la cultura occidental, predominantemente cristiana, ha influido de diferentes formas para ello. Además, la consideración del estatus del embrión humano en un plano ontológico similar al de un individuo adulto, podría influir de otras formas. La temática de la donación de embriones deberá ser enriquecida con aportaciones de la antropología, el bio derecho, etc.

Reproductive medicine. Basic definitions

The different clinical presentations of infertility and sterility have given origin to their study in a novel area called reproductive medicine. Reproductive medicine is in charge of the prevention, diagnosis and opportune treatment of the problems of human fertility.

A reproductive problem is that one present in the couple who does not obtain a spontaneous pregnancy. Sterility is the inability of the man or the woman to conceive. Primary sterility is acknowledged when the couple, after a year of sexual relations without use of contraceptive method and with deliberate search of descendants, has not become pregnant. Secondary sterility occurs when the couple, after conceiving, does not obtain a new gestation after trying for two or more years. On the other hand, infertility is the inability to produce a living child. Therefore, primary infertility is suffered by the couple who has a gestation without a suitable ending (abortion, repeated loss of gestation, etc.), and the secondary infertility occurs when after a childbirth with at least one child being born alive, they cannot attain a new gestation upon maturity. After a complete medical evaluation, the treatment plan could include simple techniques of assisted fertilization (like the intrauterine insemination) or complex techniques of assisted fertilization (like IVF and ICSI).

IVF technique begins with the ovarian hyperstimulation with exogenous hormones, in a controlled way, and the transvaginal ovular capture guided by ultrasound; then, every ovum with a high quality is incubated with sperm treated previously in the gamete laboratory by an embryologist. After the gamete meeting, a culture of the zygote is done to be able to visualize the cellular division and thus to demonstrate its fertilization. Later the transference to the uterus is made. The pregnancy probability increases with the number of transferred embryos: 9% with one, 18% with two, 29% with three and 32% with four. The rest of produced embryos is cryopreserved. The success of the technique, understood like «baby in house», cannot exceed 40%, basically because the knowledge of the molecular mechanisms that regulate the implantation of the human embryo is still very limited.

ICSI technique consists in the same steps that the IVF, but differs in the way of fertilization, which is done here by a direct injection of a sperm into the cytoplasm of an ovum.

The use of these new techniques as tools to the service of human reproduction have undertaken the analysis and the debate in this kind of treatments, with special emphasis on the psycho-logical, social and ethical aspects. This is so because now appears the possibility (unthinkable before), of 5 relatives as parents: the genetic mother (the ovum producer), the biological mother (who held the pregnagcy), the social mother (who will take care of the product in postpartum), the genetic father (sperm producer), and the social father (who will take care of the product in postpartum).

Anxiety in reproductive medicine

The emotional and psychological aspects have been, in general, little studied and understood in the population of the couples that have fertility problems. Usually it is accepted that the reproductive problems have repercussions in the psychological sphere, but still it is discussed that the psychological factor is a cause of fertility problems. At the beginning of this type of studies, it could have suggested that women with a traditional feminine roll are more anxious than men, but they would not show levels of depression nor of sexual or marital dissatisfaction. Nevertheless, the taller will depend largely on the conceptions that settle down around the relation between masculinity and paternity, femininity and maternity.

Gender perspective

Gender perspective makes reference to the academic, illustrated and scientific conception that synthesizes the theory, the liberating philosophy and the policy, created by the women in the femnist culture. Gender perspective allows to analyze and to understand the characteristics that define women and men in a specific way, as well as their similarities and differences. This gender perspective analyzes the vital possibilities of women and of men: the sense of their lives, their expectations and opportunities, the complex and diverse social relations, that occur between both genders, as well as the institutional and daily conflicts that they must face and the ways in which they do it.

The feminist gender analysis is detractive of the patriarchal order, it contains specific criticism of the injurious, destructive, oppressive and alienated aspects that are present due to the generic organization based on the inequality, injustice, and political hierarchy sustained by people based on gender. The category of captivity for the feminine gender and of dominion for the masculine gender cannot escape to the scope of the reproductive medicine and to the theoretical possibility which is becoming more and more real, of using human embryos for research.

Guilt anxiety

Guilt anxiety can be associated independently with the disapproving vision of Christianity in the West, in respect to the reproductive medicine in general and to the donation of embryos in particular, wether its aim is reproductive or not. It would be possible to locate a first instance of patriarchal dominion through the Church and the exerted control over sexuality and reproductivity in the Family, and a second one of patriarchal dominion when the previous one not being enough, it uses reproductive medicine like a dominion agent on the feminine captivity, that is, the "motherspouse" captivity.

Separation anxiety

It is possible to consider what the series of procedures involved arouses in a so technified reproductive medicine: the solitude sensation that can experience a human body when self perceived by itself like a biological body; like another object more of the technological and science to the service of the human reproduction. Solitude, isolation, loss of what has been gained or isolation from what it is about to be gained through the technique (the non had son until the moment to go to receive diagnosis). If one considers the embryo like a being of equal ontological value that an adult, these will be a greater anxiety of separation when donating embryos.

Final considerations

Reproductive medicine has too many matters not sufficiently explored. Other sciences should make new theoretical constructions, besides psychology (which should study empirically and theoretically if the anxiety is the same when people is thinking about embryo donation, and when they are donating the embryos). For example, anthropology must review and (eventually) redefine some concepts as family, incest and others. Law must create new norms about gamete and embryo donation, and contribute with the legal definitions of "father", "mother", "son"; maybe even make laws regarding the legal disposition of cryopre-served embryos, etc. Finally, real world is too complicated as are our mental maps and schemes.