RESUMEN
Currently, both the U.S. Food and Drug Administration and American Society for Reproductive Medicine exclude sperm donation from men who have sex with men. The recommended screening includes questioning donors about their sexual practices and performing a physical examination to look for signs of anal intercourse in addition to standard human immunodeficiency virus (HIV) laboratory testing. The rationale cited is concern over increased risk of HIV transmission in this higher prevalence population. We were unable to find evidence that excluding men who have sex with men or those with signs of anal intercourse on physical examination decreases the false-negative rate of laboratory testing. Current policy allows for men who have sex with men to be prohibited from donating sperm for the use of gestational carriers and therefore discriminates against this population for whom assisted reproductive technology may be their only means of genetic reproduction. We suggest policy revision to include the most advanced HIV laboratory tests and eliminating exclusionary demographics as part of screening.
Asunto(s)
Infecciones por VIH/prevención & control , Política de Salud , Homosexualidad Masculina , Conducta Sexual , Donantes de Tejidos , VIH/aislamiento & purificación , Humanos , Masculino , Semen/virología , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Fetal or neonatal brain injury can result in lifelong neurologic disability. The most significant risk factor for perinatal brain injury is prematurity; however, in absolute numbers, full-term infants represent the majority of affected children. Research on strategies to prevent or mitigate the impact of perinatal brain injury ("perinatal neuroprotection") has established the mitigating roles of magnesium sulfate administration for preterm infants and therapeutic hypothermia for term infants with suspected perinatal brain injury. Banked umbilical cord blood, erythropoietin, and a number of other agents that may improve neuronal repair show promise for improving outcomes following perinatal brain injury in animal models. Other preventative strategies include delayed umbilical cord clamping in preterm infants and progesterone in women with prior preterm birth or short cervix and avoidance of infections. Despite these advances, we have not successfully decreased the rate of preterm birth, nor are we able to predict term infants at risk of hypoxic brain injury in order to intervene prior to the hypoxic event. Further, we lack the ability to modulate the sequelae of neuronal cell insults or the ability to repair brain injury after it has been sustained. As a consequence, despite exciting advances in the field of perinatal neuroprotection, perinatal brain injury still impacts thousands of newborns each year with significant long-term morbidity and mortality.