Cir Cir 2012;80:285-286

Readability of Education and Consent Forms in Assisted Reproduction Procedures of the Latin American Network of Assisted Reproduction (RED) To the Editor: An article recently appeared in Cirugia y Cirujanos that referred to the Readability of Education and Consent Forms Procedures in Assisted Reproduction Procedures in the Latin American Network of Assisted Reproduction (RED). The conclusion reached in the paper is that the eight forms have a somewhat difficult readability, which corresponds to the INFLESZ scale for printed or scientific texts, making them difficult to understand for an average reader. On this basis we can propose modifications to improve formal readability.1 Recognizing that bioethics is an important element in clinical care in all areas of medicine including infertility, a meeting of experts was coordinated by the Bioethics Interest Group LARA Network. An external consultant was invited to the Network in the capacity as a bioethics specialist, particularly as relates to assisted reproductive techniques. The working group reworked the written forms of the process of informed consent for assisted reproduction procedures, currently a manual containing 23 forms.2 These forms include a translation into Portuguese.3 In addition to increasing the number of forms, the quality of services has also improved because the forms have a linguistic readability according to the INFLESZ scale as very easy, indicating that comprehension applies to persons with a basic level of education. Mara Teresa Urbina Grupo de Inters en Biotica de Red LARA UNIFERTES Anexo A, piso 4 de la Clnica El vila Av. San Juan Bosco esq. Sexta Transversal Altamira, Caracas, Venezuela, CP 1060 Tel. and FAX: 2761876 E-mail: mturbina@hotmail.com

References
1. lvarez-Daz JA. Legibilidad de los formularios de educacin y consentimiento en procedimientos de reproduccin asistida de la Red Latinoamericana de Reproduccin Asistida. Cir Ciruj 2012;80:162 170. 2. Gallardo Lozano E, Borges de Souza MC, Bronfenmajer S, Urbina MT, lvarez-Daz JA. Consentimientos Red Latinoamericana de Reproduccin Asistida. Mxico, DF: Red Latinoamericana de Reproduccin Asistida 2009 (consulted 2012 March 26). Available at: http://www.redlara.com/images/arq/consentimentos%20informa dos%20esp.pdf 3. Gallardo Lozano E, Borges de Souza MC, Bronfenmajer S, Urbina MT, lvarez-Daz JA. Consentimentos Red Latinoamericana de Reproduccin Asistida. Mxico, DF: Red Latinoamericana de Reproduccin Asistida 2009 (consulted 2012 March 26). Available at: http://www.redlara.com/images/arq/consentimentos%20informa dos%20port.pdf

Letter to the Editor Reply to Letter: Readability of Education and Consent Forms in Assisted Reproduction Procedures of the Latin American Network of Assisted Reproduction (RED) To the Editor: Understanding the process of informed consent is of utmost importance as a process that should include an appropriate written form to provide evidence that we have achieved the basic objectives of this process. It is therefore important that the Network now includes 23 LARA forms for various procedures of low- and high complexity [controlled ovarian stimulation, intrauterine insemination, intrauterine insemination with donor, gamete transfer to the Fallopian tube, in vitro fertilization and embryo transfer, in vitro fertilization and embryo transfer with sperm donor, in vitro fertilization and embryo transfer with egg donor, egg donation, intracytoplasmic sperm injection, embryo cryopreservation, cryopreservation of pronuclear stage oocytes, cryopreservation of oocytes, thawing of embryos and embryonic

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transfer, embryo donation, embryo thawing and transfer of donor embryos, in vitro fertilization/surrogate uterus (form for genetic mother), in vitro fertilization/surrogate uterus (form for the surrogate mother), intrauterine insemination in HIV+ males, intrauterine insemination in HIV+ females, anesthesia procedures in assisted reproductive technologies, preimplantation genetic diagnosis, recovery of sperm from the epididymis or testis, and in vitro maturation of eggs].1 It is also very important that the forms have a minimum number of sections: objectives; explanations, benefits, risks, inconveniences and side effects, treatment alternatives, alternatives to treatment failure, explanation for reasons leading to patient decision, and explicit instructions stating that consent may be revoked at any time.1 It is also very important to allow sufficient space to customize the written form (because the process is also customized). This also improves, in some way, the readability of the linguistic material in written form. From the population point of view, it is clear that this is a benefit for persons who seek assisted human reproduction technologies in facilities related to the LARA Network (135 centers in 11 countries). As of 2009 (most recent available data),2 27,401 cycles were initiated, 25,152 follicular aspirations and 35,287 embryo transfers were performed (to mention only some statistics, which increase every year). From an individual point of view, in medicine we must not lose sight of the fact that, since the time of Hippocrates, each individual is a specific human being. Therefore, the informed consent process should also be individualized. To achieve this, ethical dimensions should

always be considered in the context of patient-centered medicine.3 Jorge Alberto lvarez Daz Departamento de Atencin a la Salud Universidad Autnoma MetropolitanaUnidad Xochimilco Mxico, D.F., Mexico Edificio A, 2 piso rea de Postgrados en Ciencias Biolgicas y de la Salud Calzada del Hueso 1100, Col. Villa Quietud, Del. Coyoacn CP 04960. Mxico, D.F., Mexico Tel: 54837204 and 54837118, ext. 19 E-mail: bioetica_reproductiva@hotmail.com References
1. Gallardo Lozano E, Borges de Souza MC, Bronfenmajer S, Urbina MT, lvarez-Daz JA. Consentimientos Red Latinoamericana de Reproduccin Asistida. Mxico, DF: Red Latinoamericana de Reproduccin Asistida; 2009 (consultado 2012 April 12). Available at: http://www.redlara.com/images/arq/consentimentos%20informados%20esp.pdf 2. Zegers-Hochschild F, Schwarze JE, Musri C, Crosby J. Registro Latinoamericano de Reproduccin Asistida 2009. Santiago de Chile: Red Latinoamericana de Reproduccin Asistida 2011 (consulted 2012 April 12). Available at: http://www.redlara.com/images/arq/Registro2009.pdf 3. Balint E. The possibilities of patient-centered medicine. J R Coll Gen Pract 1969;17:269276.

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