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Resultados de inseminación artificial (conyugales y de donante) del Registro Nacional de Actividad – Registro de la Sociedad Española de Fertilidad en los años 2018 y 2019
Luis Martínez-Granadosa, Irene Cuevasb, Fernando Pradosc, Isabel Ponsd, Montserrat de Andrése, Lourdes Sánchez-Castrof, Rafael Lafuenteg, María José de los Santosh, Julio Herreroi, Yolanda Cabelloj, Ana Belén Castelk, Ignacio Rodríguezl, Luis Gijónm, José Antonio Castillan,ñ,o,
Autor para correspondencia
josea.castilla.sspa@juntadeandalucia.es

Autor para correspondencia.
a Unidad de Reproducción Humana, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
b Unidad de Medicina Reproductiva, Hospital General Universitari, Valencia, España
c CGF Oyala, Ciudad de la Paz, Guinea Ecuatorial
d Unidad de Reproducción Humana García del Real, Instituto de Medicina EGR, Madrid, España
e Unidad de Reproducción, Hospital Universitario Reina Sofía, Córdoba, España
f Unidad de Reproducción HU Central de Asturias, Oviedo, España
g CIRH, EUGIN, Barcelona, España
h Laboratorio FIV, IVI, Valencia, España
i Centro de Reproducción Asistida, Hospital Universitari Vall d´Hebron, Barcelona, España
j OVERTURE LIFE, Alcobendas, Madrid, España
k Instituto de Fertilidad IFER, Mallorca, España
l Dexeus mujer, Barcelona, España
m FIV Valencia, Valencia, España
n Unidad de Reproducción, UGC Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Granada, España
ñ Instituto de Investigación Biosanitaria ibs GRANADA, Granada, España
o CEIFER Biobanco - NextClinics, Granada, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Introducci&#243;n</span><p id="p0005" class="elsevierStylePara elsevierViewall">En Europa se realizan anualmente m&#225;s de 200&#46;000 ciclos de inseminaci&#243;n artificial &#40;IA&#41; &#40;<a class="elsevierStyleCrossRef" href="#bb0025">European IVF-Monitoring Consortium &#91;EIM&#93; for the European Society of Human Reproduction and Embryology &#91;ESHRE&#93;&#44; 2021</a>&#41; y en China m&#225;s de 125&#46;000 &#40;<a class="elsevierStyleCrossRef" href="#bb0005">Bai et al&#46;&#44; 2016</a>&#41;&#44; por lo que&#44; a pesar de la controversia sobre su utilidad&#44; sigue siendo muy utilizada&#46; Espa&#241;a est&#225; entre los pa&#237;ses que m&#225;s ciclos realiza a nivel europeo &#40;<a class="elsevierStyleCrossRef" href="#bb0025">European IVF-Monitoring Consortium &#91;EIM&#93; for the European Society of Human Reproduction and Embryology &#91;ESHRE&#93;&#44; 2021</a>&#41;&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">En este trabajo los datos de IA conyugal &#40;IAC&#41; y de donante &#40;IAD&#41; del Registro Nacional de Actividad &#8211; Registro de la Sociedad Espa&#241;ola de Fertilidad &#40;RNA-Registro SEF&#41; de los a&#241;os 2018 y 2019 son presentados y se comparan con a&#241;os anteriores &#40;<a class="elsevierStyleCrossRef" href="#bb0015">Canales et al&#46;&#44; 2020</a>&#59; <a class="elsevierStyleCrossRef" href="#bb0010">Canales et al&#46;&#44; 2018</a>&#59; <a class="elsevierStyleCrossRef" href="#bb0050">Prado et al&#46;&#44; 2017</a>&#59; <a class="elsevierStyleCrossRef" href="#bb0055">Prados et al&#46;&#44; 2011</a>&#59; <a class="elsevierStyleCrossRef" href="#bb0070">Zamora et al&#46;&#44; 2014</a>&#59; <a class="elsevierStyleCrossRef" href="#bb0030">Fernandez-Shaw et al&#46;&#44; 2010</a>&#59; <a class="elsevierStyleCrossRefs" href="#bb0040">Hern&#225;ndez et al&#46;&#44; 2009a&#44; 2009b</a>&#41;&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Material y m&#233;todos</span><p id="p0015" class="elsevierStylePara elsevierViewall">El RNA-Registro SEF es un registro con datos agregados de pacientes por cl&#237;nicas&#46; Se analiza la participaci&#243;n de los centros a nivel nacional y auton&#243;mico&#46; Se describen las siguientes variables de la IAC e IAD&#58; ciclos&#44; gestaciones y tipo de estas &#40;&#250;nica&#44; gemelar&#44; triple o superior&#41;&#44; abortos&#44; embarazos ect&#243;picos&#44; tipo de parto&#44; y complicaciones&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Resultados</span><p id="p0020" class="elsevierStylePara elsevierViewall">El n&#250;mero de centros participantes en IA fue de 313 en 2018 y de 304 en 2019&#44; siendo las Comunidades Aut&#243;nomas de Catalu&#241;a y Madrid las que m&#225;s ciclos reportan &#40;<a class="elsevierStyleCrossRef" href="#t0005">tabla 1</a>&#41;&#46; La evoluci&#243;n de los ciclos realizados y de los centros participantes desde 2006 hasta 2019 se muestra en la figura 1&#46; La adecuada cumplimentaci&#243;n&#44; por parte de los centros&#44; del RNA-Registro SEF es obligatoria desde el a&#241;o 2014&#46; Observ&#225;ndose una disminuci&#243;n progresiva en el n&#250;mero de ciclos de IAC y un aumento en los ciclos de IAD a partir de este a&#241;o &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0025" class="elsevierStylePara elsevierViewall">El n&#250;mero total de ciclos recogidos del a&#241;o 2018 fue 34&#46;100&#44; siendo 21&#46;467 &#40;63&#44;0&#37;&#41; de IAC y 12&#46;633 &#40;37&#44;0&#37;&#41; de IAD&#46; El 92&#44;9&#37; de los ciclos se realizaron en las mujeres con una edad inferior a los 40 a&#241;os&#46; En los ciclos de IAC&#44; las mujeres menores de 40 a&#241;os representan el 96&#44;5&#37; de los casos y en los ciclos de IAD eran menores de 40 a&#241;os el 86&#44;9&#37; de los casos&#46; En el a&#241;o 2019 se recogieron 32&#46;548 ciclos&#44; siendo 18&#46;984 &#40;58&#44;33&#37;&#41; de IAC y 13&#46;564 &#40;41&#44;67&#37;&#41; de IAD&#46; El 93&#44;4&#37; de los ciclos se realizaron en menores de 40 a&#241;os&#46; En IAC las mujeres menores de 40 a&#241;os representan un 96&#44;8&#37; y en IAD un 88&#44;6&#37; &#40;<a class="elsevierStyleCrossRef" href="#t0010">tabla 2</a>&#41;&#46; El porcentaje total de gestaci&#243;n en los &#250;ltimos a&#241;os se ha mantenido constante&#44; tanto en IAC como en IAD &#40;<a class="elsevierStyleCrossRefs" href="#f0010">figs&#46; 2 y 3</a>&#41;&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia><p id="p0030" class="elsevierStylePara elsevierViewall">En IAC la tasa de embarazo &#250;nico fue ligeramente superior en las mujeres a partir de los 40 a&#241;os que en las mujeres menores de 40 a&#241;os &#40;89&#44;6&#37; frente a 88&#44;4&#37; en 2018 y 92&#44;1&#37; frente a 90&#44;0&#37; en 2019&#41;&#46; En IAD la tasa de embarazo m&#250;ltiple fue similar en las mujeres menores de 40 a&#241;os que a partir de los 40 a&#241;os en 2018 &#40;10&#44;7&#37; frente a 11&#44;3&#37;&#41;&#46; Sin embargo&#44; recuper&#243; la tendencia a ser menor en las mujeres a partir de los 40 a&#241;os en 2019 &#40;9&#44;1&#37; frente a 6&#44;4&#37;&#41;&#46; Respecto al total de gestaciones&#44; el porcentaje de gestaciones m&#250;ltiples es 11&#44;6&#37; en IAC y 10&#44;7&#37; en IAD en 2018 y de 9&#44;9&#37; en IAC y 8&#44;9&#37; en IAD en el a&#241;o 2019&#46; En la figura 3 se muestra la evoluci&#243;n de las tasas de gestaci&#243;n m&#250;ltiple en IAC e IAD respectivamente&#46; El descenso de la tasa de embarazo m&#250;ltiple en IAC observado desde el a&#241;o 2007&#44; sigue descendiendo en 2019&#44; siendo del 9&#44;9&#37;&#46; Igual ocurre con la tasa de embarazo m&#250;ltiple en IAD que contin&#250;a descendiendo&#44; y pasa de 13&#44;2&#37; en 2012 a 8&#44;9&#37; en 2019 &#40;<a class="elsevierStyleCrossRef" href="#f0015">fig&#46; 3</a>&#41;&#46; El porcentaje de embarazos triples y de m&#225;s de 3 sacos permanecen en cifras estables en torno al 0&#44;7&#37; para triples y 0&#44;1&#37; para m&#225;s de 3 sacos en ambos a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#t0010">tabla 2</a>&#41;&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">Respecto a la evoluci&#243;n de los embarazos de IAC existe un mayor porcentaje de abortos en las mujeres a partir de los 40 a&#241;os que en las mujeres menores de 40 a&#241;os &#40;34&#44;3&#37; frente 17&#44;4&#37; en 2018 y de 30&#44;2&#37; frente a 15&#44;9&#37; en 2019&#41;&#46; En IAD el porcentaje de abortos vuelve a ser mayor en las mujeres a partir de los 40 a&#241;os &#40;39&#44;5&#37; frente a 16&#44;2&#37; en 2018 y de 32&#44;9&#37; frente a 16&#44;9&#37; en 2019&#41;&#46; Con relaci&#243;n al total de partos&#44; observamos una tasa total de partos m&#250;ltiples de 11&#44;1&#37; en IAC y de 11&#44;7&#37; en IAD en 2018&#44; correspondiendo en 2019 unas cifras de 9&#44;7&#37; para IAC y de 7&#44;6&#37; para IAD&#44; siendo en ambos casos superior en las mujeres menores de 40 a&#241;os&#46; En 2019 no se registra ning&#250;n parto cu&#225;druple &#40;<a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0040" class="elsevierStylePara elsevierViewall">Se observa una tendencia a disminuir el porcentaje de embarazos de evoluci&#243;n desconocida&#44; que se sit&#250;a en un 3&#44;4&#37; del total de IA en 2018&#46; En IAC&#44; un 2&#44;5&#37; de los embarazos fue de evoluci&#243;n desconocida &#40;2&#44;6&#37; en las mujeres menores de 40 a&#241;os y 1&#44;5&#37; en las mujeres a partir de los 40 a&#241;os&#41; y un 4&#44;3&#37; para IAD &#40;4&#44;4&#37; en las mujeres menores de 40 a&#241;os y 3&#44;4&#37; en las mujeres a partir de los 40 a&#241;os&#41;&#46; Estas cifras de embarazos de evoluci&#243;n desconocida aumentan en 2019&#44; un 4&#44;6&#37; del total de IA&#44; siendo de 2&#44;4&#37; para IAC &#40;2&#44;3&#37; en las mujeres menores de 40 a&#241;os y 4&#44;8&#37; en las mujeres a partir de los 40 a&#241;os&#41; y un 4&#44;7&#37; para IAD &#40;5&#44;0&#37; en las mujeres menores de 40 a&#241;os y 1&#44;7&#37; en las mujeres a partir de los 40 a&#241;os&#41;&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">La atenci&#243;n a los deseos reproductivos de las parejas serodiscordantes mediante IA ha disminuido ligeramente&#44; suponiendo un 3&#44;6&#37; de las IAC realizadas en 2018 y un 2&#44;7&#37; en 2019&#46; El n&#250;mero total de ciclos IAC recogidos en las parejas serodiscordantes en el a&#241;o 2018 fue 761&#44; de los que 199 &#40;26&#44;1&#37;&#41; dieron lugar a la gestaci&#243;n&#46; En el a&#241;o 2019 el n&#250;mero total de ciclos de IAC recogidos en las parejas serodiscordantes fue de 511&#44; obteni&#233;ndose 52 gestaciones &#40;10&#44;2&#37;&#41;&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall">Respecto a las complicaciones de la t&#233;cnica&#44; solo se ha registrado el s&#237;ndrome de hiperestimulaci&#243;n ov&#225;rica en un 0&#44;03&#37; en 2018 y 0&#44;009&#37; en 2019 de los ciclos de IA iniciados&#44; La complicaci&#243;n m&#225;s frecuente ha sido la reducci&#243;n embrionaria en 0&#44;055&#37; de los ciclos de IA iniciados en 2019 &#40;<a class="elsevierStyleCrossRef" href="#t0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="t0020"></elsevierMultimedia></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Discusi&#243;n</span><p id="p0055" class="elsevierStylePara elsevierViewall">A pesar de la discusi&#243;n sobre la indicaci&#243;n de la IAC &#40;<a class="elsevierStyleCrossRef" href="#bb0065">Wang et al&#46;&#44; 2021</a>&#41;&#44; el n&#250;mero de ciclos de IA en Espa&#241;a y el resto del mundo es elevado &#40;<a class="elsevierStyleCrossRef" href="#bb0005">Bai et al&#46;&#44; 2016</a>&#59; <a class="elsevierStyleCrossRef" href="#bb0025">EIM for the ESHRE&#44; 2021</a>&#41;&#46; La tendencia a disminuir en este registro los ciclos de IAC puede relacionarse con el retraso en la b&#250;squeda del embarazo&#44; lo que hace que las mujeres con deseos reproductivos no cumplidos acudan a edades m&#225;s tard&#237;as a los centros de reproducci&#243;n&#44; edades en las que la IAC no ser&#237;a la mejor indicaci&#243;n&#46; Nuestros resultados confirman la importancia de la edad de las pacientes en los resultados de la IA&#44; tal como han demostrado otros autores &#40;<a class="elsevierStyleCrossRef" href="#bb0065">Wang et al&#46;&#44; 2021</a>&#59; <a class="elsevierStyleCrossRef" href="#bb0020">Dinelli et al&#46;&#44; 2016</a>&#41;&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">En el caso de la IAD&#44; donde se observa un incremento anual&#44; se podr&#237;a relacionar este aumento con el incremento de los nuevos modelos familiares en nuestro pa&#237;s y a la realizaci&#243;n de esta t&#233;cnica en las mujeres procedentes de pa&#237;ses vecinos como Francia o Italia&#44; donde no se realizan IAD a las mujeres con deseos de maternidad en solitario o parejas de personas con sexo biol&#243;gico mujer &#40;<a class="elsevierStyleCrossRef" href="#bb0060">Shenfield et al&#46;&#44; 2010</a>&#41;&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">Se mantiene la tendencia a disminuir la tasa de gestaci&#243;n m&#250;ltiple en IA&#44; siendo esta ligeramente inferior que en FIV &#40;<a class="elsevierStyleCrossRef" href="#bb0025">EIM for the ESHRE&#44; 2021</a>&#41;&#46; La tasa de gestaci&#243;n m&#250;ltiple en IAC se acerca a la observada en IAD&#46; Esto podr&#237;a deberse a un paulatino mejor uso de los protocolos de estimulaci&#243;n debido a que hay una mejor&#237;a en las indicaciones de la t&#233;cnica&#44; y por tanto un mejor pron&#243;stico &#40;<a class="elsevierStyleCrossRef" href="#bb0020">Dinelli et al&#46;&#44; 2016</a>&#41;&#46; Seg&#250;n los datos del RNA-Registro SEF del a&#241;o 2019&#44; de las pacientes que se realizaron una IAC el 55&#44;7&#37; eran menores de 35 a&#241;os&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">Entre las limitaciones de este trabajo&#44; destaca que&#44; al registrarse los datos por centro&#44; no es posible ajustar por n&#250;mero de espermatozoides inseminados ni por el n&#250;mero de ciclos realizados&#46; Sin embargo&#44; la tasa global de aproximadamente 13&#37; gestaciones por ciclo&#44; observada en nuestro pa&#237;s&#44; es similar a la de registros internacionales con muchos m&#225;s ciclos &#40;China 13&#44;3&#37; con 126&#46;872 ciclos registrados&#41; &#40;<a class="elsevierStyleCrossRef" href="#bb0005">Bai et al&#46;&#44; 2016</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#bb0035">Geisler et al&#46; &#40;2017&#41;</a> han recomendado realizar solo 2 ciclos de IAC&#44; ya que la mayor&#237;a de los embarazos con esta t&#233;cnica se consiguen en los 2 primeros ciclos&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; creemos que el futuro de IAD ser&#225; expansivo y el de la IAC tendr&#225; una evoluci&#243;n inversa en nuestro pa&#237;s&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Agradecimientos</span><p id="p0080" class="elsevierStylePara elsevierViewall">Los autores agradecen a todos los centros participantes en el Registro Nacional de Actividad &#8211; Registro de la Sociedad Espa&#241;ola de Fertilidad el esfuerzo realizado para recoger todos los datos que se muestran en este art&#237;culo&#44; as&#237; como la confianza depositada en el comit&#233; de este registro&#46;</p></span></span>"
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            0 => "T&#233;cnicas de reproducci&#243;n asistida"
            1 => "Inseminaci&#243;n intrauterina"
            2 => "Inseminaci&#243;n artificial conyugal"
            3 => "Inseminaci&#243;n artificial de donante"
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            3 => "Donor artificial insemination"
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        "titulo" => "Resumen"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Introducci&#243;n&#58; la inseminaci&#243;n artificial es una t&#233;cnica de reproducci&#243;n asistida ampliamente utilizada&#44; a pesar de la controversia sobre su utilidad&#46; En este trabajo se presentan los datos de IA conyugal &#40;IAC&#41; y de donante &#40;IAD&#41; del Registro Nacional de Actividad-Registro SEF &#40;RNA-Registro SEF&#41; de los a&#241;os 2018 y 2019&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Material y m&#233;todos&#58; los datos de la IAC e IAD recopilados por el RNA &#8211; Registro SEF durante los a&#241;os 2018 y 2019 son analizados&#46; Estos se comparan con los datos obtenidos en los a&#241;os anteriores&#46; Este es un registro obligatorio para los centros de reproducci&#243;n espa&#241;oles y con recogida de datos anuales agregados por centro&#44; monitorizando de forma aleatoria <span class="elsevierStyleItalic">in situ</span> los datos aportados por m&#225;s del 15&#37; de los centros participantes&#46; Se analizaron un total de 34&#46;100 ciclos en 2018 &#40;21&#46;467 ciclos de IAC y 12&#46;633 de IAD&#41; y 32&#46;548 ciclos en 2019 &#40;18&#46;984 ciclos de IAC y 13&#46;564 de IAD&#41;&#46;</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">Resultados&#58; el n&#250;mero de ciclos de IAC sigue disminuyendo y la IAD aumentando como en los &#250;ltimos a&#241;os&#46; No se han observado diferencias significativas en la tasa global de gestaciones por ciclo tanto para IAC &#40;2018&#58; 13&#44;1&#37;&#59; 2019&#58; 12&#44;8&#37;&#41; como para IAD &#40;2018&#58; 19&#44;0&#37; y 2019&#58; 18&#44;8&#37;&#41;&#46; El 11&#44;6&#37; de las gestaciones obtenidas mediante IAC fueron m&#250;ltiples en 2018&#46; Cifras cercanas aparecen en 2019 con 9&#44;9&#37;&#46; Resultados similares se han observado en IAD&#44; la tasa de gestaci&#243;n m&#250;ltiple en 2018 fue de 10&#44;7&#37; y en 2019 de 8&#44;9&#37;&#46; En ambas t&#233;cnicas se observa un descenso paulatino de la tasa de embarazo m&#250;ltiple con los a&#241;os&#46; En aquellos embarazos conseguidos con IAC&#44; un 17&#44;8&#37; terminaron en aborto en 2018 y 16&#44;3&#37; en 2019&#46; En la t&#233;cnica con donante terminaron en aborto un 18&#44;0&#37; en 2018 y 18&#44;0&#37; en 2019&#46;</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Conclusiones&#58; el uso de IAC va en descenso&#44; al contrario que el de IAD&#46; Sin embargo&#44; el porcentaje de embarazo m&#250;ltiple tiende a descender en ambas t&#233;cnicas&#46;</p></span>"
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        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">Introduction&#46; Artificial insemination is a widely used assisted reproduction technique&#44; despite controversy over its usefulness&#46; This document presents the data from the National Register of Activity in Assisted Human Reproduction &#40;RNA &#8211; Register SEF&#41;&#44; for Artificial Insemination during 2018 and 2019&#46;</p><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">Material and methods&#46; The data for conjugal and donor artificial insemination &#40;AI-C and AI-D respectively&#41; collected by the RNA &#8211; Register SEF during 2018 and 2019 was analysed and compared with data obtained in previous years&#46; Participation was mandatory for Spanish assisted reproduction centres and annual aggregate data was collected by centre and in situ monitoring carried out at random on data provided by more than 15&#37; of participating centres&#46; A total of 34&#44;100 cycles were analysed in 2018 &#40;21&#44;467 AI-C cycles and 12&#44;633 AI-D cycles&#41; and 32&#44;548 cycles in 2019 &#40;18&#44;948 AI-C and 13&#44;564 AI-D cycles&#41;&#46;</p><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">Results&#46; No significant differences were observed in the overall gestation rate per cycle&#44; either for AI-C &#40;2018&#58; 13&#46;1&#37;&#59; 2019&#58; 12&#46;8&#37;&#41; or for AI-D &#40;2018&#58; 19&#46;0&#37;&#59; 2019&#58; 18&#46;8&#37;&#41;&#46; In 2018&#44; 11&#46;6&#37; of the pregnancies obtained through AI-C were multiple pregnancies&#46; Similar figures of 9&#46;9&#37; were obtained in 2019&#46; Similar results have been observed in AI-D&#44; where the multiple gestation rate was 10&#46;7&#37; in 2018 and 8&#46;9&#37; in 2019&#46; In pregnancies obtained with AI-C&#44; 17&#46;8&#37; resulted in miscarriage in 2018 and 16&#46;3&#37; in 2019&#46; With the donor technique&#44; 18&#46;0&#37; resulted in miscarriage in 2018 and 18&#46;0&#37; in 2019&#46;</p><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">Conclusions&#46; Despite a slight increase in the number of participating centres&#44; a decrease is observed in the use of AI-C&#44; but this trend does not occur with AI-D&#46;</p></span>"
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 579
            "Ancho" => 1890
            "Tamanyo" => 60067
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "al0010"
            "detalle" => "Figura "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Tasa de gestaci&#243;n en IAC e IAD hasta 2019&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "f0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 618
            "Ancho" => 1890
            "Tamanyo" => 70931
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "al0015"
            "detalle" => "Figura "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Tasa de embarazo m&#250;ltiple en IAC e IAD hasta 2019&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "t0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "al0020"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#176; de centros participantes</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup colgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" colspan="2" style="border-bottom: 2px solid black">Centros P&#250;blicos</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup colgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" colspan="2" style="border-bottom: 2px solid black">Centros Privados</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#176; ciclos IAC</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#176; ciclos IAD</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total ciclos</th></tr><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Total Espa&#241;a</span></th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">313</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">304</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">21&#46;467</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">18&#46;984</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12&#46;633</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">13&#46;564</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">34&#46;100</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">32&#46;548</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">215&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total N &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tf0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Andaluc&#237;a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;19&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;19&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;518 &#40;11&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;626 &#40;13&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;709 &#40;13&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;873 &#40;13&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;227 &#40;12&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;499 &#40;13&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Arag&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">793 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">791 &#40;4&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  """
              ]
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          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tf0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="np0005">Porcentaje respecto al total de centros participantes&#46;</p>"
            ]
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          "es" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Centros participantes en el registro de inseminaciones &#40;IAC-IAD&#41; de la SEF en el a&#241;o 2018 y 2019&#46;</p>"
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      4 => array:8 [
        "identificador" => "t0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "al0025"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mujeres &#60; 40 a&#241;os</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mujeres &#62; 40 a&#241;os</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IAC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ciclos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">20&#46;713 &#40;96&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;372 &#40;96&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">754 &#40;3&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">612 &#40;3&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#46;467 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;984 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gestaciones&#47;ciclos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;738 &#40;13&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#46;372 &#40;12&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63 &#40;10&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;805 &#40;13&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;435 &#40;12&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#218;nicas&#47;gestaciones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#46;420 &#40;88&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;135 &#40;90&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">60 &#40;89&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;92&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;480 &#40;88&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;193 &#40;90&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gemelares&#47;gestaciones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">279 &#40;10&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">219 &#40;9&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;9&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;7&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">285 &#40;10&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">224 &#40;9&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Triples&#47;gestaciones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#62; 3 sacos&#47;gestaciones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;0&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total m&#250;ltiples&#47;gestaciones</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IAD</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ciclos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">10&#46;979 &#40;86&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total de gestaciones</span>&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 23409320
Idioma original: Español
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