Learn the answers to the most frequently asked questions about assisted reproduction:
It is considered unethical to choose the sex of the baby in Assisted Reproduction according to the resolution number 1358 on 11/11/1992 of the Federal Counsel of Medicine.
In the Resolution?s own words:
"In regards to assisted reproduction techniques, we have as general principles that assisted reproduction facilitates the process of procreation, and can be used when there is the effective possibility of success and it is not to be used as an intention to select any biological trait of the future child, including sex".
Yes. According to the Federal Counsel of Medicine, resolution number 1.184/2003, Article 7th: "The donation of gametes will be allowed under the responsibility of the health services that work with Assisted Reproduction. Remuneration for this material is not allowed under any circumstance." The donation of eggs is a simple procedure. After physical and blood compatibility exams candidates that wish to donate must undergo a monitored medical treatment previous to the follicular aspiration. All donors are volunteers and should be examined in regards to genetic and sexually transmitted diseases and should be part of an assisted reproduction program.
Yes. This treatment is recommended to women that do not have eggs or that produce eggs with low quality. The donation of eggs is advised to women that carry genetic diseases that could be transmitted to their children and cannot be diagnosed using PGD technique (Preimplantation genetic diagnosis).After physical compatibility studies, egg donor candidates must undergo a monitored medicated treatment for egg collection. After which, the eggs will be fertilized with the semen of the receptor?s partner. Egg donors are volunteers and they are evaluated regarding genetic and sexually transmitted diseases.
Yes. Egg preservation through freezing is suggested to women that are in reproductive age and wish to delay their pregnancy either due to a professional issue or health issues like chemotherapy or radiotherapy treatment for cancer where there is the possibility of damaging the egg production.
Intrauterine insemination with donor semen is a legal and ethical procedure according to the Federal Council of Medicine. Technically, we use semen from the Semen bank and we perform the intrauterine insemination during the ovulation period of the patient.
There are two ways to treat a couple which has one partner that has performed a vasectomy. First we try, when indicated, to perform a surgery to reconnect the vans deferens. If the surgery is successful, natural pregnancy may occur. However, we know that if the vasectomy was performed a long time ago, the possibility of success is lower. If that is the case, for non operated vasectomies the best treatment indicated is In Vitro Fertilization (IVF) with collection of the sperm done directly on the testicles or the epididymis.
If you have a tubal ligation done, there are two possible treatments: surgical reversal and In Vitro Fertilization (IVF). The great inconvenience of the surgery is that patients need a post op period of recuperation of approximately 6 months to try to get pregnant. Approximately 50% of patients that perform the reversal get pregnant. After a year without success it is indicated to go through In Vitro Fertilization. We also indicate IVF for patients that are over 35 year old, because it is not necessary to wait to start treatment, since age is a critical factor in the success of a pregnancy.
Gestational Surrogacy (uterus substitution) is recommended for couples of which the woman does not have a uterus or when pregnancy is not recommended. According to the Code of the Medical Ethics of the Federal Council of Medicine gestational surrogacy can only be carried out when the surrogate mother is a first or second degree relative of the couple that is being treated. When the couple does not have relatives, it is necessary to ask for an expert opinion with the Council of Medicine to get an authorization for the treatment.
In this case, the treatment consists of helping the woman to produce eggs; they will be then fertilized in the laboratory by the sperm of her partner. Once the pre embryos are formed, we will make the transfer to the substitute uterus. It is important to point out that gestational surrogacy cannot be a commercial affair.
Unfortunately, a woman has a limited reproductive life which normally ends around her 50s. We know that a spontaneous gestation after 45 is extremely rare and for a woman that wishes to have children with that age it is necessary to undergo an assisted reproductive treatment, and even with treatment chances for a successful pregnancy are not great.
Women that get pregnant after 45 with the help of infertility treatment usually are patients that received eggs from younger women, that is, they were donated. For this technique donated eggs are fertilized with the sperm of the receptor's husband. Once the embryos are formed they will be transferred to the receptor's uterus.
Intrauterine Insemination (IUI) is a simple technique, recommended for the treatment of some infertility causes, like moderate seminal alterations that could be making it harder for the sperm to meet the eggs; sterility without apparent cause (SWAC) and moderate endometriosis. In this case, the semen is prepared in the lab, where the best sperm are selected and placed inside the female reproductive system (uterus and fallopian tubes during ovulation. IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) are Assisted Reproduction procedures. Their recommendation is very broad: damage on the fallopian tubes, endometriosis, relevant male factor, immunological factors, sterility without apparent cause (SWAC) and unsuccessful prior treatments. After fertilization, the embryos, up to four, are transferred to the uterus.
The probability of multiple pregnancy increases with the use of fertilization methods. In a natural pregnancy usually just one egg is fertilized. In an assisted pregnancy in which the fertilization takes place in a laboratory of assisted reproduction it is important to obtain the highest number possible of good quality embryos produced with the eggs collected from the mother and the sperm from the father. That procedure enhances the probability of a pregnancy, and also the probability of a multiple gestation.
In Europe where reproductive assisted treatments rules are stricter, the multiple pregnancy rate ,26,4% hasn't changed in four years. This number encompasses 24,4% of twin pregnancies, 2% triple pregnancies and 0,04% quadruplets pregnancies. Many clinics around the world are trying to lower those rates even more and they have been transferring a smaller amount of embryos or sometimes just one embryo. It depends on the age of the patient and the embryonary quality.
The necessary exams are: hormonal evaluation, uterus and ovaries ultrasound, fallopian tubes evaluation, sexually transmitted disease testing and a spermogram from the partner. Other exams, if needed, will be asked according to the specialist evaluation.
Endometriosis may or may not be an infertility factor. There are important exams that can be done to confirm if the endometriosis is or isn't affecting the process of getting pregnant. It is important to remember that in one third of the couples, infertility causes can be from either men or woman or both. However, when there is the presence of endometriosis with a degree III or IV, that is, alterations on the anatomy of the pelvis, the recommendation is in vitro fertilization.
If your problem is with your fallopian tubes, the recommendation is in vitro fertilization (IVF), because it is on the fallopian tubes that the gametes (eggs and sperm) meet and where fertilization takes place. If that is not possible, we use the IVF laboratory that has the necessary conditions to fertilize the eggs with the sperm outside of the body.
The lack of ovulation (anovulation) is one of the most common causes of conjugal infertility and among them the Polycystic Ovaries Syndrome is the most frequent. However, we should also make sure that there are not other causes of infertility, such as male factor, fallopian tubes factor, uterine factor, etc. Once it is defined that anovulation is the cause of infertility, we start a treatment with medicine to induce the ovulation and we plan sexual intercourse for the right moment of the ovulatory period (planned coitus). If we are not successful after 3 attempts with this treatment, usually we will perform an intrauterine insemination (also 3 attempts), and if there is no success we recommend in vitro fertilization.
Usually there aren't any side effects because the hormones used are the same as the ones that circulate in our bodies and the ones for treatment are used for only a short time. However, on assisted fertilization treatments, IVF/ ICSI, there is a risk of developing Ovarian Hyperstimulation Syndrome when there is a large quantity of eggs present.
The recommended treatment after performing all the exams lasts around 15 to 20 days. In our clinic the treatment starts, most of times, in the beginning of the menstrual cycle.
The highest amount of embryos that can be transferred is four. This is due to the fact that statically a higher number of embryos does not increase pregnancy rates; it only increases the chances of a multiple pregnancy. It is worth noting that more than 95% of pregnancies achieved through IVS or ICSI are of one or two fetus. Currently, we consider the age of the couple as well as the quality of the embryo to define in agreement with the couple the number of preembryos that will be transferred. We currently try not to transfer more than 3 embryos.
The chances for a couple to get pregnant in each menstrual cycle is of 15%, that is, after a year of active sexual life without using birth control, 80% of couples will manage to get pregnant. Consequently, after one year of trying without success it would be important to look for a specialist in Human Reproduction so an inquiry can be started. With women over 35 years old we recommend talking to a specialist after six months of active sexual life without birth control.
The procedure to use assisted reproduction techniques as a single mother is ethical and legal according to the Federal Council of Medicine. Technically we use semen from the semen bank and we perform the intrauterine insemination at the moment of your ovulation.
The chances for you to get pregnant diminish as you grow old and it becomes even harder after 40. In this age group, most pregnancies do not occur spontaneously and it is necessary to induce ovulation or to resort to other techniques that improve your fertility. Usually a spontaneous pregnancy after the age of 45 is extremely rare because the risks of chromosomal disorders increase with age and the chance of a miscarriage is very high.
| Pregnancy rates with the transfer of four embryos and woman's age | |
| Woman's age | Clinic Pregnancy Rates |
| < 35 years old | 37,3% |
| 35-39 years old | 29,1% |
| 40 years old or more | 37,3% |
| Source: RLA 2000 | |
For azoospermia, the recommended treatment is in vitro fertilization (IVF) with the collection of sperm directly from the testicles (epididymis). However, before any procedure is done, we need to understand what is causing the azoospermia and for that we perform genetic exams like karyotype and a Y chromosome microdeletion so we can prepare a success prognostic of finding sperm in the testicle. After these procedures we recommend a biopsy, that is, collection of a small fragment of the testicle and then analyze it so we can be sure that there is sperm formation.
Global rates of successful pregnancies with assisted reproductive methods are higher than natural pregnancies. The chances for a couple to have a natural pregnancy are of 15%; the success rate for each menstrual cycle after IUI is of 20% and after IVF/ ICSI is of 40%. Because success chances increase, after 4 tries, the "cumulative" rate of successful pregnancy can reach up to 90% per couple.
Yes. This is a procedure performed when there are extra embryos, that is, more than four embryos of good quality. They can remain frozen for an undetermined amount of time. One of the advantages of this technique is that is allows for the increase of chances to get pregnant per try, because there will be more than one embryonary transfer with just one ovarian stimulation, that lowers the costs of treatment with drugs in case there is no success in the first transference. It is necessary a term of agreement filled out and signed by the couple to freeze the embryos.
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