Assisted reproduction is the set of techniques used by doctors specialized in fertility, whose main objective is to help pregnancy in women with difficulties of becoming pregnant. These techniques, such as artificial insemination, in vitro fertilization or ovarian stimulation, for example, involve handling eggs, spermatozoa or both outside the body, allowing a pregnancy without the couple having sex.
Assisted reproduction, or assisted human reproduction, is allowed in Brazil, by the Federal Council of Medicine, to assist in the problems of fertilization and human reproduction, facilitating pregnancy, and the maximum age for pregnancy is 50 years for women.
The main techniques
The main techniques of assisted reproduction include:
1. Fertilization in vitro
In vitro fertilization consists of joining the egg and sperm in the laboratory to form the embryo, and then transferring the embryo to the woman’s uterus so that it is implanted and results in pregnancy.
To do in vitro fertilization, some steps are followed by stimulating ovulation in women with injection of medications for 8 to 14 days. The eggs are then collected, as well as the man’s sperm, which are put in contact on the same glass in the laboratory, to allow sperm to feund the eggs and form the embryo.
If this does not happen, sperm can be injected into the egg with a needle, which is a procedure called intracytoplasmic injection of sperm.
After graduating, the amount of embryos placed in the uterus vary according to the age of the woman, and according to the resolution of the Federal Council of Medicine, the limit of embryos includes:
- Women up to 35 years: up to 2 embryos;
- Women between 36 and 39 years old: up to 3 embryos;
- Women aged 40 years or older: up to 4 embryos.
The number of embryos will never be greater than 4, to avoid pregnancy risk for both women and embryos.
When indicated: IVF is indicated for couples who are unable to get pregnant spontaneously in 6 to 12 months of non-use contracting attempts. This technique is one of the most used in assisted reproduction and can be performed in private clinics and hospitals and even in the SUS.
Is it possible to choose the sex of the baby?
According to the legislation of the Federal Council of Medicine (1) it is forbidden to perform any technique of assisted reproduction for the purpose of choosing the sex of the baby or any other biological characteristic, being considered unethical.
However, there is no absolute prohibition, since there is a risk of health problems or genetic diseases related to the sex of the baby, such as fragile X syndrome in girls or hemophilia in boys, for example, the choice of sex is allowed, provided that there is a history of genetic changes in the family.
To assess the risk of developing sex-related diseases, before implanting the embryo, a pre-implantation genetic diagnosis is made by the doctor, which analyzes the baby’s genes.
2. Intracytoplasmic injection of sperm
Intracytoplasmic injection of sperm is a type of in vitro fertilization made in the laboratory, in which a sperm is injected inside each egg through a needle, so that the embryo is fertilization and formation.
When it is indicated: usually, this technique is indicated when there is a serious problem in the sperm, such as insufficient amount of sperm in the semen or sperm of low quality sperm, or when the other technique of in vitro fertilization in which the eggs and sperm are left in contact in the laboratory do not result in fertilization or there has been insufficient fertilization.
3. Artificial intrauterine insemination
Intrauterine insemination is a type of artificial insemination in which sperm is placed directly inside the woman’s uterus, increasing the chances of fertilization of the egg.
To make this type of technique, the semen of the man is collected and the most active sperm are selected by washing a semen sample. Insemination of sperm is done on the day expected for the ovular woman and hormones are usually used to stimulate ovulation. Understand how intrauterine artificial insemination is done.
Intrauterine insemination is called homologous artificial insemination when the partner’s semen of the partner and artificial insemination is used heterologist when the semen of an anonymous donor is used.
When it is indicated: intrauterine artificial insemination is indicated by the doctor when the woman has ovulation irregularities or has scars on the cervix making it difficult to mobilize sperm to the egg, or when the man has low sperm counts or sperm with little mobility, for example.
4. Artificial intracervical insemination
Intracervical insemination is another type of artificial insemination in which sperm are placed directly on the cervix, being an assisted reproduction technique that most closely resembles normal sexual intercourse.
In the same way as intrauterine insemination, semen is collected and treated and then deposited in the cervix during the ovulation phase of the woman.
When it is indicated: artificial intracervical insemination is indicated when there is no possibility of vaginal penetration by the partner, by impotence or some problem in the anatomy of the vagina, preventing sexual intercourse.
5. Ovarian stimulation
Ovarian stimulation consists of inducing ovulation through injections or use of pills with hormones that stimulate the production of eggs in women, increasing the chances of becoming pregnant.
When indicated: this technique is indicated mainly for women with hormonal changes and irregular menstrual cycles, as in cases of polycystic ovaries. See how ovulation induction works.
6. Intratubebary transfer of gametes
Intratuber transfer of gametes is an assisted reproduction technique that consists of depositing eggs and sperm within the fallopian tube in the woman, also called the fallopian tube.
This technique is similar to in vitro fertilization, in which eggs and sperm are collected that are treated in the laboratory, but the difference is that there is no fertilization and the formation of the embryo to be implanted.
The eggs and sperm treated are deposited directly in the uterine tube by laparoscopy, through a small cut made in the abdomen, or they can be inserted through the vagina, being used an ultrasound to guide the correct site in the fallopian tube. In this way, the chances of fertilization occurring in the fallopian tube are increased.
When it is indicated: intratubulary transfer of gametes is indicated in cases where the woman has normal function of the uterine tubes but has unexplained infertility.
7. Cryopreservation of gametes or embryos
The cryopreservation of gametes or embryos consists of freezing eggs or sperm or the embryo at low temperatures preserved in liquid nitrogen for a future pregnancy.
When it is indicated: cryopreservation is indicated to keep sperm or eggs with the age of the person at the time of collection, in cases of impossibility of a pregnancy due to the treatment of cancer or other diseases that do not allow pregnancy immediately. In addition, the cryopreservation of embryos allows to preserve the embryos not used in in vitro fertilization, and may remain frozen for a minimum period of 3 years, and may be discarded, according to the will of the person or the couple, after this time.
8. Programed sexual relationship
Scheduled sexual intercourse, also called scheduled intercourse, is the least complex technique of assisted reproduction, which consists of planning sexual intercourse for the same day that the woman will ovulate.
In this technique, the doctor monitors through ultrasounds of the ovaries throughout the month to check the exact day of ovulation, allowing to identify the ideal day to try to conceive, recommending that sexual intercourse happen on this day, increasing the chances of a pregnancy.
When it is indicated: scheduled sexual intercourse is indicated in mild cases of infertility, for women who have ovulatory disorders, irregular and very long menstrual cycles or diagnosed with polycystic ovary syndrome, for example.
9.Egg donation
In this technique, the breeding clinic produces an embryo from the egg of an unknown donor and the sperm of the partner of the woman who wishes to become pregnant.
This embryo is then placed in the woman’s uterus, which will need to take hormones to prepare the body for pregnancy. It should also be noted that it is possible to know the physical and personality characteristics of the ovum woman, such as skin and eye color, height and profession.
When indicated: egg donation can be used when a woman can no longer produce eggs, which usually happens due to early menopause.
10. Donation of sperm
In the technique of reproduction assisted by sperm donation, the embryo is formed from the sperm of an unknown donor and the egg of the woman who wishes to become pregnant. It is important to highlight that it is possible to choose the characteristics of the sperm donor man, such as height, skin color and profession, but it is not possible to identify who is the donor.
When indicated: sperm donation can be done when the man cannot produce sperm, a problem usually caused by genetic changes.
11. Preplace de Pregnancy
The surrogacy, also known as “rental belly”, is when the entire pregnancy is done in the belly of another woman.
In Brazil, the term “rental berth” is not used because it is not possible by law to “rent” a woman’s uterus. The rules for this type of assisted reproduction require that there can be no payment for the process and that a woman, voluntarily, can lend the uterus to the gestation of the child of another person.
A woman who lends the uterus voluntarily must be a relative to 4th degree of the father or mother of the child, and may be:
- First degree: mother or daughter;
- Second degree: Grandma or sister;
- Third grade: Aunt or niece;
- Fourth degree: cousin.
In the event that the person wishes to seek another woman who is not related to the pregnancy of substitution, a request should be filed with a request in the Regional Council of Medicine, which should analyze the case in a specific case.
When it is indicated: usually, the pregnancy of replacement is indicated when the woman has high-risk diseases, such as kidney or cardiac, when she does not have the uterus, when she has undergone many flaws in other techniques to become pregnant or have malformations in the uterus.
Reproduction assisted homoaffective
Assisted reproduction is allowed by the Federal Council of Medicine for same-sex relationships and single persons provided that the right to conscientious objection by the doctor is respected, that is, the doctor is not obliged to perform assisted reproduction, but can perform, if he wishes and agrees with the procedure.
In the case of female homosexual couples, assisted reproduction is called shared pregnancy, and can be done when there is no infertility and the egg used is one of the women of the couple. In addition, the embryo obtained by assisted reproduction should be implanted in one of the best of the couple.
Situations that can hinder pregnancy
The general rule of thumb is to seek help to get pregnant after 6 to 12 months of unsuccessful attempts, as this is the period when most couples take to get pregnant. However, you need to be aware of some situations that can hinder pregnancy, such as:
1. Age of the woman
After the woman turns 35, it is common for the quality of eggs to decrease, making the couple more difficult to get pregnant. Thus, it is recommended to try the natural pregnancy for 6 months and after that time, it is advisable to seek medical help.
2. Problems in the reproductive apparatus
Women with problems in the reproductive tract, such as septado uterus, endometriosis, polycystic ovary or tubal obstruction should seek the doctor as soon as they decide to become pregnant, as these diseases increase the difficulty of generating children, and should be treated and accompanied by the gynecologist.
The same rule applies to men diagnosed with varicocele, which is the increase of veins in the testicles, the main cause of male infertility.
3. Irregular menstrual cycle
The irregular menstrual cycle is a sign that ovulation may not be occurring monthly. This means that it is more difficult to predict the fertile period, the planning of sexual intercourse and the chances of getting pregnant.
Thus, in the presence of irregular menstrual cycle, the doctor should be sought for him to evaluate the cause of the problem and start the appropriate treatment.
4. History of 3 or more abortions
Having a history of 3 or more abortions is a reason to see the doctor when deciding to become pregnant, since it is necessary to evaluate the causes of abortions and carefully plan the next pregnancy.
In addition to the care before becoming pregnant, the entire pregnancy should be closely monitored by the doctor, to avoid complications both for mother and baby.
