Renata and her daughter Alice Catarina. Assisted reproduction was performed at SUS. Photograph: Disclosure
It was then that they got informed, joined groups on social networks and found the way. “It has to go through the internal system, which is called the Cross system, (the Central for Regulation of the Supply of Health Services). It was there that our dream began to come true.”
Until everything worked out, she didn’t want to tell many people, so as not to create expectations.
“But when I managed to get pregnant, I started talking to be able to bring information to people, no wonder many people come to me wanting to know how the ticket is”.
She sums it up: “You go to the AMA (Outpatient Medical Care) regulation center, they will insert you into the Cross system register (Center for Regulation of Health Offers and Services) and there you stand in line”.
In her case, the entry was quick. “I didn’t wait in line for days, I did the entire procedure in the same week, the answer came directly from the hospital, I received an email to go to the consultation on April 30, 2019. I will not forget that date.”
egg donor
In the first consultation, Renata was informed of the possibility of being an egg donor, since at a young age – at the time she was 24 years old – she could help other women to get pregnant, such as oncology patients and older people. “That day I accepted to be a donor. And when the doctor learned that my blood factor is B negative, he said that he had a B negative recipient and had no donor in the hospital. I was very happy to be able to help someone, in addition to receiving help.”
From May to October 2019, she was checked and treated for an infection. Once she finished this phase, she was able to start ovarian stimulation (pharmacological treatment to develop ovarian follicles to maturity). This resulted in hyperstimulation and 26 eggs were collected from Renata. Of these, 15 eggs were mature. “I kept eight and donated seven, which stayed with the receiver. I hope she managed to get as pregnant as I did.”
Renata waited two cycles of menstruation to be able to do the embryonic transfer and it worked on the first try. “I had my first ultrasound at six weeks. There was a little embryo in his place, right there, with his heart already beating”, she recalls.
The pregnancy was uneventful, says Renata. “I had two bleeds at the beginning, but other than that it was fine. On July 16, 2020 Catarina was born, beautiful, perfect, wonderful. That’s when our journey into motherhood began!
Option
In addition to being an option for couples like Renata and Rafael, assisted reproduction can be a means for people who opt for independent production, people with illnesses that have caused (or could cause) infertility, such as cancer, for same-sex couples or couples infertile.
According to the Brazilian Society of Assisted Reproduction (SBRH), marital infertility affects about 15% of Brazilian couples of reproductive age, which represents about 20 million individuals or 10 million couples. Currently, about 10% of assisted reproduction cycles are carried out by same-sex couples, informed the SBRH.
Each attempt to get pregnant using assisted reproduction techniques costs between R$5,000 and R$30,000, explains the president of the association, Paulo Gallo de Sá, a gynecologist and specialist in human reproduction. “The cost of the particular treatment will depend on the type of assisted reproduction treatment and the quality of the reproduction centre.”
Intrauterine insemination (IUI) costs an average of R$ 5,000, including medication. The technique consists of insemination and introduction into the uterus of semen prepared in the laboratory, with the aim of obtaining pregnancy. In this way, insemination brings the egg(s) closer to the sperm so that fertilization occurs naturally in the fallopian tube.
Fertilization
Private in vitro fertilization (IVF) can cost an average of R$ 30,000, including medication. IVF is a treatment that consists of carrying out the fertilization of the egg with the sperm in a laboratory environment, forming embryos that will be cultivated, selected and transferred to the uterus.
Some services offer a variant of the process, called mini-IVF, which costs on average less than half: R$ 14,000, with medication. “These are low-cost treatments, with a lower dose of medication, seeking a smaller number of eggs and avoiding the freezing of surplus embryos”, says the gynecologist.
Those who cannot afford to pay these amounts can try through public health at one of the service centers accredited by the Unified Health System (SUS). Since 2012, one concierge of the Ministry of Health allocates financial resources to health establishments that carry out care procedures for assisted human reproduction, within the scope of the SUS, including in vitro fertilization and/or intracytoplasmic sperm injection.
“Brazil has very few assisted human reproduction centers that carry out highly complex techniques (in vitro fertilization)”, according to Paulo Gallo de Sá, who approves the services. “All ten centers are considered benchmarks and meet the safety and quality conditions required by Anvisa (National Health Surveillance Agency), he said.
Embryologist Vanessa Rodrigues Alves agrees with Gallo de Sá regarding the number of centers in the country. “Very few breeding centers are completely free. I think the government lacks support to make it a little cheaper (IVF) even in private, that is, there are other ways for the government to help, not just paying 100% for the treatment. Cheaper rates on the drugs and equipment we use in fertilization could make human reproduction a little more popular and have a greater number of clinics in Brazil”.
Specialist in human reproduction, Vanessa worked for eight years at Pérola Byington Hospital, in São Paulo. It details how to enter the hospital. “The patient has to go through an AMA gynecologist, who will place her in the state government’s Cross system, which makes this selection to enter the hospital and achieve assisted human reproduction. It takes some time to get called, but it’s not a years-long queue like it used to be,” she explains.
For the specialist, assisted human reproduction has been growing and has to be more valued. “Many patients suffer from diseases that prevent them from getting pregnant, infertility is a recognized type of disease, it should be a mandatory treatment. We have the right to form a family, ”she opines.
The expert also points out that the dream of becoming pregnant goes beyond infertility. “We have homoaffective female couples, for example, who need semen from a bank, which is not cheap, male homoaffective couples who need a supportive belly and will need donated eggs to be able to have a pregnancy”.
Assisted human reproduction centers
The Assisted Human Reproduction centers (CRHAs) are in seven capitals of the country, four of which are in São Paulo: Byington Pearl Hospital, Hospital das Clínicas of the University of São Paulo – USP (in the capital and in Ribeirão Preto) and São Paulo Hospital of the University of São Paulo (Unifesp).
There are also two centers in Porto Alegre: Hospital de Clínicas de Porto Alegre and Hospital Fêmina, a center in Brasília, the Hospital Materno Infantil de Brasília; in Belo Horizonte, the Clinical Hospital of the Federal University of Minas Gerais. In Goiânia, the Hospital das Clínicas of the Federal University of Goiás and one in Natal, the Januário Cicco Maternity School of the Federal University of Rio Grande do Norte.
Of these centres, only four provide treatment completely free of charge: Maternidade Escola Januário Cicco, Hospital Pérola Byington, Hospital das Clínicas of the University of São Paulo – USP and Hospital Materno Infantil de Brasília. In the others, the patient needs to pay for the medications at an average cost of R$ 5,000.
In a note sent to Brazil Agency, the Ministry of Health reported that the Unified Health System (SUS) offers comprehensive follow-up for family planning in primary care services, including consultations, exams, among other procedures; and assisted reproduction in health establishments qualified in assisted human reproduction procedures.
“Expanding women’s access to services, as well as ensuring quality monitoring in the SUS is a priority for the Ministry of Health”, highlighted the folder, but informed that it does not have the number of families waiting for assisted reproduction in the SUS.
According to a report made available by Anvisa, the SisEmbryo. Throughout the country, there are 181 Centers for Assisted Human Reproduction (CRHAs) and only ten offer treatment through the SUS. Most centers are in the Southeast Region, with 60 of them concentrated in the state of São Paulo.
Data from SisEmbrio also show that, last year, the fertilization rate of patients younger than 35 years old was 76.68%, with 1363 clinical pregnancies and in patients older than 35 years old, the fertilization rate was 79.63 %, with 2023 clinical pregnancies.
SisEmbrio includes data on embryo freezing for research, in vitro fertilization, clinical pregnancy rates, gamete freezing, embryo transfers and information on rates and quality indicators.
Path
Those who are in the city of São Paulo, like Renata Wenceslau, must first go to one of the 470 basic health units (UBSs) which are the gateway to the line of care aimed at women’s health in the city of São Paulo, including monitoring the couple who have difficulty getting pregnant.
In the UBSs of the city, medical and gynecological examinations are carried out to investigate possible menstrual and infectious disorders, which may indicate the cause of infertility, as well as sperm analysis for men. In addition, guidance is given on the most opportune times for a pregnancy, both in the physical and psychological aspect, as well as in the socioeconomic aspect.
After analysis of the exams, the patient is inserted in the Central of Regulation of Offers of Health Services (Cross) for accompaniment in the specialized network, of the Secretariat of State of Health (SES) of São Paulo.
According to the SES, appointments are made by Primary Health Care via the Health Offers and Services Regulation Center (Cross), following the established protocol, which is to be 37 years, 11 months and 30 days old and have a previous diagnosis of infertility. . As soon as the patient is attended, the necessary tests are requested and the appropriate treatment is indicated.
The SES reported that it does not have the number of patients waiting to be treated at assisted reproduction centers. “The queues are decentralized, we are working to unify them”, informed the folder’s press office.
Hope
For those in line waiting for a chance to get pregnant through the SUS, Renata advises not to give up. “Everything has a right time to happen, it may seem very cliché, I heard this phrase several times when I was trying to get pregnant. But, it’s worth the wait, really if you don’t have conditions to do a treatment in the private network, wait. And if you can be a donor, depending on your age, it is worth seeking out the clinics”.
The path was not easy, she recalls. “The days during the induction were nine endless days, it was the worst part for me, in addition to the physical pain I felt, I was afraid, very afraid, anyone who deals with infertility knows, we are very afraid”.
After that fight, she now celebrates her daughter’s life. “Being a mother has its bonuses and costs, I don’t romanticize motherhood, but it’s really magical, I love being Catarina’s mother.”
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