Frequent Asked Questions

This is a very common doubt that comes up when a couple engages in an Assisted Reproduction process. They might think whether they should go for an In Vitro Fertilization (IVF), or for an intrauterine insemination, and so on.

The pregnancy success rate depends on several factors, such as how old is the couple, the woman’s egg cells stock or how severe the male problem is. So the recommendations for each treatment varies in each case.

IVF is usually recommended for more complex infertility cases (profound endometriosis, low ovarian stock, semen disturbs such as low concentration or mobility), while the intrauterine insemination is recommended for less complex cases, such as when there is a soft semen or ovulation disturb.

In order for us to indicate the best way to solve the problem, it’s necessary to understand each situation and evaluate each couple’s history individually.

In a general way, the intrauterine insemination is recommended in less complex cases, such as soft disturbs regarding ovulation and semen. While In Vitro Fertilization is usually better in complex cases, like azoospermia, endometriosis, uterine tubes disturbs, seminal DNA fragmentation, and so on.

In an intrauterine process, the woman passes through an ovarian stimulation by means of certain medications (which takes around 13 to 15 days), and then sperm (properly prepared in lab) is injected in her womb so that the fertilization may occur.

Now regarding in vitro fertilization, ovarian stimulation is more intensely provoked. Than after that, unlike intra uterine insemination, the egg cells are collected and the fertilization is done in lab (outside the woman’s body). Then, we wait until the embryo is formed, which takes five days, and then place it back in the woman’s womb.

It’s worth noting that each situation might be different and that each case must be individually treated.

The success in an Assisted Reproduction process highly relies in a good timing, studying and listening to the couple and knowing their history.

Other factors that must be taken into account are:

• How old is the couple: after 35, women tend to produce fewer eggs, which reduces her chances of getting pregnant, and men present a sperm quality reduction. Freezing their gametes (eggs and sperm) may be an efficient treatment in these cases.
• Unhealthy habits: over consuming alcohol, smoking and a sedentary lifestyle may alter a couple’s reproductive capacity, harming not only their gametes but also the embryo’s endometrial fixation as well.
• Physical issues: Preemptive medical exams regarding both men and women diseases and disturbs (such as endometriosis, fibroids and varicocele) may increase an In Vitro Fertilization (IVF) success rate.
• Healthy state of mind: This is a must, since failed attempts may generate frustration and insecurity in a couple. Psychological assistance, as well as the support from family and friends are very important too.
• Quality of life: Eating healthy and nutritious food and regularly exercising also contributes to IVF success rate.
• Well-chosen doctor and medical team: A relationship of trust between the couple and the doctor and the medical team raises their confidence and tranquility. Which has a positive influence over the process.

Each couple has different habits, sexual routine and lifestyle – which can be healthy or not – therefore, it is important to entirely understand them early on, so that we can raise the treatment success rate.

Medical Science evolution has made it possible for many couples to make their dream of having a baby become true by means of Assisted Reproduction.

From the other hand, the chance of having twins might threaten some couples and cause anxiety.

In an In Vitro Fertilization (IVF) both male and female gametes (sperm and egg cells, respectively) are joined together in lab, in order to create embryos. After some days, when these embryos have already evolved, they are transferred to a woman’s womb.

Nowadays, the couple must take the decision regarding how many embryos are going to be transferred, with their doctor assistance. This decision must be within some limits, established by CFM (Conselho Federal de Medicina), taking into account some other factors, such as how many embryos were formed, their former attempts, if there is any desire of having twins, what might go wrong, how old is the woman, and so on.

Besides that, the embryo implantation process depends on the amount of eggs, sperm and embryos, endometrium characteristics and the interaction between the endometrium and embryo (s).

If each step is taken and returns a positive result, it’s possible to reduce the number of transferred embryos, which decreases the chance of having twins.

A couple should recur to a Human Reproduction expert doctor, who’s going to solve each and every doubt they might have and then help them to choose the best way achieving pregnancy – that’s what I always recommend.

Thanks to Assisted Reproduction evolution, having kids is a more and more achievable dream.

However, there are still some (uncommon) cases in which we need to look for a gametes bank, even with all the available treatments for infertile couples.

When it is impossible to use a couple’s egg and/or sperm, or when a single woman or a homosexual couple want to have a baby, recurring to a gametes bank might be a good idea (along with fertilization techniques of course).

The Assisted Reproduction techniques to use are going to be the same. The only difference is that the egg or the sperm will be donated.

To be a donor, one will have to pass through several exams that ensures us that he/she is both physically and mentally healthy.

This process might vary from one place to another around the world, mainly regarding the information shared about a donor in a gametes bank.

Information regarding the donors are stored and anonymously shared to whoever recurs to a gametes bank to choose a donor, in Brazil.

This is a female surgery considered definitive. It consists in the rupture of the uterine tubes to prevent sperm passage.

It’s more often recommended to patients that present some kind of disease, such as hypertension, diabetes or eclampsia (convulsions during pregnancy) family history.

Since it does not affect a woman’s ovulation, it’s possible to revert the process. But in order to do that, many things should be taken into account, such as the patient’s age, the uterine tubes length and vitality, what was the technique used in the sterilization process, amount of scar tissue left and how skilled is the surgeon.

This reversal process might work better in younger women, under the age of 35, that don’t present any infertility indicators. For patients above 35, In Vitro Fertilization (IVF) might be a better option, since it’s secure and efficient.

When the intrauterine tubes are repaired, they might not fully restore their function, which may cause troubles during pregnancy, such as ectopic pregnancy (in the tube itself).

Therefore, it’s wiser to make the sterilization surgery your last option, since there are many other contraceptive methods, such as IUD, birth control pills, and so on.

In a vasectomy, the sperm flow from the testicles and epididymis (a tube that lies right above the testicles) to the vas deferens, which lead it to the urethra, is blocked.

It is a secure sterilization method that despite sterilizing a man, it has no effect in his male hormone production and sexual performance.

It is possible to make a vasectomy reversal surgery, and it may be a good option if the testicles are still producing sperm. But the more time passes after vasectomy, the harder it is to be successful in it’s reversal process.

There are some things that should be taken into account before doing a reversal vasectomy surgery, such as how old is the patient, which technique was used in vasectomy, the distance between the two vas deferens obstruction points and if there is any fibrosis and/or obstructions below the blocking point.

After proper exams and professional evaluation, if the reversal surgery is considered a bad idea, the couple may rely on Assisted Reproduction treatments, such as In Vitro Fertilization, in which a man’s sperm can be fetched directly from the testicles or epididymis through puncturing.

It is worth noting that this puncturing may prevent a future vasectomy reversal, so the path the couple is going to take is a decision that must be carefully taken, with the assistance of their doctor.

Not every oncological treatment causes infertility. It all depends on what kind of oncological therapy he passed through, where the cancer was, how fertile the man was before it and how old is he.

Chemotherapy has a chance of damaging the testicles sperm production through the blood flux. Radiotherapy, if applied in the genital area, may put a man’s fertility at stake. Even though, this kind of patient must pass through an evaluation, for this may have been just a temporary damage.

From the other hand, when the testicles or the prostate are removed in a surgery, the infertility is permanent.

It is recommended that before proceeding to such a treatment, the patient asks the oncologist if it is possible to go for a sperm cryopreservation (freeze them).

If a patient did not choose to do a sperm cryopreservation before an oncological treatment and now wants to have kids, he must look for a Human Reproduction expert to evaluate him regarding his fertility.

In some specific cases, in which there was no cryopreservation and a patient becomes azoospermic (lack of sperm in the ejaculated fluid), there are still some alternative options that we can implement in order to extract the sperm directly from the testicles or epididymis. This can be done by means of surgeries such as Micro-TESE, PESA and MESA.

Thanks to medical science evolution, it is possible to predict how much time a woman has to get pregnant. If a woman wishes to become a mother but feels like it’s not the time yet, she can schedule it, avoiding having trouble later on.

The main exams recommended for such cases are:

• Ovarian stock evaluation: a proper amount of follicle stimulating hormone (FSH), estradiol, inhibin b and anti-müllerian hormone (AMH) is used to estimate how many egg cells are still left.
• Transvaginal ultrasound and antral follicle count: It also is used to count the number of egg cells. With proper intestinal prepare, it can also help to see if there is any trace of endometriosis.

If the results point to a low ovarian stock, it’s possible to freeze her eggs to preserve her fertility.

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