FREQUENTLY ASKED QUESTIONS
In Portugal, who is eligible for Medically Assisted Reproduction treatment?
A: According to article 6 of Law no. 32/2006, of 26 July, the beneficiaries of Medically Assisted Reproduction (MAR) techniques are:
"1 - … married couples who are not legally or actually separated and couples, of different sexes, who have lived as spouses for at least two years are eligible for MAR techniques.
2 - The techniques can only be used for people who are at least 18 years old and are not prevented or disqualified due to anomalies."
With regard to situations where there is a need for fertility preservation (i.e. cryopreservation of gametes), as is the case with cancer patients at reproductive age, we mainly have male patients. The reason is very simple: perhaps due to the greater biological complexity of female gametes, cryopreservation techniques for eggs or ovarian tissue have still not advanced as far as the methods available for cryopreservation of sperm. However, the advances in recent years lead us to believe that bibliographic data will soon be available that will allow us to safely apply some of the techniques already available for preserving female fertility.
Cryopreservation of embryos is another solution for couples where one of the partners is suffering from cancer. However, due to some treatment implications, this cannot be used as a means of fertility preservation in all cases.
According to your clinical data, what are the most common causes of infertility in both sexes?
A: The records for 2013 show that the highest percentage of couples coming to CETI have infertility problems affecting both sexes. This is followed by couples suffering from infertility exclusively due to the male factor. In these cases, there can be many causes, from genetic and environmental causes (including drinking/smoking habits, pollution, hazardous jobs, such as those where the individual is exposed to high temperatures) to traumatic situations. The most common cause of female infertility at CETI is a disease called Endometriosis.
Is there a higher probability of malformation and mutations in babies born through assisted reproduction?
A: A review article published in February 2014 (Fauser et al., 2014) which compares the incidence of genetic/epigenetic anomalies and congenital malformations in children born through MAR techniques and those conceived naturally drew the following conclusions:
- Children born through MAR techniques have lower birth weights and higher peripheral fat, blood pressure and fasting glycaemia when compared to children in the control group (conceived without MAR techniques);
- Growth, development and cognitive function are similar in the children in both groups.
- There is insufficient data to establish a direct link between assisted reproduction and its consequences for the health of children conceived using these techniques. However, it is important to remembers that the women who use MAR techniques are often older, which increases the probability of having gametes with more anomalies. This can create a bias when analyses of this type are carried out.
Bibliography: Fauser BC, Devroey P, Diedrich K, Balaban B, Bonduelle M, Delemarre-van de Waal HA, Estella C, Ezcurra D, Geraedts JP, Howles CM, Lerner-Geva L, Serna J, Wells D; Evian Annual Reproduction (EVAR) Workshop Group 2011.Health outcomes of children born after IVF/ICSI: a review of current expert opinion and literature. Reprod Biomed Online. 2014 Feb;28(2):162-82.
What is the incidence of multiple pregnancies following Medically Assisted Reproduction treatment?
A: Over the 17 years of clinical practice, triplet pregnancy has been rare after Medically Assisted Reproduction at CETI. Twin pregnancy is more common, although the majority are single foetus pregnancies. However, directives from ESHRE - the European Society of Human Reproduction and Embryology increasingly advocate the transfer of fewer embryos to the maternal uterus. In many EU countries, no more than 1 embryo may be transferred. In Portugal, the decision to transfer 3 embryos must be duly justified by the doctor who is treating the couple.
Does CETI provide any type of psychological counselling for couples?
: Yes, when necessary. Infertility consultations at CETI are multidisciplinary and psychological counselling can be requested by the couple or clinically indicated by the infertility specialist.
How have CETI and its treatments evolved over its years in operation?
A: CETI was founded in 1998 and there have been considerable advances in MAR since then. There are always improvements and technical advances in an area which, in itself, is still undergoing major evolution. At CETI, there is not only a need, but also a great desire to keep up with the main scientific advances in this area in order to be able to provide the best response scientifically possible to the increasing number of situations of infertility in the couples who come to us. This desire signifies continuous training for all employees and frequent participation in specialty congresses, as well as cooperation in some research projects
What is endometriosis? How is it detected? And how is it treated?
Endometriosis consists of the presence of endometrial tissue outside of the uterus. There are several degrees of severity and it can affect various organs, such as the peritoneum, ovaries, bladder and intestines. Endometriosis is a disease that is clinically diagnosed based on patient history and the gynaecological examination. Although this is limited, a pelvic ultrasound may help, as well as magnetic resonance or diagnostic laparoscopy in specific situations. Endometriosis may be treated medically (with medicine) or surgically (through minimally invasive laparoscopic surgery), which is the main treatment for this disease, or through Medically Assisted Reproduction techniques.
How does age influence the fertility of each partner in the couple? How much does age affect infertility?
As women get older, the number of eggs and their quality decrease. This implies less fertility and a higher probability of chromosome anomalies, which is aggravated after the age of 35. Men's aging is not necessarily associated with a decrease in sperm but, after the age of 45, there can be a reduction in fertility due to changes in the genetic material of the sperm.
How can I increase my fertility?
Fertility can be increased by adopting a healthy lifestyle, such as not smoking, not abusing alcohol or drugs, or preserved, by cryopreserving eggs before the age of 35. The ideal solution is for women not to delay maternity for too long.
What are polycystic ovaries?
Polycystic ovaries are a hormonal and ovulatory dysfunction. Ultrasound detects globular ovaries with a lot of follicles (> 10) around the stroma. This condition can be associated with changes in the menstrual cycle or signs of excess androgens (acne, excess hair) or certain analytical hormonal alterations. In this case, we are talking about polycystic ovary syndrome, which can cause changes in ovulation, requiring medical or surgical treatment to increase the probability of pregnancy.
How successful are Medically Assisted Reproduction techniques?
Medically Assisted Reproduction (MAR) techniques first appeared in the 1970s and have evolved significantly since then. Intracytoplasmic sperm injection appeared in 1992, providing a response to very serious cases of male infertility.
Over the last 10 years, success rates have stabilised. We now have success rates between 30 and 60%, depending on the infertility factor associated with the couple.
Some of the factors contributing to this stabilisation are:
- Optimisation of culture media;
- Preservation of fertility through cryopreservation of gametes; and
- Embryo vitrification.
Also, in recent years, there have been developments in the technology used in this area, such as a variety of video systems and monitoring of the development of gametes and embryos in order to help select the best embryo to be transferred to the maternal uterus.
How are potential donors selected??
Potential egg donors, who know that CETI carries out MAR treatments, come to CETI voluntarily and offer to donate eggs.
Next, a consultation is scheduled to find out if the candidate meets CETI's eligibility criteria. The basic eligibility requirements are:
- To be aged between 18 and 35;
- Not to have donated eggs more than three times; and
- If the candidate has already donated eggs, this must have been over six months previously.
During the consultation, the clinical history is prepared and a gynaecological examination and a transvaginal ultrasound are done in order to rule out the existence of any disease.
Blood is also drawn in order to check for any infections and for a chromosome study.
Then, once this study has been done and the results are normal, the candidate is deemed eligible to be an egg donor at CETI.
What genetic and biological heritage does a child born from a treatment using egg donation get from the recipient?
The genetic heritage of a child born from an egg donation cycle is the genetic heritage of the donor. However, all of the exchanges between a pregnant woman and an embryo and foetus, which develop and becomes implanted in her uterus, are also important and fundamental.
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