SUS offers egg freezing for women with cancer – 04/13/2024 – Health

“One of the things that gives the most pleasure to those who are in a laboratory is precisely seeing the little embryo when we are going to transfer it [para o útero] and then the mother carries the child on her lap”, says Nilka Donadio, doctor responsible for the Assisted Human Reproduction Laboratory at Hospital da Mulher, in São Paulo. The specialist is part of the team that offers, via SUS (Unified Health System, ), egg freezing for women who will cancer treatment or have a condition that compromises ovarian reserve.

Hospital da Mulher is one of the few institutions in the city of São Paulo that performs the fertility preservation procedure completely free of charge. The procedure is provided for by the SUS, but not all women who could have access to it are aware of this possibility. This is because they are not guided by the professionals who care for them at the beginning of the disease treatment. Those who can do it have prior knowledge of the subject or receive guidance from private clinics to seek the procedure through the public network.

Under treatment for breast cancer through the SUS, hairdresser Ludmilla Matias, 26, was not informed by her responsible doctor that it was possible to preserve her fertility free of charge. She found out after contacting the reporter.

“I started treatment when I was 25. The doctor talked about the possibility of freezing my eggs, but as we needed to start treatment as soon as possible, it wouldn’t be possible. And also as we don’t have the financial means, we wouldn’t be able to do it privately. We didn’t know that the SUS There is this type of treatment, I know now”, she says.

According to a report released by Anvisa (National Health Surveillance Agency) through SisEmbrio (National Embryo Registration System), Brazil has 161 Assisted Human Reproduction Centers (CRHAs), with only ten of them offering treatment through the SUS.

The procedure is not a guarantee of future pregnancy, but a possibility that takes into account age, number of eggs, clinical history of the patient and partner, explains the doctor at Hospital da Mulher.

“I can preserve, that is, freeze an egg, regardless of age. But the patient has to be aware that, if I froze an egg from a 42-year-old patient with breast cancer, she will have a statistic, a future chance of pregnancy, which could be different, of course, from a patient who had the same condition as her, but who I froze at 35 years old”, says Donadio.

The professional highlights that frozen eggs do not age and can be preserved indefinitely. To perform the procedure, patients undergo a cycle of ovarian stimulation and egg collection before starting chemotherapy treatment.

The objective of the institutions that perform the procedure is to speed up the fertility preservation process and ensure that the treatment does not delay the start of chemotherapy. At Hospital da Mulher, the goal is to collect eggs within a short interval, of around 20 days.

When carried out in private institutions, the average cost of the procedure, including medications and the first annual freezing fee, is approximately R$24,000, according to a survey carried out by IVF Brazil, a market consultancy specializing in human reproduction.

In 2023, in the Southeast region, 89,629 eggs were preserved from women under 35 years old and 136,414 above this age group. Since 2020 to date, 45,768 egg freezing procedures have been recorded, totaling more than 350,737 eggs preserved.

The Assisted Human Reproduction Centers (CRHAs) are distributed in seven Brazilian cities, namely: São Paulo (Hospital da Mulher, Hospital das Clínicas de São Paulo and Hospital São Paulo da Unifesp), Ribeirão Preto (Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto), Porto Alegre (Hospital Fêmina and Hospital das Clínicas de Porto Alegre), Brasília (Hospital Regional da Asa Sul), Natal (Maternidade Escola Januário Cicco), Goiânia (Hospital das Clínicas da Universidade Federal de Goiás) and Belo Horizonte ( Hospital das Clínicas of the Federal University of Minas Gerais).

Ana Claudia, 36, a volunteer at the Oncoguia Institute, also did not have the service offered by the public network after being diagnosed with cancer. She only knew it was possible when she started researching the treatment.

“No professional offered it to me. I discovered that chemotherapy can cause infertility by researching the subject on the internet, because my biggest dream has always been to be a mother”, she says, who also underwent fertility preservation at the Women’s Hospital.

Human resources analyst Jaqueline Almeida, 29, says that the hardest part of hearing the news about cancer was knowing that the treatment could leave her infertile.

“When I went to the surgeon, I had already seen the tests and was prepared for what he was going to tell me, but when he asked me if I had children, it hurt me more than knowing about the disease”, she says. “The doctor said that if I wanted to have children one day, I would need to freeze my eggs. I cried a lot, especially when he mentioned the cost.”

Jaqueline was only informed that the Women’s Hospital offered fertility preservation procedures free of charge because her private doctor, at Hospital AC Camargo, was aware of it. With a referral, she went to the institution and managed to carry out the procedure. AC Camargo is a private unit that has an agreement with SUS.

The flow of care for oncofertility and in vitro fertilization (IVF) patients begins with referral through the state regulatory system, known as Cross (Center for Regulation of Health Offers and Services).

Cancer patients skip the referral stage and are treated directly at the fertility preservation clinic. Oncological treatment is evaluated and encouragement for fertility preservation can begin on the same day of the consultation.

“I was not advised by the SUS to seek egg freezing,” says Michelle Maria de Farias Dumas, 38, business administration specialist and psychology student, who froze her eggs in 2020.

Dumas was diagnosed with two cancers, one of her thyroid, at the age of 24, and another of her breast, at the age of 34. During her oncological treatment through the SUS, she did not receive guidance on freezing eggs in the public network. He found out about the procedure from a private doctor who also followed his treatment and, thus, was able to perform the technique.

“The person who gave me guidance was a private doctor. He said that because I was young he could do the freezing”, he adds. Despite some delays due to the Covid-19 pandemic, Dumas, a resident of Salvador, came to São Paulo to freeze her eggs at the Women’s Hospital.

Artur Dzik, lead doctor in the Assisted Human Reproduction sector at Hospital da Mulher, says the biggest problem is the lack of communication about this service between specialists and patients, resulting in a lack of adequate referral for women who could benefit from it. .

“The doctors [das mulheres supracitadas] They should have informed them of the possibility of fertility preservation. There is no difficulty on our part [como Hospital da Mulher]. It is medical information, in the public domain”, he states. He highlights that the Women’s Hospital is receiving patients from other state hospitals to freeze eggs, aiming to meet the growing demand for oncological preservation.

The São Paulo State Department of Health was contacted by the report on the subject and responded that the Women’s Hospital began offering the egg freezing service to patients referred from other units at the beginning of this year, via Cross, as mentioned above.

“The Women’s Hospital also intensified the unit’s internal communication, to expand the reach of egg freezing services to patients who, according to the unit’s medical criteria, are starting treatment to combat cancer and who want to preserve their fertility.”

The Ministry of Health, consulted about the lack of communication for cancer patients about the option of free fertility preservation via SUS, did not return contact until the publication of this report.

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