Woman waits up to eight years to have IVF in the SUS – 03/11/2024 – Balance and Health

It took eight years for Marli Peixoto de Jesus, 33, to reach a public human reproduction center and begin the IVF (in vitro fertilization) process to try to fulfill her dream of becoming a mother.

For seven and a half years, she was monitored at a health center in Jardim Ângela, in the south of São Paulo. There, she learned that she had polycystic ovaries and her husband had varicocele (varicose veins in the testicles), two of the main causes of marital infertility.

“Did you know that in the SUS [Sistema Único de Saúde] it would be almost impossible to achieve IVF. She was always sad and crying. I couldn’t believe it when they called me to say I had an appointment at HM [Hospital da Mulher de SP] to start treatment”, she said on February 27, the first day of ovarian stimulation.

On the same day, in the surgical center next door, two embryos were transferred to the uterus of Ana Patrícia Santana, 39, after waiting three years in the municipality’s primary care. Her husband, Igney Teles Santana, 45, said he was anxious. “I’m calm. I felt anxious before I got here,” said Ana.

Four decades after the first birth of a Brazilian baby through IVF and almost 20 years after the launch of a national policy of comprehensive care in assisted reproduction, women who depend on the SUS to get pregnant face numerous difficulties in accessing treatment.

The obstacles begin with the limited supply of public services. Only ten of the 197 assisted reproduction centers in the country serve the SUS. Of these, only four offer completely free treatment. In the rest, couples need to pay for medications and other supplies

In private clinics, an IVF cycle can cost from R$25,000 to R$50,000, depending on the associated procedures. The treatment is also not expected to be covered by health plans. According to international literature, the pregnancy rate with IVF varies between 35% and 50% for each cycle, depending on the woman’s age.

The state of São Paulo has four of the ten centers that serve SUS patients. But only the Women’s Hospital (formerly Pérola Byington) and the Hospital das Clínicas de São Paulo, both in the capital of São Paulo, offer completely free treatment through state government funds.

At the Hospital das Clínicas de Ribeirão Preto, at USP (University of São Paulo), patients need to pay for the medication, around R$6,000 per cycle until last month. At the reproduction service at Hospital São Paulo, linked to Unifesp (Federal University of São Paulo), around R$12,000 is charged for medications and the culture medium used in the treatment.

The other centers that serve the SUS are in Porto Alegre (RS), with two centers; Belo Horizonte (MG), Goiânia (GO) and Brasília (DF) and Natal (RN). In the last two, treatment is also free.

Although IVF is included in the 2005 Ministry of Health policy, the treatment is not included in the SUS table. “In the history of this policy, there were some specific federal transfers. Everything we have today is at the expense of the state Treasury”, says Morris Pimenta e Souza, technical director of HM (Women’s Hospital).

According to the State Department of Health, 189 in vitro fertilization cycles were carried out in 2023 at the HM reproduction center, at an operational cost of R$4.6 million.

“As a public hospital, we leave nothing to be desired for any private reproduction service”, says Nilka Fernandes Donadio, head of the institution’s reproduction laboratory.

At the reproduction center at Hospital das Clínicas de São Paulo, there were 234 IVF cycles last year. The amount allocated by the hospital to the reproduction sector was almost R$2.7 million. Currently, there is a waiting list of 50 couples.

Carrying out IVF in public centers can take one to two years (after the woman is already registered with the service), there is an age limit (in general, 38 years old) and a limit on attempts (up to two IVF cycles). In the capital of São Paulo, vacancies at the Hospital das Clínicas and Hospital da Mulher centers are regulated by Siresp (Computerized Regulation System of the State of São Paulo), formerly Cross.

According to gynecologist and obstetrician Edmundo Baracat, professor at USP and coordinator of the women’s health area at the State Department of Health, the São Paulo government is studying the expansion of the offer of IVF in other regions and increasing the capacity of existing centers. However, there is no budget forecast for this year.

Baracat states that a mapping of the demand for infertile couples will be carried out and how many can benefit from low-complexity treatment, such as intrauterine insemination.

“We have women with tubal obstruction who can have a uterine tube reanastomosis, those with endometriosis can undergo treatment. It does not exclude the possibility of having to undergo IVF, but there are other therapeutic options”, he says.

In his opinion, the Ministry of Health should be the main promoter of a public policy that guarantees the reproductive rights of couples who want a child and face difficulties. “There has to be financing.”

For gynecologist and USP professor Rui Ferriani, coordinator of the reproduction center at Hospital das Clínicas de Ribeirão Preto, access is today the main problem with assisted reproduction in the country and one of the biggest factors of exclusion in the reproductive area.

“Those who have infertility and have money solve their problem in private clinics. Those who don’t have it get frustrated or sell everything they have to pay for the procedures.”

According to him, at the Ribeirão institution, there is a waiting list of around 350 couples who wait up to two years to have IVF.

Until last month, couples paid an average of R$6,000 for medicines. According to Ferriani, the State Department of Health promised, starting this month, to include R$3.5 million in the local budget to cover the cost of medications.

At the reproduction center at Hospital São Paulo, couples who enter the service first undergo an investigation into the reasons for infertility.

If IVF is indicated, which happens in 60% of cases, the couple has to pay for hospitalization, medication and the costs of the culture media involved, which amounts to around R$12,000. “Because they don’t pay medical fees, it’s more affordable than privately”, says urologist Renato Fraietta, coordinator of the integrated human reproduction sector at Unifesp.

The doctor says he advises couples against selling assets, such as their car, to pay for treatment. “I always say that it’s not guaranteed, the person will have at most a 50% chance.” Each year, around 300 IVF cycles are performed at the service.

A member of the reproduction technical chamber of the CFM (Federal Council of Medicine), Ferriani says that a demand that has grown a lot is that of women diagnosed with cancer and who seek out reproduction centers to try to preserve their fertility before starting chemotherapy.

In these cases, as there is a high risk of infertility after cancer treatment, the medical recommendation is to freeze the eggs for use in the future.

“It is an obligation for the SUS to offer egg preservation to young women undergoing cancer treatment. The vast majority are unable to pay for the medications [para a estimulação ovariana]”, reinforces Ferriani.

The Women’s Hospital is one of the few services that offers free treatment. Every month, ten women diagnosed with cancer are seen and have their eggs frozen.

“These are women who would have their reproductive prognosis sealed [infertilidade] and here they have the possibility of preserving this fertility. It pleases our eyes to be able to offer this, but we would like to be able to offer it on a much larger scale”, says Nilka Donadio.

Artur Dzik, director of the reproduction center at Hospital da Mulher, states that the right to reproduction is part of a woman’s citizenship. “It is possible to offer reproductive dignity to the SUS patient. The big problem is access and this is a global problem”

According to him, the need for assisted reproduction tends to increase more and more because men and women are more infertile due to environmental factors, such as pollution, and behavioral factors, such as obesity.

“Classic problems, such as endometriosis and polycystic ovaries, have also increased. Women are getting pregnant later. We need to be prepared to give more access to this problem, which is here to stay.”

In a statement, the Ministry of Health reported that it plans to form an internal working group to review the 2005 human reproduction policy, with the consultancy and guidance of experts in the field.

According to the ministry, a regulatory impact analysis on the topic must also be carried out and concrete proposals drawn up based on the results of this analysis to improve access and quality of assisted human reproduction services in the SUS.

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