Fortunately, this audience is growing in clinics, overcoming any prejudice
Today, it is no longer unusual to find LGBTQIA+ couples interested in having children at human reproduction clinics. And if this is a complicated quest for heterosexual couples, it is much more exhausting for homosexuals because, in addition to facing the usual and expected difficulties of treatment, they can sometimes also face prejudice. However, this has been increasingly common and these conflicts, which were much more pronounced in the past, have been mitigated by the greater frequency of these consultations and with the increasingly common and notorious appearance of these relationships not only in literature (films). , telenovelas, series, etc.) but also in real life, luckily.
Medical ethics limits medical acts to what the Federal Council of Medicine (CFM) defines as right or wrong and obliges health professionals to strictly follow the rules established by them. These standards help to avoid some of the exaggerations and may be modified as determined by this board. But are there any specific ethical or legal restrictions on these treatments?
“None. In 2013, the CFM allowed the use of assisted reproduction techniques for singles and same-sex couples. Since then, family structures began to be constituted in different ways. The ethical rules laid down are similar to those of heterosexual couples with specific adaptations to be followed”, he says Arnaldo Cambiaghi, specialist in gynecology and obstetrics with performance certificate in the field of assisted reproduction and technical manager of the Human Reproduction Center of IPGO.
Following criticism from sectoral entities, the CFM again modified the regulations regarding assisted reproduction in Brazil on September 20 of this year. In the new rules, among other changes, the entity banned explicit citation of transgender people. According to the council, the standard was updated because, as it was before, it could lead to different interpretations.
It is important to note that all couples (male or female) who will undergo assisted reproduction treatment should seek a center specializing in human reproduction for evaluation.
This topic is so important to IPGO that Cambiaghi created an e-book, together with HR specialist Rogério Leão, to help LGBTQIA+ couples clarify their doubts and access all the information they need: Fertilization Treatments in Homosexual Couples – Straight to the Top. It can be downloaded for free by clicking here.
female homosexual couples
In any same-sex couple, it is not possible to generate a child with genetic material from two women or two men. In female couples, it is always necessary to use donated sperm and there are two options: artificial insemination or insemination. in vitro.
“Artificial insemination is a method accompanied by a doctor and consists in the process of placing sperm directly in the intrauterine cavity, close to the tubes, so fertilization takes place inside the mother’s organism, as in a spontaneous pregnancy, while IVF is completely different. , as fertilization and early embryonic development takes place in the fertilization laboratory”, explains Cambiaghi.
In insemination, one of the women will always become pregnant with her eggs. IVF is called fertilization. in vitro because fertilization is carried out in the laboratory (see details ahead), that is, unlike what happens in the natural method, the embryo is formed (the union of the female gamete, the egg, with the male gamete, the spermatozoon). outside the woman’s womb. Here we will have two possibilities: in the first, one of the women will be pregnant with her eggs, in the second, it is a joint pregnancy.
In this case, the two women undergo tests that evaluate their reproductive capacity, the anatomy of the uterus, the analysis of factors such as age and diseases such as diabetes, hypertension, etc. In this way it is possible for a woman to experience the pregnancy of her partner’s biological child. This method is guaranteed as right by the Federal Council of Medicine, since CFM Resolution No. 2,121/2015, and reaffirmed in CFM Resolution No. 2,168/2017.
If they choose intrauterine insemination, only the one who will undergo treatment should undergo evaluation. In case it is fertilization in vitro, it is necessary to identify who will stimulate the ovaries and who will be pregnant so that examinations can be directed according to the role that each will play: ovarian function examinations for what will provide eggs and evaluation of the uterus and failures of implantation. for what you are going to do. If the same woman will play both roles, only she will be fully appreciated.
Gay male couples
For gay male couples, the dream of fatherhood is a little more complicated, but yes, possible. It is more difficult, first, because it must always be fertilized. in vitro (IVF) using donated eggs. In addition, the subsequent pregnancy will have to be in a surrogate womb. In this consultation, the entire process necessary for the treatment, the chances of success and the limitations will be explained. “The sperm donor must undergo a fertility evaluation by means of a spermogram. It is also important that the woman who will become pregnant for the couple undergoes a consultation and a medical and gynecological evaluation,” the specialist emphasizes.
The couple then chooses an anonymous egg donor. In this case, it follows the normal rules established by the CFM Resolution, namely: the donation will never be for-profit or commercial in nature. In the case of temporary uterus donation (known as surrogacy), the CFM stipulates that “temporary uterus donors must belong to the family of one of the partners by blood relationship up to the fourth degree (first degree – mother/daughter ; second degree – sister/grandmother; third degree – aunt/niece; fourth degree – cousin), to give up the uterus for the pregnancy of the embryos. As a rule, exceptional authorization can be requested from the Regional Medical Council (CRM) of jurisdiction. In all cases, the age limit of up to 50 years must be respected.
The last step consists in choosing who will collect the sperm.
Thus, in short, the fertilization procedure is carried out in vitro, in which the anonymously donated egg is fertilized in the laboratory, with male gametes collected from one of the partners and, after initial development, the embryos are implanted in the surrogate uterus and thus managed. “It is possible for a part of the eggs to be fertilized with sperm from one of the men of the couple and the other part of the eggs with the partner’s sperm, forming embryos of both, however it is not allowed by the CFM that. transfer an embryo from each partner to the uterus. in the same cycle. At different times it is possible. We remember that the egg donor and the woman who will give the uterus cannot be the same person”, concludes Cambiaghi.
20th IPGO International Human Reproduction Course
These and other topics on this topic will be covered during the lecture. “Practical aspects of assisted reproduction in the LGBTQIA+ population“, on Sunday November 13 by the Human Reproduction specialist Ana Carolina Japur Rosa Silva, associate professor and doctor in the Department of Gynecology and Obstetrics at the Faculty of Medicine of Ribeirão Preto, USP, during the 20th Course in International Human Reproduction at the IPGO (Instituto Paulista de Ginecologia e Obstetrícia) to be held on the 12th and 13th November, online. The course is aimed at trainee doctors, residents, professionals and academics in the field of health.
To learn more, check the schedule, speakers, Brazilians and foreigners and prices, visit the IPGO courses website.
