Médico especialista da Febrasgo esclarece as dúvidas mais comuns das mulheres
O assunto não é novo, mas em algum momento pode ser tema na vida de uma boa parte das mulheres: congelamento de óvulos. Isso porque são muitas as dúvidas sobre o tema, ainda mais que a maternidade tardia está cada vez mais comum.
Em 2019, uma pesquisa feita na Inglaterra pelo Centro de Pesquisa em Reprodução da Universidade De Montfort, na Inglaterra, revelou que a maioria das mulheres congela os óvulos por falta de um parceiro.
Dados do 13° Relatório do Sistema Nacional de Produção de Embriões (SisEmbrio), produzido no ano passado com dados de 2019 pela Agência Nacional de Vigilância Sanitária (Anvisa), mostram que o número de procedimentos ligados à reprodução humana cresce no Brasil. Os dados de 2019 mostram que o número de ciclos de fertilização in vitro vem crescendo no Brasil ao longo dos anos. Segundo o relatório, em 2019 foram realizados 43.956 ciclos de fertilização, o que representou um crescimento de mais de 800 ciclos em relação ao ano anterior.
Quando o motivo para adiar a maternidade é a carreira, já existem empresas que decidiram dar uma mãozinha às colaboradoras. Companhias como Apple e Google incluíram em seus pacotes de benefícios o reembolso para o congelamento de óvulos.
Neste caso, o congelamento de óvulos pouparia a mulher da pressão em ser mãe antes dos 35 anos, quando, muitas delas, encontram-se no auge de suas carreiras. Mas, existe idade limite para congelar óvulos? Quanto tempo pode-se manter óvulos congelados?
Para esclarecer responder a essas perguntas, o Feito Para Ela conversou com o médico Rui Alberto Ferriani, ginecologista e presidente da Comissão Nacional Especializada de Reprodução Humana da Febrasgo.
Confira a entrevista:
Qual a idade ideal e qual a idade limite para a mulher congelar óvulos?
Dr. Rui Alberto Ferriani – Não existe idade ideal. O que a gente sabe é que quanto mais jovem for a mulher, maior a capacidade dela produzir óvulos. E quanto mais velha, menor a probabilidade. A idade ideal de uma mulher engravidar, quando a produção é máxima, é entre 30 e 35 anos. Após isso, vai depender de cada mulher, mas esse número começa a diminuir. Uma mulher que se submete a congelamento após os 40 anos, tem uma chance de ter óvulos de boa qualidade muito pequena. A idade também limita o número de óvulos a ser produzido.
Existem “requisitos” para congelamento de óvulos?
Dr. Rui Alberto Ferriani – Não tem requisito. Temos dois grandes motivos de congelamento. Um é a paciente que tem chance de perder função dos ovários. Isso acontece quando ela vai se submeter a um tratamento de quimioterapia, por exemplo. Essa é o que chamamos de indicação médica. A outra é a chamada indicação social, quando a mulher não está com um parceiro definido, não está querendo engravidar e a idade vem chegando. E ela se preocupa em congelar. No geral, ela precisa ter uma produção no ovário, para que possa responder ao estímulo e ter óvulos para serem captados e congelados.
Avaliação da reserva ovariana é fundamental para previsão da taxa de sucesso nos tratamentos de reprodução assistida?
Dr. Rui Alberto Ferriani – A Avaliação da reserva ovariana não é fundamental para o estímulo. Essa avaliação pode ser feita pelo ultrassom, que fornece também uma informação sobre essa reserva. A dosagem de hormônio antimulleriano (AMH) é outra maneira de fazer essa avaliação. Essas duas informações servem como balizamento para saber se ela tem mais pressa ou menos pressa para fazer o seu procedimento. O que sabemos é que a mulher que tem o AMH baixo, ela vai produzir menos óvulos, mas não necessariamente significa que ela não vai engravidar espontaneamente. É até um detalhe interessante, uma mulher que tem o hormônio AMH baixo, e às vezes ela já tem parceiro, recomendamos que ela tente uma gravidez naturalmente. Isso porque a chance de gravidez espontânea ainda persiste. Já quando o hormônio antimulleriano é baixo, ao estimular a ovulação, a mulher tende a produzir uma quantidade de óvulos reduzida. Portanto, saber da reserva é fundamental para definir prognóstico, mas não precisa ser dosagem de AMH.
Quantos anos os óvulos podem ficar congelados? Há tempo limite?
Dr. Rui Alberto Ferriani -Até hoje não conhecemos nenhum limite de tempo para guardar óvulos e embriões. Existem já bebês nascidos de embriões congelados há mais de 20 anos. No entanto, não é tão frequente. Aparentemente porque não é conhecido de longo prazo isso. Se a mulher congela em torno dos 33 anos, ela tem uma boa chance de engravidar até aos 42 anos com os óvulos de quando era mais jovem. Isso é uma coisa boa. O que envelhece é a idade do óvulo. Assim, estabelecemos 50 anos a idade limite para a mulher engravidar com esses óvulos que foram congelados, a depender das condições clínicas dela.
BOX
Como funciona o congelamento de óvulos?
O processo de congelamento de óvulos envolve várias etapas. A paciente precisa fazer uma indução de ovulação. Geralmente, dura por volta de 10 dias. Envolve ainda o uso de alguns medicamentos que irão estimular o crescimento de folículos.
Por volta do 12° dia após o início da indução, a paciente é sedada para que os óvulos possam ser coletados. Esse processo é feito com uma agulha especial que fica acoplada a um ultrassom.
Após a coleta, eles serão encaminhados para um laboratório. Eles ficarão em uma incubadora para terminar de maturar, se necessário, e posteriormente selecionados.
Só então ocorre o congelamento de óvulos. Para isso, utiliza- se nitrogênio líquido em uma temperatura de -196°C.
Esses óvulos ficarão armazenados até que a paciente decida engravidar.
O custo desse procedimento depende muito da clínica onde você fará o processo. Uma vez congelados os óvulos, a mulher paga uma taxa anual para mantê-los armazenados.
Vale lembrar que é preciso levar em conta, ainda, todos os processos que envolvem o pós congelamento de óvulos, como o descongelamento e a fertilização, por exemplo.
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