Factors related to infertility in Brazil and their relationship with success rates after assisted reproduction treatment: an integrative review

Abstract

This integrative review evaluated the most commonly diagnosed causes of infertility in men and women in Brazil, as well as the medically assisted reproduction technologies regularly employed in these cases. We searched in four electronic databases (PubMed, including Medline; Scopus; Web of Science and LILACS), and two grey literature (Google Scholar and OpenGrey), guided by the focused question: "What are the main factors responsible for male and female infertility in Brazil, and what are its relationships with success rates after assisted reproduction treatment?". We included interventional or observational studies, without limitation by language or year of publication. Our searches in the electronic indexers recovered 1,119 articles, and after analyzing the inclusion and exclusion criteria, 27 articles composed the body of analysis for this review. We grouped the studies into four themes: factors responsible for male and female infertility, assisted reproductive technologies (ART) used in the infertility treatment, assisted reproduction procedures, and clinical predictors of success rates in ART. Despite the scarcity of studies analyzing the association between infertility and assisted reproductive technologies in Brazil, it was possible to infer that the most prevalent infertility cause in women was endometriosis, while in men it was azoospermia. The most widely assisted reproductive technology applied in the country is the intracytoplasmic injection of spermatozoa (ICSI), ensuring better success rates in the treatment of infertility for men and women.

Prevalence and predictive factors for infertility-related stress among infertile couples

“…According to a recent large systematic review, the couples' age, number of oocytes recovered, and embryo quality were considered the most critical predictors of infertility success. 33 Even if there are numerous effective infertility therapies available, high costs could be a significant obstacle to finishing treatment cycles, especially in the absence of health insurance. 34 Despite the increasing frequency of infertility, there are irregularities in the coverage, expenses, and reimbursement policies of health insurance.…”

Infertilidade

“…Em relação à investigação feminina, é importante levantar, ainda na anamnese, a história ginecológica da paciente, abordando questões sobre o ciclo menstrual, métodos contraceptivos já utilizados, comorbidades (obesidade, hirsutismo, diabetes, patologias autoimunes, outras) e cirurgias anteriores, principalmente pélvica (SZAMATOWICZ 2020; PREFEITURA DE BELO HORIZONTE, 2022). No exame físico, o exame pélvico deve ser realizado em todas as pacientes, com inspeção da genitália interna e externa, à procura de alterações inflamatórias, vulvovaginites, sinais de virilização, hímen íntegro ou presença de sinais de DIP (LAMAITA et al, 2018).…”

“…Dentro desse fator, estão compreendidas as más formações, lesões neoplásicas ou benignas, infecções e alterações anatômicas (LAMAITA et al, 2018). O teste pós coito tem como finalidade analisar a receptividade do muco cervical e a habilidade em permitir a sobrevivência e a migração dos espermatozoides em seu conteúdo (PREFEITURA DE BELO HORIZONTE, 2022). ]…”

“…Os aspectos epidemiológicos da infertilidade carecem de estudos robustos que possibilitem determinar com precisão sua incidência e prevalência, especialmente em relação à realidade brasileira, para a qual os dados são ainda mais escassos. A estimativa de que a infertilidade esteja presente em cerca de 15% a 20% dos casais é a mais frequente na literatura nacional (PREFEITURA DE BELO HORIZONTE, 2022;LAMAITA et al, 2018). No panorama internacional, esse número se encontra na faixa de 8% a 12% dos casais em idade reprodutiva, sendo a infertilidade secundária a forma mais comum (VANDER BORGHT & WYNS, 2018).…”

Endometriosis: A Disease with Few Direct Treatment Options

“…The World Health Organization (WHO) defines infertility as the inability of a couple to establish a clinical pregnancy after 12 months of regular unprotected sex. Among the main causes of infertility, the following stand out: polycystic ovary syndrome, endocrine/anovulatory age, advanced age, and endometriosis, the latter being the most prevalent cause [92]. The mechanisms of infertility related to endometriosis are still not widely understood.…”