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Infertility, the latest data show an increase in heterologous fertilization treatments in Italy

On June 28, 2018 the Annual Report of the Law 40/2004 concerning medically assisted procreation (PMA) was transmitted to Parliament, compared to the activity of PMA centers in 2016 and the use of funding (articles 2) and 18) in the year 2017.

The framework relating to the application of law no. 40/2004 for the year 2016 offers little variation compared to the previous situation regarding homologous fertilization. On the other hand, there is an increase in heterologous fertilization treatments.

Some data

It is the public and private centers affiliated to carry out the largest number of assisted reproduction treatments. In fact, although the private PMA centers are more than the public ones (101 vs 64), in the private sector, however, fewer treatment cycles are carried out:

• 35.0% of the centers are public and 37.1% of the cycles performed

• 9.8% is a private agreement and 28.8% of the cycles are performed

• 55.2% are private and turned on 34.1% of the cycles.

Furthermore, a large number of PMA centers in Italy have a limited number of procedures throughout the year. Only 24.6% of the II and III level centers have done more than 500 cycles, compared to a European average of centers that take more than 500 cycles of 41.0%. (European IVF Monitoring, EIM 2013).

Considering all the techniques of PMA (homologous and heterologous), both of I level (insemination), and of II and III level (in vitro fertilization), from 2015 to 2106 increase the treated pairs (from 74.292 to 77.522), the cycles performed (from 95.110 to 97.656) and children born alive (from 12.836 to 13.582). This increase is fundamentally related to heterologous fertilization and homologous norms with cryopreservation of gametes.

In fact, couples, the cycles started and those born of techniques of II and III level that are homologous to a fresco and homologous simple inseminations diminish; There is an increase in gamete donation techniques, both for insemination and for II and III level fertilization techniques, in total pairs increase (from 2,462 to 5,450, + 121%), cycles increase (from 2,800 at 6.247, + 123%) and the number of births increased (from 601 to 1.457, + 142%).

Of the 6,247 cycles with gamete donation, 1,611 cycles started with seed donation, equal to 25.8%; 2,901 are those with donation of oocytes (fresh and frozen), equal to 46.4%, 1,735 are those with embryos, previously formed by donated and cryopreserved gametes, equal to 27.8%.

Only 1,399, equal to 84.4% of the total cycles with seed donation, cycles with imported oocytes (female heterologous) are 2,727, equal to 94% of the total cycles with oocyte donation.

Twins and trigeminal pregnancies decrease, the latter being in line with the European average, despite a persistent variability among the centers. The evaluation of negative outcomes on monitored pregnancies remains constant, for in vitro fertilization both from fresh and from thawing.

Confirmed the increase of women over 40 who access these techniques: they are 35.2% in 2016, they were 20.7% in 2005. The average age of women who undergo homologous fresco techniques remains : 36.8 years. In heterologous fertilization, the woman's age is greater if the donation is of oocytes (41.4 years) and less if the donation is of seed (35.2). The age of those who adhere to the female heterologous (compared to the homologue) seems to indicate that this technique is chosen for physiological infertility, due to the age of the woman, and not for specific pathologies.

Success rates of PMA techniques

The percentages of success of the techniques are unchanged: if we consider as an indicator of the gravity of pregnancies obtained on cycles started, for the level techniques it is a value of 10.9% (it was 10.5% in 2015), (from 18, 2% in 2015 to 17.3% in 2016), from 26.2% to 27.5%, decreases for oocyte thawing techniques (from 16.6% to 16.3%)

One of the variables that affects the behavior of women. As the age increases, in fact, the relationship between pregnancies obtained and cycles started undergoes a progressive decline while the risk that pregnancy does not result in a birth increases. Success rates decreased linearly from 23.9% for needs under 35 to 4.5% for those over 43.