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Medically assisted procreation. There is an increase in treatments with the Heterologous Fertilization

Few changes with respect to the situation of the previous year as regards fertilization without gamete donation, while there is an increase in treatments with gamete donation (heterologous fertilization). To trace the picture on the implementation of Law 40 of 2004 in the field of medically assisted procreation (MAP), is the Italian Report to Parliament on PMA 2019, concerning the activity of PMA centers in 2017 and the use of funding in 2018. Here the main data.

 

More cycles in accredited public and private centers

The trend is confirmed according to which the greatest number of assisted fertilization treatments is carried out in public and private affiliated centers.

In fact, although the number of private PMA centers is higher in number than the public ones (106 vs 67), fewer treatment cycles are carried out in the private sector: 35.3% of the centers are public and perform 37.4% of the cycles; 8.9% is private agreement and makes 29.5% of cycles; 55.8% are private and carry 33.1% of the cycles.

Furthermore, a large number of PMA centers carry out a reduced number of procedures during the year: only 23.1% of the II and III level centers did more than 500 cycles, against a European average of 41.5% .

13,973 children born of PMA

Considering all the PMA techniques - both level I (insemination), level II and level (in vitro fertilization) with or without gamete donation - from 2016 to 2017, treated couples increase (from 77.522 to 78.366), the cycles carried out (from 97.656 to 97.888) and children born alive (from 13.582 to 13.973). The increase is attributable to the increase in the cycles carried out with cryopreservation techniques and the cycles carried out with gamete donation.

In fact, the numerical data of the pairs, the cycles started and those born for all the techniques without gamete donations, both from simple insemination and from II and III level techniques, remain unchanged, while there is a significant increase in the application of techniques with gamete donation: in total the couples increase (from 5,450 to 6,429, + 18.0%), the cycles increase (from 6,247 to 7,514, + 20.3%) and births increase (from 1,457 to 1,737, + 19.2%).

Cycles with gamete donation: 7514

Of the 7,514 cycles with gamete donation, 1,582 cycles started with seed donation, equal to 21.1%; 3,149 are those with oocyte donation (fresh and frozen), equal to 41.9%; 2,783 are those with embryos, previously formed from donated and cryopreserved gametes, equal to 37.0%.

The cycles that used imported donated seed for a factor of male infertility were 1,304, equal to 82.4% of all the cycles performed with seed donation, while the cycles performed with oocyte donation for a female infertility factor were 3,035, equal to 96.4% of the total cycles with oocyte donation.

Twin pregnancies are falling

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

Patient age, higher if PMA is with gamete donation

The data on the age of patients accessing PMA techniques shows that compared to 2016, women under 35 and women aged between 35 and 39 years are on the increase, while the proportion of patients decreases by almost one percentage point with an age greater than or equal to 40 years. The average age of women undergoing techniques without fresh gamete donation is 36.7 years, higher than the European average of 34.7 years. In fertilization with donation of gametes the age of the woman is greater if the donation is of eggs (42.4 years) and less if the donation is of seed (35.6). The greater age of those who access the donation cycles seems to indicate that this technique is chosen above all for physiological infertility, due precisely to the age of the woman and not to specific pathologies.