In Italy, where cradles are empty, more and more babies are born from assisted fertilization. On average, the rate has gone from 32% in 2010 to 42% in 2020, about 30% more, with peaks between 70% and 80% in women ‘under 38’. This progressive increase is also the result of 5 strategies that have improved the success rates of PMA in 10 years, according to an extensive study by the Genera group and presented at the 40th congress of the European Society of Reproductive Medicine and Embryology (ESHRE), currently underway in Amsterdam.
The five winning strategies are personalized hormonal therapies that are never the same from woman to woman, aimed at reducing the risk of complications, such as ovarian hyperstimulation, without compromising the result; blastocyst culture, that is, bringing the embryos produced in the laboratory to the fifth-seventh day of development, the most suitable stage to facilitate implantation in the uterus; the freeze-all approach, that is, the choice to freeze the gametes and embryos before proceeding with the transfer, in order to have time to optimize the conditions of the maternal uterus; the pre-implantation genetic test that allows knowing the health status of the embryos before the transfer and, finally, the most recent adoption of the multicycle approach, that is, sensitizing the couple to ‘not give up’ – the experts explain – and to consider PMA as a path, whose potential often does not materialize in a single attempt but, on average, in at least three.
Since 2004, when Law 40 on Medically Assisted Procreation came into force, 217,000 children have been born using PMA techniques, currently 4% of the births that occur each year in our country (ISS data). “Over the past 10 years, the period of time we considered for this study – explains Alberto Vaiarelli, first author of the paper, gynecologist and medical-scientific coordinator of the Genera center in Rome – the implementation and increasing adoption of these approaches have improved the results of in vitro fertilization. The main indicator of the success of in vitro fertilization is the cumulative rate of children born, but there are other results to consider for a more in-depth evaluation of the efficacy and efficiency of the treatment, including the time needed to get to have a child, the rate of spontaneous abortion and the prevalence of twin pregnancies. Furthermore, the couple should always be put in the best conditions – he underlines – to think about a family planning project, aiming to have more than one child, when possible”.
The study was based on analyzing the data of 6,600 couples undergoing PMA at the Genera center in Rome, divided into 11 groups based on the year of their first treatment (2010-2020) and compared to verify the birth of a child within 3 years, the prevalence of spontaneous abortion and twin birth and the prevalence of single births of more than 2 children within 6 years. Hormonal stimulation occurred with different protocols, all patients underwent ICSI (intracytoplasmic insemination, i.e. the laboratory technique that allows the insertion of a single sperm inside the mature oocyte) on fresh oocytes, but with culture on the second-third day of development or blastocysts (5-7 days), fresh or freeze-all transfer of embryos not tested with PGT or tested and found to be chromosomally healthy (euploid), transfers of single or multiple embryos.
It has emerged that, over the years, the adoption of strategies hypothesized by experts as the best to optimize success rates has progressively increased. With the effect of a continuous improvement in the cumulative rate of children born within 3 years: it has increased on average from 32% in 2010 to 42% in 2020, with peaks between 70% and 80% in women ‘under 38’ in the case of normal ovarian reserve. At the same time, the number of women who have suffered a spontaneous abortion has halved (from 12% to less than 6%) and women with twin births have decreased (from 7.5% to 0.5%).
“Clinical and laboratory advances – Vaiarelli concludes – have improved the efficacy and efficiency of in vitro fertilization over time, also satisfying the desire for family planning. The technologies we have in store for the future and the improvement of workflows will help us achieve the goal of reducing the abandonment of treatment by couples. This means conceiving PMA as a journey, and not as a single attempt”.
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