Infertility is an increasingly widespread pathology at a global level, which affects approximately 17.5% of the adult population, or approximately 1 in 6 people. In Italy the percentage stands at around 15% of couples. Significant numbers that underline the importance of making medically assisted procreation (PMA) procedures more accessible and guaranteeing high quality treatments to those who need it. In our country, a new formulation of menotropin – an active ingredient for the treatment of fertility disorders – is available for a personalized approach.
“Globally and nationally we are seeing a steady decline in birth rates and a delay in the average age of first motherhood. More and more couples believe they can easily conceive even after the age of 40-45, ignoring biological limits – says Nicola Colacurci, past president of the Italian Society of Gynecology and Obstetrics (Sigo) and coordinator of Giss Reproductive Medicine – Therefore it is essential to promote education on motherhood and responsible sexuality that raises couples' awareness of the optimal biological age for having children, considering that reproductive capacity decreases from the age of 35, which also affects the success of the ART process”.
The most common causes of infertility for women “include a reduced ovarian reserve, tubal problems, endocrine infertility and endometriosis – explains Guglielmo Ragusa, president of the Italian Society of Human Reproduction (Siru) – while male infertility occurs when it is low the number of healthy sperm or when there are problems with sperm function that make it difficult for the egg to fertilize under normal conditions. The suggestion for couples with difficulty conceiving is not to wait too long to consult a gynaecologist, especially if the woman he is over 35 years old.”
Age is certainly a fundamental factor also with regards to ovarian stimulation, a step that occurs in an initial phase and therefore very important in the Pma process whose objective is to increase the production of mature follicles during an ovarian cycle, to collect an adequate number of egg cells which can then be fertilized in the laboratory with the sperm of the partner or an external donor.
The stimulation phase, which lasts on average 15 days – we read in a note – involves the subcutaneous injection of hormones called gonadotropins which stimulate the ovaries to produce more mature oocytes and which the woman can self-administer independently. In ovarian cycles, these hormones are physiologically secreted by the pituitary gland and regulate the reproductive functions of the male and female genital organs.
“Thanks to scientific advances, today we have several treatment options that allow us to personalize the approach to ovarian stimulation, selecting the optimal treatment protocol for each patient. In this way, the probability of pregnancy increases at the same time as minimizing the risks of these treatments – comments Adolfo Allegra, national president of Cecos Italia (Egg and sperm conservation centres) – Being able to have new formulations that are versatile in terms of administration concretely meets the need strongly felt by women, to be able to have therapies that are easy to handle and self-administer, thus increasing adherence to treatment. Furthermore, in this way it is possible to calibrate the dosage of the drug with great precision based on specific individual needs.”
There are several factors that can affect the ovarian response to stimulation. “In addition to the woman's age – recalls Paola Anserini, president of the Italian Society of Fertility, Sterility and Reproductive Medicine (Sifes-mr) – her ovarian reserve must be considered, i.e. the number of still immature oocytes present in the ovaries, which decreases depending on the advancing years but which can also be influenced by other elements. Furthermore, other factors to consider when evaluating a woman's fertility also include body mass index and response to previous cycles of ovarian stimulation, as well as the cause of infertility and its duration which may influence the outcome of treatments.”
Gonadotropins, used in PMA treatments since the 1980s – the note reports – have a solid efficacy and safety profile demonstrated over time. “As regards the possible relationship between the use of gonadotropins and the increased risk of cancer, there is still no conclusive evidence – adds Allegra – even if the most recent literature appears comforting, at least for women who have not had children . Furthermore, with the use of these drugs neither distant effects nor an increase in the risk of the onset of other diseases have been reported in a significantly different way compared to the untreated control population”.
Technological advancement has also increasingly improved the production processes of gonadotropins over time, guaranteeing today a high degree of purity and reliability. “In the field of reproductive medicine, Ibsa has long experience and has generated very solid scientific and technological know-how. Our research and development philosophy is based on listening carefully to patients to offer treatments in the best form” – states Tiziano Fossati, Head of Pharmaceutical Research and Development at Ibsa.
According to recent estimates, from 2012 to 2022 – the note details – there was a 73% increase in the use of ART techniques, with 3.7 births out of 100 obtained with assisted procreation. In particular, in vitro fertilization with transfer of embryos into the uterus (IVF) remains the most used technique, rising from 37% to 48% in ten years. Pma procedures will soon also become part of the essential levels of assistance (Lea).
“The integration of PMA techniques into the LEAs is a fundamental step forward to guarantee equal access to all couples with fertility problems looking for a child, regardless of the region of residence – remarks Luca Mencaglia, president of the PMA Foundation – Unfortunately , it is recent news that the entry into force of the new Lea tariff has been postponed further to January 2025, a postponement which weighs particularly heavily in the field of reproductive medicine where the time factor plays a crucial role in the probability of success of treatments, at least for those couples who approach these paths already at an advanced age”.
The MAP process, including the ovarian stimulation step, is a complex journey also from a psychological point of view. “The diagnosis of infertility and the use of MAP can represent a real life crisis, personal, relational and family – admits Silvia Grossi, psychologist and psychotherapist – since they are an important source of stress, chronic and constant, which has a significant impact both on psychological well-being and in various spheres of life”. These levels of stress “can also significantly impact the decision to abandon treatments: 1 in 4 couples give up precisely because of the emotional and physical challenges that are often underestimated at the beginning of the route. Many couples avoid psychological support for fear of feeling even more inadequate, but in reality it is an opportunity to better experience the emotional stresses of the moment, improve individual well-being and strengthen the couple's bond, with consequent positive effects also on treatment compliance ” concludes the expert.
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