What does infertility mean?
Infertility is a disease of the reproductive system that alters one of the most basic functions of the body: the ability to conceive and carry on pregnancy, with the aim of having the baby in one’s arms. Infertility affects 10% -15% of couples. This makes it one of the most common diseases in people between the ages of 20 and 45. The longer a woman tries to get pregnant without being able to conceive, the lower her chances of getting pregnant without seeking medical attention. Most (85%) of couples with normal fertility will conceive within a year of targeted attempts.
If a couple does not conceive in the first year, their chances of conceiving decrease every month and the rate at which these chances decrease is closely related to the woman’s age. Generally it is recommended to investigate with medical examinations when the pregnancy does not arrive after 12 months of targeted attempts (if the woman is younger than 36 years) or already after 6 months of failed attempts if the woman is over 36 years old.
However, if health problems such as endometriosis, PCOS, autoimmune problems, etc. already exist at the beginning of the research. which can make the search for pregnancy much more difficult, it is good to talk to your doctor immediately.
Broadly speaking we can say that about a third of infertility cases can be attributed to male factors and about a third to factors affecting the female sphere. For the remaining third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20% of cases, the cause is unknown. There is talk of unexplained or idiopathic infertility.
How is infertility diagnosed?
There are a series of in-depth examinations to try to trace the causes or failure to conceive, or take root or continue the pregnancy
It always starts from the initial anamnesis up to the more or less invasive diagnostic tests.
What happens if I am diagnosed with infertility?
Most cases of infertility – 85 to 90 percent – are treated with conventional therapies, such as drug treatment or surgery on the reproductive organs.
If drug therapies or interventions alone do not lead to results, or if these two interventions are not applicable, homologous or heterologous assisted fertilization or adoption can be used, always taking into consideration the wishes and possibilities of the couple.
What is assisted fertilization?
In infertile couples where women have obstructed or absent fallopian tubes or in couples where men have low sperm count, assisted fertilization (MAP) offers a chance for parenting to couples who until recently would not have had. no hope of having a biological child.
Is in vitro fertilization expensive?
Like other extremely delicate medical procedures, IVF involves highly skilled professionals and sophisticated laboratories and equipment. It may also be necessary to repeat the treatment to be able to conceive and carry the pregnancy.
In Italy there are public or private facilities with agreements, where it is possible to undertake the assisted fertilization process at the cost of the ticket and obviously paying for drugs unless exempted.
In private centers the costs are around 700 euros upwards for the IUI and 2000 euros upwards for the IVF. Costs vary greatly depending on the type of stimulation, use of cryopreservation and / or pre-implantation diagnosis
To do a example of costs in the public, in Veneto, we took the PMA center of the Padua hospital as a reference
The total amount for benefits varies according to the tests deemed necessary by the doctor for a correct diagnosis of the causes of infertility.
You can find all the costs listed in this document from page. 8.
Does in vitro fertilization work?
Yes, assisted fertilization treatments work because millions of children have been born all over the world since the distant 80s thanks to these techniques that have gradually improved.
In Italy in 2018, based on the latest data made available by the PMA National Register, the following results were obtained
- 345 MAP centers active in 2018
- 298 centers with access for at least 1 couple, of which 110 at I level and 188 at II and III level
- 77,509 couples treated with first, second and third level medically assisted procreation techniques
- 97,508 treatment cycles started
- 18,994 pregnancies obtained
- 12,797 parts documented
- 14,139 live born children representing 3.2% of the total born in Italy in 2018 (439,747 live births, Source: ISTAT)
What impact does infertility have on psychological well-being?
A diagnosis of infertility weighs like a boulder on the heads of couples who are faced with a new situation, often completely unknown, full of question marks and certainly disorienting. The couple is hit by a lot of notions, complicated words, numbers and statistics. How to extricate yourself from all this? Addressing the multitude of medical decisions and the uncertainties that infertility brings can be important emotional upheavals. And it is for this reason that couples are advised or better still, to undertake a path with a psychotherapist specialized in infertility.
Why am I not responding to ovarian stimulation medications?
A response to ovarian stimulation depends on a number of different factors, the most important including ovarian reserve (available oocytes), hormone levels, proper administration of any medications, and lifestyle factors.
How does ovarian reserve affect ovarian stimulation?
To respond to ovarian stimulation, a woman must have oocytes available to respond to medications. If a woman has a reduced ovarian reserve (which is defined by high blood levels of follicle stimulating hormone (FSH), low blood levels of anti-Müllerian hormone (AMH), or a low number of antral follicles) she may not respond adequately to stimulation. For these patients, an alternative stimulation protocol can be tried or, in the most difficult cases, it is proposed to resort to the donation of gametes (heterologous fertilization)
It is also possible that a woman has the necessary oocytes but does not have the appropriate pituitary hormones to respond adequately to stimulation. In this case, the use of a stimulation drug that may contain both FSH and luteinizing hormone (LH) can allow for an optimal response.
Lifestyle can also affect a woman’s response to stimulation. Optimizing weight, diet and stress and stopping smoking, drinking alcohol, and taking drugs can improve the response to ovarian stimulation.
When should pre-implantation diagnosis be used?
The Preimplantation Genetic Test (PGT) is a technique aimed at highlighting abnormalities present in the embryos before their transfer to the patient’s uterus, after an in vitro fertilization treatment.
From a practical point of view, pre-implantation diagnosis consists in the sampling and subsequent analysis of the DNA contained in the cells of an embryo that has reached the blastocyst stage (this is how the embryo is defined at 5 and 6 days from conception).
To be able to carry out pre-implantation diagnosis the couple must undergo in vitro fertilization treatment: once the embryos have been obtained, they must grow in the incubator until they reach the blastocyst state.
Preimplantation diagnosis should be used, for example, in patients who have inherited disorders in the family, such as monogenic diseases (e.g. cystic fibrosis or sickle cell anemia) and sex chromosome-related (such as Duchenne muscular dystrophy and fragile X syndrome). . Currently, most couples resort to pre-implantation diagnosis to transfer only the chromosomally healthy blastocysts during an assisted fertilization process.It is known that with increasing age the errors in the number of chromosomes contained in the oocytes increase and consequently the risk for the couple to have embryos with an inadequate number of chromosomes.
National PMA Register
ASRM, American Society for Reproductive Medicine
PMA CENTER Center for Medically Assisted Procreation and Fertility Preservation of Padua