The cost of PMA
In Italy, 62% of the second and third level treatment cycles with the couple’s gametes are provided by the NHS through affiliated public and private centres, a percentage which drops to 27% for donated gametes, with enormous differences between the regions. Lombardy – the first region in Italy for number of cycles (22,258 second and third level cycles started, equal to 26% of the total) provides coverage of over 90%. In second place in terms of number of cycles is the Lazio region (12,597), almost all of which were carried out in private centres, in third place is Tuscany (11,244), which operates almost entirely through the public sector. The objective of the tariff decree is also to bridge these divergences.
«The greatest critical issues are in the South, where the regions are not prepared and the structures are lacking» specifies Luca Mencaglia, coordinator of the technical table on infertility of the Ministry of Health and coordinator of the PMA network of the Tuscany region, explaining that «these regions will have to agree private centers and strengthen public centres. Otherwise citizens are forced to go outside the region.”
Differences from region to region
According to the latest report from the ministry, in 2021 Lombardy carried out 28.9% of cycles on patients resident in other regions, Tuscany 54.9%. The majority of the centers (54.6%) that carried out level II-III activities in 2021 are private, the most widespread type in the central and southern regions of Italy, while the 68 public centers (36.8%) ) are more present in the northern regions. The 16 affiliated private centers (8.6%) were located only in 4 regions: Lombardy, Tuscany, Piedmont and Friuli Venezia Giulia.
«For years, as scientific societies in the sector, we have hoped for the creation in each region of public structures or large centers in agreement that provide at least 1,000 cycles a year, with dedicated and adequate staff. Many, however, even in Lombardy, provide fewer than 500 cycles”, underlines Paolo Emanuele Levi-Setti, full professor of Humanitas University and director of the Humanitas Fertility Center, which in 2023 treated 2,181 couples, obtaining 1,342 pregnancies, over 90 % in agreement with the health service.
In Italy, the centers that have carried out less than 200 cycles represent approximately one third (33%) of the total, while 34% have carried out at least 500 level II and III cycles. Despite the postponement of the tariff decree, since January 2024 Humanitas has approved the access criteria envisaged, raising the number of ART attempts per couple from 3 to 6 both for treatments with the couple’s gametes and for donation and from 43 to 46 years the maximum age expected for women. Communication is crucial. «Information on the web, often misleading, should be better monitored. The creation of a mandatory national register of single cycles, on the model of the US register and as hoped for by the European Union itself, would give certainty and security to couples” concludes the director of the Humanitas Fertility Center.