Seven years from the abolition of the ban on heterologous fertilization and almost six thousand children born, up to the latest data from the Higher Institute of Health in 2018. And it is therefore reasonable to think that there are many more: in 2018 they were born in 2002 and if the number remained the same in 2019 and in 2020 it would be over ten thousand births. Children born precisely thanks to heterologous fertilization, the technique that uses oocytes or sperm from donors, taken from a bank. A technique – that of the heterologous – prohibited in Italy by law 40 of 2004 and readmitted by the Council ten years later, on April 9, 2014, upon appeal by the courts of Florence, Milan and Catania. Until then – but in many cases it also happens today – couples were forced to go abroad, especially to Spain, where the idea of egg donation is not a taboo and women are willing to do it, as is the donation. blood, receiving a fee that does not exceed a thousand euros. It is not a question of money, but of mentality, a mentality that has made Spain the largest donor egg bank in the world. It is the main destination of the so-called “procreative tourism”.
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From 2014, however, gamete donation can also be used in Italy. And there are couples who – despite the difficulties, including economic ones, considering that only a few public centers offer this possibility and therefore everything takes place privately – decide to stay in Italy. Like that of SIMON, a forty-year-old architect and his partner Mirko, who became Caterina’s parents 4 and a half months ago. Five years ago Simona was diagnosed with endometriosis. So a pregnancy would have been difficult, even more so considering the age. Then he meets Mirko and the project of having a child is more pressing for both of them. “For a year we tried of course – he says – but then we turned to an assisted reproduction center and there the first bad news: my oocytes were scarce and of bad quality”. At this point, the use of a gynecologist friend, Cincy Argento, who works in a large private Roman center in Pma is a new attempt. “We were able to produce only one embryo, which was aneuploid (with chromosomal anomaly, ed) at the pre-implantation analysis. We therefore decided to resort to egg donation: in 2019 I immediately got pregnant but unfortunately I lost the two children to a monochorionic monoamniotic twin pregnancy (Fetuses share placenta and amniotic sac, ed). A difficult time for us. Then, after a few months a second attempt, on the very day of the first Dpcm of the pandemic and this time Caterina was born ”.
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Doubts, hesitations before choosing to have an egg from an anonymous Spanish bank? “Mirko and I had no ethical doubts or hesitations – continues Simona – we talked about it and decided to accept the egg donation proposal. Did we tell friends and family? In reality, everyone knows about assisted procreation and few about egg donation, but not for a precise choice, rather for the difficulties of meeting due to the pandemic. However, we have already heard from a psychologist because we would like to find the right way to tell Catherine when the time comes. Would we do it again? A hundred times, and it is a pity that in Italy it is so difficult ”.
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Yet gamete donation could be a solution for many couples. “The success of this technique – he premises Filippo Maria Ubaldi, president Sifes-Mr (Italian Society of Fertility and Sterility-Reproductive Medicine) – lies in the fact that it can solve many cases of male infertility, premature menopause or difficulties due to the woman’s late age, over 42-43 years. Procrastinating motherhood involves a degeneration of female gametes and the need to resort to egg donation. But beware: the risks associated with maternity in old age remain. Until the first trimester of pregnancy they are the same at all ages but in the second and third trimesters elasticity and vascularization of the tissues, conditions of the uterus and can increase obstetric risks, the danger of preterm birth, hypertension and gestational diabetes ” .
Heterologous fertilization, in Italy still too few egg donors
FABIO DI TODARO
But the donation of gametes – especially that of oocytes, the most frequent – is not available to everyone in our country. So much so that many couples – at least those who have the economic possibility – go abroad: Spain, above all, but not only. After all – stresses disheartened Filomena Gallo, lawyer who defended couples at the Consulta to obtain heterologous fertilization, secretary of the Luca Coscioni association and Sifes-Mr councilor – in Italy not only is this procedure not provided in all regions but there is not even a tariff of services included in Lea with costs borne by the NHS, except for the pre-implantation diagnosis. “Those who reside in Puglia cannot perform the heterologous one – specifies Gallo – and if they go to other regions they have very strict reimbursement limits. In Sicily, on the other hand, the couple can work heterologous only in the private sector or outside the region, but only if they are addressed to public structures. If it is addressed to the private individual, there is no right to reimbursement “.
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And then there is the pandemic problem, which has blocked the activity of many centers, affecting couples in what is the most critical element of their quest for parenthood: time. And in the regions where public access to PMA is regulated by age limits, the block due to Covid has not been taken into account. And only Tuscany, Lazio and Campania have extended the age limit. Couples from other regions have seen the waiting list lengthen or have been cut off due to age restrictions.
Heterologous, the Council of State places a limit on the age of donors and the number of oocytes
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