L’infertility it is an increasingly widespread pathology: it affects approximately 1 in 6 people in the world and 15% of couples in Italy. As emerged during the press conference of CLAIM, which was attended by numerous experts on the subject, these numbers highlight the importance of guaranteeing accessible and high-quality therapies to those who need them. That’s why a personalized approach to ovarian stimulationfirst step in the journey of medically assisted procreation (PMA), can help make a difference to the outcome of treatments.
Ovarian stimulation in PMA
According to Report on the trend of births from the Statistics Office of the Ministry of Healthfrom 2012 to 2022 the use of PMA techniques is rose by 73%. In 2022, for every 100 pregnancies there were 3.7 births with ART. In particular, in vitro fertilization with transfer of embryos into the uterus (IVF) is confirmed most used techniquegoing from 37% to 48% in ten years.
Ovarian stimulation represents an important step in the PMA process. This phase, which lasts on average 15 daysinvolves the subcutaneous injection of gonadotropins. It’s about hormones, physiologically secreted by the pituitary gland, which regulate the reproductive functions of the male and female genital organs. The goal of stimulation is 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 partner’s sperm or an external donor.
Ovarian stimulation and PMA: the importance of a personalized approach
«The variety of gonadotropin-based products available today allows us to carry out highly personalized treatment protocolsmaximizing clinical outcomes and minimizing risks,” he commented Adolfo AllegraNational President of CECOS Italia (Oocyte and Sperm Conservation Centres).
«No new versatile formulations in the methods of administration they respond to a deeply felt need on the part of women to be able to have access to therapies easy to handle and self-administer, increasing adherence to treatment. In addition to offering the possibility of precisely calibrate the dosage of the drug based on the specific needs of each patient.”
Are gonadotropins safe?
Gonadotropins have been used in PMA treatments since the 1980s. Since then, technological advancement has increasingly improved the production processes, to guarantee a high degree of purity and reliability. «In general, new generation gonadotropin-based drugs have a very solid efficacy and safety profile», continues Allegra.
«There is no definitive scientific evidence that demonstrate a direct link between the use of these drugs and an increased risk of cancer. Nor have any long-term effects been reported linked to the increased risk of the onset of other diseases or interaction with the progress of pre-existing pathologies, in a manner different from that to which a pregnant woman is normally exposed.”
«The greatest risk is represented by ovarian hyperstimulation syndrome (OHSS) which, however, was more frequent in the past. While today it represents a very rare complication thanks to the possibility of building “tailor-made” therapeutic protocols for each patient, based on specific hormonal characteristics, as well as factors such as age, weight and ovarian reserve”.
Ovarian stimulation and PMA: what factors can affect it?
There are several factors which can affect the ovarian response to stimulation. «In addition to theage of the woman should be considered his ovarian reservethat is, the number of still immature oocytes present in the ovaries, which decreases as a function of age but which can also be influenced by other elements”, he explains Paola AnseriniPresident of the Italian Society of Fertility, Sterility and Reproductive Medicine (SIFES-MR).
«Other factors to consider when evaluating a woman’s fertility also includebody mass index and the response to previous cycles of ovarian stimulation. As well as the cause of infertility and its duration which can influence the outcome of treatments”.
The introduction of PMA in LEA
In the near future, PMA procedures will also become part of the Essential Levels of Assistance (LEA). «The integration of PMA techniques into LEA it is a fundamental step forward for ensure equal access to all couples with fertility problems looking for a child, regardless of the region of residence”, he highlights Luca MencagliaPresident of the PMA Foundation.
«Unfortunately, it is recent news that the entry into force of the new LEA tariff has been postponed further January 2025. This postponement 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 are already approaching these paths at an advanced age.”