Conception

Infertility and assisted reproduction: questions and answers

What does it mean to be infertile? What awaits me after an infertility diagnosis? How much does an assisted reproduction treatment cost? What are the chances of success?

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 the pregnancy, with the aim of having the baby in your 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 conceiving, the lower her chances of getting pregnant without medical treatment. The majority (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 age of the woman. It is generally recommended to deepen 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 there are already at the beginning of the search for health problems such as endometriosis, PCOS, autoimmune problems, etc. that can make it much more difficult to find pregnancy, it is good to talk about it immediately with your doctor.

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. We speak of unexplained or idiopathic infertility.

How is infertility diagnosed?

There are a series of in-depth examinations to try to trace the causes of the failure to conceive, or engraftment or continuation of pregnancy

It always starts from the initial anamnesis up to the more or less invasive diagnostic tests.

What happens in case of infertility diagnosis?

Most cases of infertility – 85 to 90 percent – ​​are treated with conventional therapies, such as drug treatment or surgery on the reproductive organs.

If pharmacological therapies alone or interventions do not lead to results, or if these two interventions are not applicable, one can resort to homologous or heterologous assisted fertilization , or to adoption, always taking into consideration the wishes and possibilities of the couple.

What is assisted fertilization?

In infertile couples where women have blocked or absent tubes or in couples where men have low sperm counts, assisted reproduction (MAP) offers a chance at parenthood to couples who until recently would not have had no hope of having a biological child.

Is IVF expensive?

Like other extremely delicate medical procedures, IVF involves highly trained professionals and sophisticated laboratories and equipment. It may also be necessary to repeat the treatment in order to conceive and continue the pregnancy.

In Italy there are public or private structures with special agreements, where it is possible to undertake the process of assisted reproduction at the cost of the co-payment and obviously paying for the medicines unless there are exemptions.

In private centers the costs are around 700 euros upwards for IUI and 2000 euros upwards for IVF. Costs vary greatly depending on the type of stimulation, cryopreservation and/or pre-implantation diagnosis.

To give an example of costs in the public, in Veneto, we have taken as a reference the PMA center of the Padua hospital

The total amount for benefits varies depending on 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.

For example,:

Does IVF work?

Yes, assisted reproduction treatments work because since the distant 80s millions of children have been born all over the world thanks to these techniques that have gradually been perfected.

In Italy in 2018, according to the latest data made available by the PMA National Register, the following results were obtained

  • 345 active LDC centers in 2018
  • 298 centers with access of at least 1 pair, of which 110 of I level and 188 of 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 documented parts
  • 14,139 live births representing 3.2% of the total number of births 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 head of couples who are facing a new situation, often completely unknown, full of question marks and certainly disorienting. The couple is invested by many notions, complicated words, numbers and statistics. How to extricate yourself from all this? Dealing with the multitude of medical decisions and uncertainties that infertility entails can lead to major . And it is for this reason that it is recommended or better yet, it is recommended that couples undertake a path with a psychotherapist specialized in infertility.

Why don’t I respond to ovarian stimulation medication?

A response to ovarian stimulation depends on a number of different factors, the most important of which include 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 eggs available to respond to medication. If a woman has a reduced To respond to (which is defined by elevated blood levels of follicle stimulating hormone (FSH), low blood levels of anti-Müllerian hormone (AMH) or a low antral follicle count) 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 gamete donation (heterologous fertilization)

It is also possible for a woman to have the necessary oocytes but not have the appropriate pituitary hormones to respond adequately to stimulation. In this case, the use of a that may contain both FSH and luteinizing hormone (LH), may allow for an optimal response.

Lifestyle can also influence a woman’s response to stimulation. Optimizing weight, diet and stress, quitting smoking, drinking alcohol and taking drugs can improve the response to ovarian stimulation.

When should pre-implantation diagnosis be used?

Preimplantation genetic testing (PGT) is a technique aimed at detecting abnormalities present in embryos before their transfer to the patient’s uterus, after in vitro fertilization treatment.

From a practical point of view, preimplantation diagnosis consists of the collection 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 5 and 6 days after conception).

In order to carry out preimplantation diagnosis, it is necessary for the couple to undergo in vitro fertilization treatment: once the embryos have been obtained, they must grow in an incubator until they reach the state of blastocyst.

For example, patients who have hereditary pathologies in the family, such as monogenic diseases (e.g. cystic fibrosis or sickle cell anemia) and linked to sex chromosomes (such as Duchenne muscular dystrophy and fragile X syndrome) should resort to pre-implantation diagnosis . Currently, the majority of couples resort to pre-implantation diagnosis to transfer only chromosomally healthy blastocysts during an assisted fertilization process. It is in fact known that with increasing age, errors in the number of chromosomes contained in the oocytes increase and consequently the risk for the couple of having embryos with an inadequate number of chromosomes.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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