For Medically assisted procreation (PMA) means a set of advanced procedures and medical techniques, aimed at assisting couples who encounter difficulties in natural conception. These techniques intervene in the fertilization process, which normally occurs when one sperm male encounters and fertilize a egg female. In recent decades, artificial fertilization techniques have become increasingly sophisticated. Among the main ones we find the In vitro fertilization with the transfer of the embryo (Fivet) and theIntracioplastic injecting of spermatozoa (ICSI). In Italythe Law 40/2004 It regulates access to the PMA, allowing it only to the opposite gender couples, married or cohabiting, in fertile age and with infertility certified by a doctor.
Medically assisted procreation: the techniques available
Fertilization is a highly complex process at a molecular level and regulated by levels of details hormones and from a series of biological mechanisms. Different problems, including hormonal dysfunctions, anomalies in the fallopian tubes or in the uterus, poor quality of sperm or eggs, and genetic disorders, can hinder fertility of a couple, preventing them from conceiving.
In these cases it is possible to resort to techniques of Medically assisted procreation. This technology includes a series of treatments aimed at increase the possibilities of conception For couples who face infertility problemsfacilitating the meeting between spermatozoa and oocytes. Some techniques are minimally invasive and take place inside the woman’s body. They are examples pharmacological treatments To stimulate the maturation of an oocyte and synchronize it with sexual intercourse or theIntrauterine insemination (Iui) in which the partner spermatozoa are introduced into the women’s womb during ovulation through a thin catheter, allowing natural fertilization.
There are also PMA techniques of a higher level, more complex that include the ovarian stimulation through specific hormonal treatments to encourage ovulation, the Gamete levy (egg), and fertilization that takes place out of the body of the woman, in the laboratory.
- Fivet – In vitro fertilization with embryo transfer: oocytes and spermatozoa are placed together in a plate containing adequate culture ground, allowing a sperm to penetrate the oocyte naturally.
- ICSI – Intracioplastic injecting of spermatozoa: consists in inserting a single spermatozoo directly in the oocyte through a microago. The technique is carried out in the laboratory with the use of a microscope and micromanipolatori, and each oocyte is treated individually.
During the assisted fertilization cycles, it is possible to resort to cryoconer of oocytes To use them later without having to again use ovarian stimulation, a heavy to face for the woman. These solutions offer the possibility of increasing the chances of success in assisted procreation, giving couples greater control over their reproductive path.
The choice of the most suitable technique depends on the cause of infertility and follows a gradual approach, starting with less invasive methodsboth from a medical and psychological point of view, and then move on to more complex treatmentsif necessary. The embryos created through in vitro fertilization can be transferred to the woman’s womb after a period that varies according to the development stage. The transfer 5-7 days from fertilization during the blastocystembryonic phase in which the cells differ in forming the tissues and organs of the human body, allows you to select the embryos with the best probability of survival and development, thus improving the possibilities of healthy pregnancy.
According to the report of theHigher Institute of Health (ISS) the pregnancy rate for 100 transfers from PMA to Italy increased from 16.3% in 2005 to 33% In the 2022. The success of the techniques and therefore the probability of obtaining a pregnancy, is influenced by several factors, including theage of the womanwhich represents a decisive factor: the successful percentages tend to decrease with advancing age. In Italy, an increase in the average age of women who undergo PMA, which has passed for 34 years in 2005 to 37 years, and an increase in the percentage of women over 40 years old who resort to these techniques, climbed from 20.7% to 34%, was observed.
The PMA in Italy: Law 40/2004
In Italythe PMA is regulated by Law 40/2004which establishes the access criteria. THE’Article 4 of the law establishes that access to PMA techniques is allowed only in case of infertility ascertained by a doctor and theArticle 5 It provides that they can only access it large -aged couples of different sex, combined or cohabiting, in potentially fertile age and both living.
Without prejudice to the provisions of article 4, paragraph 1, they can access the medically assisted procreation techniques couples of adults of different sex, married or cohabiting, in potentially fertile age, both living.
The Italian legislation, among the most restrictive in Europe, has undergone several changes over time following interventions of the Constitutional Court, partly expanding the possibilities of treatment. Initially, the law prohibited the use of the PMA heterologistthat is, the use of gametes of donors outside the couple. However, in 2014 the Constitutional Court He declared this prohibition for couples with absolute and irreversible infertility unconstitutional, allowing them to resort to heterologous PMA. In addition, in 2015, the Court expanded access to techniques also for the Fertile couples carriers of serious and transmissible genetic diseaseswhich before they had no right to PMA treatments.
