In vitro fecondation

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Very high success rates and fewer risks for women thanks to the genetic analysis techniques of embryos (PGT-A) and the possibility of carrying out heterologous fertilization in Italy

As recently highlighted by data released by the national and international scientific literature, assisted fertilization techniques (IVF, ICSI, IMSI) still present strong limits. According to the latest report presented in Parliament, in Italy the success rates of first-level techniques (intrauterine insemination) would be around 10-12% while those of in vitro fertilization are around 17% compared to 25% in other European countries . Percentages that are still too low, which inevitably have an extremely negative impact on the couple both psychologically and economically, often leading to states of profound frustration. “Fortunately, medicine has reached important milestones also in this field,” says Prof. Ermanno Greco, Scientific Director of the Department of Medicine and Biology of Reproduction, of the European Hospital in Rome. Today, thanks to modern in vitro fertilization techniques, the embryos to be transferred inside the uterus are no longer chosen on the basis of their apparent morphological quality (type A, B, C embryos) but on the basis of their genetic health . Multiple international studies have shown that even beautiful embryos from a morphological point of view can be genetically ill in their chromosome structure and therefore not implanted causing a failure of the PMA technique.

Dr. Greco, with the new genetic techniques, Next Generation Sequencing (NGS), which allow to evaluate the quality of the embryo, increase the percentage of children in their arms?

Absolutely yes: 80% of women become pregnant from the first attempt. Several scientific studies have clarified that the ability of embryos to nest in the uterus depends on two critical factors: 70% of their genetic normality and 30% of the ability of the uterine tissue to produce some essential molecules for the implant. This research has shown that, even in young patients (under 35), 40-50% of the embryos produced in an in vitro fertilization treatment are not genetically healthy and therefore unable to give an evolutionary pregnancy. The recent chromosomal analysis technique using NGS (Next Generation Sequencing) allows, instead of the previous methods (PCR, aCGH), not only to evaluate all the chromosomes of the embryo, but also the mitochondrial DNA, that is the energy plant that has a fundamental role in embryonic and then fetal development. The advantages for those who perform pre-implantation diagnosis are, therefore, multiple: both preventive (reduction in the percentage of failure), and therapeutic (reduction of the risk of spontaneous abortion) and improvement (increase in success rates).

For which patients is this technique particularly indicated?

Many international scientific studies show that the patients for whom this technique is particularly indicated are young women who want to carry out a single transfer embryo, optimizing the implant percentages and eliminating almost entirely the chances of multiple pregnancies (4%); women with advanced maternal age (over 36 years); patients with repeated abortion (at least two / three abortions) or those with repeated failures (at least three attempts or more than ten embryos transferred); carriers of genetic diseases (eg translocations, inversions, Mediterranean anemia, cystic fibrosis, hemophilia, muscular dystrophy, ect). Preimplantation genetic diagnosis can be carried out both on fresh embryos and on frozen embryos already produced in previous cycles of PMA. Moreover, the NGS is particularly valid for all those women who have a high capacity to produce oocytes with hormonal stimulation. But the achievements on the subject do not end there. In fact, it has been shown that male infertility can generate chromosomal abnormalities of non-negligible embryos, especially at the level of sexual chromosomes that can give rise to sick children. In this case two techniques have proved to be fundamental: the selection of spermatozoa (IMSI) and the selection of spermatozoa with intact non-fragmented DNA (MACS). Thanks to all these successes, as well as the possibility of resorting to heterologous fertilization also in Italy – the sentence n. 162/2014 of the Constitutional Court ruled that the prohibition of heterologous assisted fertilization is unconstitutional – it is no longer acceptable for a couple to go abroad to realize their dream of giving birth to a child. The success rates of our Center are in fact quite similar to those of other European countries: the experience gained by a team of highly qualified professionals allows us to crown the dream of a lot of motherhood in a totally peaceful and carefree way women.

Prof.Ermanno Greco Medicine and Biology of Reproduction • European Hospital Rome – Tel. 06 65975643-0665975614 – segreteria@icsiroma.it